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Effectiveness of 3-Day Prophylactic Negative Pressure Wound Therapy on Closed Abdominal Incisions in the Prevention of Wound Complications: A Randomized Controlled Trial
Objective
To determine the impact of negative pressure wound therapy of closed abdominal incisions on wound complications.
Background
Surgical wound complications including surgical site infection complicating open abdominal operations are a burden on the economy. The outcomes of SSI include prolonged hospital stays, adjuvant treatment delay, and incisional hernias leading to a decrease in the quality of life. Prophylactic negative pressure wound therapy has recently been tried with promising results.
Methods
A randomized controlled trial involving 140 patients post-laparotomy with primary wound closure was divided into 2 groups (70 patients each). For the first group, NPWT dressings were applied for the first 3 days and then conventional dressings for 4 days after. For the second group, conventional dressings were applied for 7 days. Patients were followed up for SSI, seroma, wound dehiscence, and hospital stay.
Results
pNPWT was associated with a significantly lower rate of SSI development compared with gauze dressings (3/70 vs. 17/70) (
p
= 0.001). It also had a significant effect on lowering the incidence of seroma (0/70 vs. 7/70) (
p
= 0.007) and delayed wound healing (0/70 vs. 8/70) (
p
= 0.006) and on decreasing days of hospital stay (2.2 ± 0.6 vs. 3.5 ± 1.8) (
p
<0.00001). No significant difference was observed with regard to hematoma (0/70 vs. 1/70) (
p
= 0.5) or wound dehiscence (0/70 vs. 2/70) (
p
= 0.5). No burst abdomens or NPWT complications were recorded in our study.
Conclusion
Three-day NPWT applied to primarily closed incisions is effective in reducing the incidence of SSI, seroma, and delayed wound healing in abdominal operations compared to conventional gauze dressings.
Journal Article
Risk of infection and wound dehiscence after use of prophylactic antibiotics in episiotomy or second degree tear (REPAIR study): single centre, double blind, placebo controlled randomised trial
AbstractObjectiveTo evaluate the effect of prophylactic antibiotics on the risk of wound complications after episiotomy or second degree tear.DesignSingle centre, double blind, placebo controlled randomised trial.SettingOne university hospital in the Capital Region of Denmark. Participants were enrolled between March and December 2023. All initial clinical consultations were conducted between March 2023 and January 2024, and all long term follow-up consultations were conducted between March and November 2024. This article reports only data from the first consultation.Participants442 women with episiotomies or second degree tears were consecutively recruited at delivery. Exclusion criteria included treatment allergy (or risk of cross reactivity with related antibiotics), antibiotic use within 24 hours of delivery, non-Danish speakers, caesarean section, or episiotomy extension.InterventionA computer generated program randomised participants to either three doses of amoxicillin (500 mg) with clavulanic acid (125 mg) or placebo starting within six hours post partum and repeated at eight hour intervals. Follow-up was conducted four to 14 days post partum. Physicians, the steering committee, and participants were blinded.Main outcome measuresWound complications (primary outcome) and clinically relevant wound complications (secondary outcome).ResultsThe study ended as planned, in December 2024. 433 women completed follow-up and were included in the primary analysis. No significant difference was observed in overall wound complications (antibiotic 47/218, 22%; placebo 62/215, 29%; P=0.10), with a risk difference of −7.2% (95% confidence interval (CI) −15.4% to 0.8%) and a relative risk of 0.75 (0.54 to 1.04). For clinically relevant wound complications, significantly fewer events occurred in the treatment group (19/218, 9% v 36/215, 17%; P=0.01), with a risk difference of −8.0% (95% CI −14.3% to −1.8%) and a relative risk of 0.52 (0.31 to 0.88). For clinically relevant wound complications, the number needed to treat was 12 (95% CI 7 to 56). Exploratory outcomes show that the treatment group reported better self-evaluated health, received fewer additional antibiotic treatments, and had smaller average wound dehiscence among patients with dehiscence. No serious adverse reactions occurred.ConclusionAlthough no significant effect was seen for overall wound complications, prophylactic antibiotics significantly reduced the risk of clinically relevant wound complications in women with episiotomies and second degree tears and should be considered in postpartum care.Trial registrationClinical Trials Information System (euclinicaltrials.eu) 2022-501930-49-00 and ClinicalTrials.gov NCT05830162.
Journal Article
The doctor is in!
\"Nickelodeon's Bubble Guppies find out about doctors and hospitals\"--Amazon.com.
