SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Compression therapy, either active or passive, is the cornerstone of treatment for all venous and lymphatic disorders. Its major limitations are poor patient compliance, difficulty to apply in the elderly, and insufficient knowledge and skill in the majority of physicians. New modalities, such as four-layer bandage, tubular gradient compression, or new textile technologies, may secure a better application in difficult cases such as leg ulcers.
A hand-made prop that aids in the efficient treatment of molluscum contagiosum with curettage or cantharidin is described. Small bandages or pieces of tape are affixed to a tongue depressor prior to the procedure so that they may be placed quickly over the treated molluscum. This improves time management and helps to reduce patient anxiety.
External coaptation includes the use of casts, splints, bandages, or slings to help stabilize fractures or luxations, reduce postoperative swelling, or help to protect wounds. Although each of these can be highly effective, it is very important to understand the various types of devices available and the indications for each. Inappropriate use of an external coaptation device can lead to unsatisfactory results.
OBJECTIVE: To evaluate the effect of intramuscular administration of recombinant equine growth hormone on healing of full thickness skin wounds on equine limbs. STUDY DESIGN: Experimental. ANIMALS: Nine Standardbred horses. METHODS: In study 1, standardized full thickness skin wounds (2.5 x 2.5 cm) were made over the dorsomedial aspect of the mid-cannon bone of 1 forelimb and 1 hindlimb in 9 horses. Wounds were bandaged without treatment (control subjects) and videorecorded twice weekly until healed. Then, in study 2, similar wounds were created on the opposite limbs; 6 horses were administered intramuscular recombinant equine growth hormone (10 microg/kg daily for 7 days, then 20 microg/kg daily for 49 days), and 3 horses (control subjects) were administered equivalent volumes of sterile water. Wounds were videorecorded twice weekly until healed. Wound healing variables were measured from the videorecordings using a computer software package and analyzed as a randomized complete block design factorial analysis of variance; significance was set at P <.05. RESULTS: No differences in the measured variables were detected between wounds in study 1 and the control wounds in study 2. In recombinant equine growth hormone-treated horses, wounds retracted more during treatment and contracted faster after treatment stopped when compared with wounds from untreated horses. No other treatment effects were detected. CONCLUSIONS: Recombinant equine growth hormone seemingly increases wound retraction. After treatment ceases, wound contraction increases. CLINICAL RELEVANCE: Intramuscular administration of recombinant equine growth hormone (10 microg/kg daily for 7 days, then 20 microg/kg daily for 49 days) does not appear to have any beneficial clinical effect on healing of equine limb wounds.
Correction of prominent ears is a commonly performed operation, not without complications. We present a retrospective analysis of the results of 122 operations for correction of prominent ears performed in the 12 months from April 1995 to March 1996, and the results of a patient questionnaire. Complications were recorded and analysed. Anterior scoring appears to have a higher complication rate if supplemented by cartilage sutures. Complication rates appear to be highest for unsupervised SHOs. Head bandages are particularly likely to fall off in boys under 7 years of age.
In 37 patients, oedema of the legs was observed following successful femoro-popliteal surgery; lymphangiograms were performed between the third and ninth post-operative days and the intact lymph vessels at the knee and at the groin were counted. In 27 patients there was partial to total disruption of the lymphatic vessels. There was a clear correlation between the degree of swelling of the leg and thigh with the number of not divided lymphatic vessels at the knee and groin. In the presence of more than three intact lymph vessels, swelling amounted to only 1 to 2 cm., whereas if all lymph vessels had been divided, swelling amounted to 7 cm. Extensive soft tissue trauma and repeat surgery resulted in a greater reduction in intact lymph vessels and correspondingly more oedema than was found with more conservative surgery and after initial operations. The pre-operative condition of the arteries, the presence of venous disease and the postoperative blood-flow in the leg had no influence on postoperative oedema. In order to avoid post-operative lymphoedema, it is necessary to preserve the lymphatics during surgery. Marked oedema requires treatment consisting of compression bandages and medicaments.