Book
Comparison of surgical wound infection and dehiscence following the use of two methods of nylon sutures and skin staples in staples in diabetic mellitus patients undergoing total knee arthroplasty surgery: a randomized clinical trial study
Objective
Timely and complete surgical wound healing substantially affects the patient’s performance and satisfaction with surgery outcomes. Sutures and staples are two common wound closure methods in total knee arthroplasty; however, their role in reducing the rate of surgical wound infections and dehiscence in diabetic patients is unclear. Therefore, this study was conducted to investigate the rate of infection and post-closure dehiscence in wounds closed with either nylon sutures or skin staples in diabetic patients undergoing total knee arthroplasty (TKA).
Methods
This is a single-blind randomized clinical trial including 70 diabetic mellitus patients undergoing TKA. Patients were selected using a restricted random sampling method and haphazardly assigned to study groups using the permuted block randomization technique, including the suture-closed (
n
= 35) and staple-closed (
n
= 35) groups. The follow-up was 2 to 8 weeks after the surgery, evaluation of wound infection and dehiscence was performed.
Results
The present study showed that there was no significant correlation between wound infection rate (P-value = 0.254) and wound dehiscence (P-value = 0.324) with the method of wound closure (i.e., sutures or staples). However, surgical wound dehiscence revealed a significant correlation with body mass index (BMI) (P-value = 0.044), Glycosylated hemoglobin (HbA1c) (P-Value = 0.001), and fasting blood glucose (FBS) (P-Value = 0.012) in diabetic mellitus patients.
Conclusion
The use of the staple technique compared to suture had no difference in the rate of wound opening and infection, but from a clinical point of view, the prevalence of wound opening after TKA in patients with the suture method was higher than that of staples. Further research is needed to confirm these findings and the long-term efficacy of each method.
Clinical trial registration
The present study was registered at the Iranian Registry of Clinical Trails (No. IRCT20230928059543N1, Trial Id:74754, approved on 12/01/2024,
https://irct.behdasht.gov.ir/user/trial/74754/view
) and conducted according to Consolidated Standards of Reporting Trials (CONSORT) guidelines.
Journal Article
Chitosan and Cellulose-Based Hydrogels for Wound Management
Wound management remains a challenge worldwide, although there are several developed wound dressing materials for the management of acute and chronic wounds. The wound dressings that are currently used include hydrogels, films, wafers, nanofibers, foams, topical formulations, transdermal patches, sponges, and bandages. Hydrogels exhibit unique features which make them suitable wound dressings such as providing a moist environment for wound healing, exhibiting high moisture content, or creating a barrier against bacterial infections, and are suitable for the management of exuding and granulating wounds. Biopolymers have been utilized for their development due to their non-toxic, biodegradable, and biocompatible properties. Hydrogels have been prepared from biopolymers such as cellulose and chitosan by crosslinking with selected synthetic polymers resulting in improved mechanical, biological, and physicochemical properties. They were useful by accelerating wound re-epithelialization and also mimic skin structure, inducing skin regeneration. Loading antibacterial agents into them prevented bacterial invasion of wounds. This review article is focused on hydrogels formulated from two biopolymers—chitosan and cellulose—for improved wound management.
Journal Article
Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR—A Randomized Trial
Background
Surgical site infections (SSI) in the groin after vascular surgery are common. The aim of the study was to evaluate the effect of negative pressure wound therapy (NPWT) on SSI incidence when applied on closed inguinal incisions after endovascular aneurysm repair (EVAR).
Methods
A multicenter randomized controlled trial (RCT). Between November 2013 and December 2020, 377 incisions (336 bilateral and 41 unilateral) from elective EVAR procedures with the primary intent of fascia closure were randomized and included, receiving either NPWT or a standard dressing. In bilateral incisions, each incision randomly received the opposite dressing of the other side, thereby becoming each other’s control. The primary endpoint was SSI incidence at 90 days postoperatively, analyzed on an intention-to-treat basis. Uni and bilaterally operated incisions were analyzed separately, and their respective p-values combined using Fisher’s method for combining
P
-values. Study protocol (NCT01913132).
Results
The SSI incidence at 90 days postoperatively in bilateral incisions was 1.8% (n = 3/168) in the NPWT and 4.8% (n = 8/168) in the standard dressing group, and in unilateral incisions 13.3% (n = 2/15) and 11.5% (n = 3/26), respectively (combined
p
= 0.49). In all SSIs, bacteria were isolated from incisional wound cultures. No additional SSIs were diagnosed between 90 days and 1 year follow-up.
Conclusions
No evidence of difference in SSI incidence was seen in these low-risk inguinal incisions when comparing NPWT with standard dressings after EVAR with the primary intent of fascia closure.
Clinical Trials:
NCT01913132.
Journal Article