In 80 patients with primary traumatic shoulder dislocation treated at the Heidelberg Orthopaedic University Hospital we had a follow-up examination. We wanted to know about age and sex of the patients, the number of redislocations in correlation to time and way of fixation. We had 70% male and 30% female patients with 97.5% of anterior dislocation. The minimum age was 16 and the maximum 87 years with an average of 44 years. 48 patients had a Desault bandage for 2 weeks and 32 had a shoulder-arm plaster cast for 3 weeks. There was no difference between both ways of fixation. We also could not see any better results after more than a 3 weeks' fixation. The most important fact for redislocation is the age and activity of the patients. A young man has a very high risk of redislocation within the first year.
There are different opinions on the duration of post-operative shoulder immobilisation following arthroscopic repair of labrum tears. Between 1993 and 1994 at our department arthroscopic repairs of the glenoid labrum as described by Habermeyer (15, 16) have been performed in 38 patients. In 20 of these patients postoperative treatment included immobilisation of the operated shoulder in a Gilchrist-bandage for 3 weeks, while in the remaining 18 patients this postoperative immobilisation period was decreased to only 1 or 2 weeks. Physiotherapy started the day after the operation, using a device for passive-motion exercises. The mean follow-up time of our examinations was 15.4 month. The mean score by Rowe rose significantly from 20.0 preoperatively to 82.6 at the follow-up examination. Results were excellent or good in 89.4% of all cases, new shoulder dislocations did not occur in any case. Patients having their shoulders immobilised for 3 weeks reached significantly higher Rowe-scores at our follow-up than those patients, whose shoulders were immobilised for only 1 or 2 weeks. Therefore, postoperative management following arthroscopic repair of labrum tears should include immobilisation of the operate shoulder for 3 weeks and an early start of passive-motion exercises.
PURPOSE: The use of intermittent pneumatic compression, in addition to elastic bandages or stockings, accelerates the healing of leg ulcers in patients with severe chronic venous insufficiency (CVI). There is recent evidence that impulse compression of the plantar venous plexus reduces post-traumatic ankle swelling and prevents postoperative venous thromboembolism. The purpose of this study was to evaluate the clinical and hemodynamic responses after home use of impulse foot compression for 3 months in patients already using therapeutic compression stockings for the management of CVI. METHODS: Twelve extremities from 9 patients with documented CVI, class 4 to 5 according to the Clinical, Etiology, Anatomy, Pathophysiology classification system, were included in this prospective cohort study. All patients were instructed to use a foot pump device at home for 2 hours a day for 3 months in addition to therapeutic compression stockings (30-40 mm Hg) worn during the day. The device was set to three cycles (3 seconds) of compression (120 mm Hg) per minute. A clinical scoring system was completed before foot compression and 1, 2, and 3 months thereafter. In addition, all patients underwent air plethysmography studies at the same time intervals, including venous volume, venous filling index, ejection fraction, and residual volume fraction. RESULTS: Patients reported significant improvement in their scores for swelling (P <.05) and pain (P <.04). Air plethysmography showed a reduction in venous volume and venous filling index, although these differences were not significant. Ejection fraction remained unchanged and residual volume fraction was significantly reduced (P <.05) compared with baseline. The foot compression devices were well tolerated by all the patients in the study. CONCLUSIONS: The use of home foot impulse compression plus elastic stockings significantly reduced the residual volume fraction as measured by air-plethysmography in a group of patients with severe CVI. This favorable hemodynamic response could, in part, explain the clinical improvement achieved by this combined treatment. However, this represents a preliminary pilot study that needs to be confirmed in future randomized controlled studies with more patients included.
OBJECTIVE: To compare rates of healing of donor sites in pigs between those dressed with silver-coated dressings and those dressed with petrolatum-impregnated absorbent gauze. DESIGN: Open study with each animal acting as its own control. SETTING: University research facility, Canada. ANIMALS: 6 young specific-pathogen-free domestic pigs. INTERVENTIONS: A total of 72 wounds about 1 cm x 2 cm x 0.4 mm were made in rows of eight on each pig with a dermatome. They were divided into three groups of 24, and dressed with petrolatum gauze, or silver-coated dressings moistened with sterile water either once only or daily for 10 days. All dressings were secured in place with an elastic bandage. MAIN OUTCOME MEASURES: Erythema, infection, epidermal migration, and healing. RESULTS: Wounds dressed with moistened silver-coated dressings re-epithelialised significantly more quickly. This resulted in complete re-epithelialisation within 70% of the time taken by those wounds dressed with petrolatum gauze. CONCLUSION: Silver-coated dressings provide a moist environment for the healing wound combined with an effective antimicrobial agent, and this significantly accelerates healing compared with wounds dressed with traditional petrolatum gauze dressings.
To investigate factors relevant to the healing of leg ulceration by high compression, patients were interviewed using a standard questionnaire prior to treatment with a four-layer bandage high-compression system in six community ulcer clinics. We explored the relation of size, ulcer duration and medical history to healing. Cumulative healing rates were high using this method, being 69% after 12 weeks and 83% after 24 weeks. Twelve-week healing rates varied slightly between clinics, ranging from 62% to 83%. Univariate analysis of the total group showed that male sex (RR = 0.77, p = 0.023), poor limb joint mobility (RR = 0.39, p < 0.001), poor general mobility (RR = 0.49, p = 0.015), treatment at home (RR = 0.52, p < 0.001), ulcer size > 10 cm2 (RR = 0.37, p < 0.001), history of deep vein thrombosis (RR = 0.67, p = 0.016) and ulcer duration >6 months (RR = 0.35, p < 0.001) were significantly inversely associated with healing, Ulcer size, duration, limb joint mobility and general mobility were significant independent factors in multivariate analysis.
This case report describes the application of a technique for the treatment of leg edema and wounds resulting from a severe distal tibiofibular fracture. Following injury and numerous fracture- and wound-related surgeries in the first year postinjury, this patient developed leg edema, required daily treatment of 2 leg wounds, and was unable to wear a shoe due to foot swelling. He was referred to the physical therapy clinic 1 year postinjury for ankle rehabilitation and to diminish the leg edema. Therapy consisting of manual lymph drainage, compressive bandaging, exercise, and skin care was provided for 7 weeks. A compression stocking was issued near the end of treatment, which the patient continued to wear daily thereafter. At the time of discharge from therapy, the leg edema had decreased 74% and the wound area of both wounds had decreased 89%. Improvements continued following discharge. By 10 weeks after the start of treatment, edema had decreased 80.9%, one wound had healed, and the second wound was 93% improved. The patient was able to wear a shoe and resume recreational activities. This case report provides insight into a treatment that may shorten rehabilitation and control the cost of caring for injuries complicated by prolonged edema.
Porcine heterografts are effective in the treatment of cutaneous ulcers as biological bandages that promote healing by: speeding the processes of granulation and epithelialization; maintaining a clean covering over the wound; reducing loss of fluid and protein; and preventing bacterial encroachment.
Management of auricular hematomas has always been a challenge for physicians. This injury is very common among wrestlers since early olympic competition times. Initial treatment usually involves simple aspiration and a compression bandage. Most of these hematomas recur; then it must be decided how to manage this recurrent problem and the eventual "cauliflower ear." A treatment is proposed that directs attention to the pathophysiology of the injury and involves total excision of the newly formed fibroneocartilaginous layer. Unless this layer is successfully removed the hematoma will persist and a thickened ear will result. This treatment can be performed on an outpatient basis under local anesthesia and allows immediate resumption of wrestling competition.
Congenital ectropion of the upper lid is a rare condition that, if treated early, can be managed without recourse to surgery. We report a case in which an initial attempt at treatment with a pressure bandage failed, leading to a rapid worsening of the condition. A subsequent attempt at repositioning led to a respiratory arrest. Successful resolution occurred after taping of the lid. The case illustrates the need for early successful repositioning to break a cycle leading to increasing lid oedema; it also illustrates the importance of vigilance to the autonomic effects of lid manipulations in neonates.
PURPOSE: To evaluate the role of tissue adhesive in the management of corneal thinning or perforation associated with active fungal keratitis. DESIGN: Retrospective noncomparative interventional case series. METHODS: Seventy-three eyes of 73 patients with microbiologically proven keratomycosis associated with thinning or perforation participated in the study. N-Butyl cyanoacrylate tissue adhesive (medical grade) and bandage contact lens were applied in addition to topical and systemic antifungal therapy. Our outcome measures included resolution of the infiltrate and preservation of the structural integrity of the globe. RESULTS: Outcome data were available for 66 eyes. The infiltrate resolved with scar formation in 42 (63.6%) eyes. In an additional eight (12.1%) eyes, tissue adhesive maintained the structural integrity of the globe while the patients awaited penetrating keratoplasty. Sixteen (24.2%) eyes showed progressive worsening or persistence of the infiltrate after application of tissue adhesive. Twenty-five (37.8%) eyes required multiple applications of tissue adhesive. The outcome was better in cases where the infiltrate measured less than 30 mm2 at the time of presentation and application of tissue adhesive (P < 0.01). CONCLUSION: In view of the poor outcome of penetrating keratoplasty in active fungal keratitis, N-butyl cyanoacrylate tissue adhesive is a useful modality for the management of progressive thinning or perforation associated with active fungal keratitis. However, close observation is mandatory to assess the progression of disease.
PURPOSE: To evaluate the safety and efficacy of Focus Night & Day extended-wear contact lenses when used for therapeutic purposes. METHODS: Fifty eyes of 50 consecutive patients presenting at the Ankara University Medical Center, Cornea and Contact Lens Service, and requiring bandage contact lens use for ocular surface disorders, were enrolled. All patients were fitted with Focus Night & Day contact lenses and were followed in regard to patient satisfaction, contact lens fit and performance, and success of treatment. RESULTS: Twenty-four patients (48%) were male, and 26 (52%) were female. Average age at the time of presentation was 46.9 +/- 21.6 years (range 1.5 to 88 years). Therapeutic contact lens indications included Fuchs' dystrophy (2 eyes), toxic epitheliopathy (1 eye), filamentous keratopathy (2 eyes), corneal perforation (2 eyes), corneal stromal melting (2 eyes), recurrent corneal erosion (4 eyes), chemical or traumatic epithelial defect (3 eyes), epithelial irregularity (1 eye), persistent epithelial defect (4 eyes), lamellar laceration (5 eyes), graft insufficiency (2 eyes), pseudophakic bullous keratopathy (7 eyes), aphakic bullous keratopathy (4 eyes), disciform keratitis (1 eye), postkeratectomy (4 eyes), and post-amniotic membrane transplantation or post-limbal autograft transplantation (6 eyes). Mean duration of continuous contact lens wear was 2.4 +/- 3.0 months (range 3 days to 12 months). At the end of the follow-up period, the mean change in visual acuity was a gain of 1.8 +/- 2.8 logMAR units (0-9 Snellen lines). No sight-threatening complications related to contact lens wear were encountered. A culture-negative sterile corneal infiltrate developed in one patient and was treated with cessation of lens wear and subsequent topical antibiotic and steroids. CONCLUSION: Focus Night & Day contact lenses are safe and effective when used for therapeutic purposes. Infrequent replacement of these lenses seems to be especially advantageous in patients for whom frequent lens insertion and removal may be associated with epithelial trauma, pain, and a potential increase in infection risk. Infrequent replacement of these lenses also decreased the office time and the cost of treatment without an increase in hypoxia-related complications.
Closed degloving wounds are uncommon but important injuries because they may be overlooked in the multiply injured patient and, if not treated correctly, may give rise to significant morbidity. This prospective study reports the results of a conservative surgical management policy in 16 patients with closed degloving wounds treated during a 1-year period in a tertiary referral center. Motor vehicle accidents caused most of the injuries, 69 percent of which occurred on the lower limb. The extent of injury ranged from 2 to 12 percent (mean 4.9 percent) of the total body surface area. The diagnosis of closed degloving wound was missed at initial assessment in one-third of patients. A uniform management policy with drainage of the degloved area through a small incision followed by compression bandaging was applied. The volume of blood and necrotic fat evacuated ranged from 15 to 800 ml (mean 120 ml). One patient with necrotic skin initially had excision and primary wound closure performed. Delayed necrosis occurred in one patient in whom extensive degloving occurred and effective compression could not be applied. Ultimate flap viability using this technique was excellent, since only 1 of 16 patents required skin grafting.