Elastic Wrap Research Articles

Eliminating Wound Tension in an Edematous Lower Extremity Defect Through Elastic Wrapping During Mohs Micrographic Surgery

Eliminating Wound Tension in an Edematous Lower Extremity Defect Through Elastic Wrapping During Mohs Micrographic Surgery

Clinical Issues — November 2024

THIS MONTH Reducing the perioperative carbon footprint Key words: sustainability, carbon footprint, greenhouse gas (GHG), energy, consumption. Exsanguination before tourniquet use Key words: elastic wrap, exsanguination, gravity, pneumatic tourniquet, limb. Using augmented reality technology in the OR Key words: augmented reality (AR), virtual reality (VR), extended reality (XR), headset, navigation. Patients wearing contact lenses during a procedure Key words: contact lens, corneal abrasion, patient positioning, eye injury, risk factors.

Low-load Resistance Exercise with Perceptually Primed Practical Blood Flow Restriction Induces Similar Motor Performance Fatigue, Physiological Changes, and Perceptual Responses Compared to Traditional Blood Flow Restriction in Males and Females.

In the recent past, practical blood flow restriction (pBFR) using non-pneumatic, usually elastic cuffs has been established as a cost-effective alternative to traditional blood flow restriction (BFR) using pneumatic cuffs, especially for training in large groups. This study investigated whether low-load resistance exercise with perceptually primed pBFR using an elastic knee wrap is suitable to induce similar motor performance fatigue as well as physiological and perceptual responses compared to traditional BFR using a pneumatic nylon cuff in males and females. In a randomized, counterbalanced cross-over study, 30 healthy subjects performed 4 sets (30-15-15-15 repetitions) of unilateral knee extensions at 20% of their one-repetition-maximum. In the pBFR condition, each individual was perceptually primed to a BFR pressure corresponding to 60% of their arterial occlusion pressure. Before and after exercise, maximal voluntary torque, maximal muscle activity, and cuff pressure-induced discomfort were assessed. Moreover, physiological (i.e., muscle activity, muscle oxygenation) and perceptual responses (i.e., effort and exercise-induced leg muscle pain) were recorded during exercise. Moderate correlations with no differences between pBFR and BFR were found regarding the decline in maximal voluntary torque and maximal muscle activity. Furthermore, no to very strong correlations between conditions, with no differences, were observed for muscle activity, muscle oxygenation, and perceptual responses during exercise sets. However, cuff pressure-induced discomfort was lower in the pBFR compared to the BFR condition. These results indicate that low-load resistance exercise combined with perceptually primed pBFR is a convenient and less discomfort inducing alternative to traditional BFR. This is especially relevant for BFR training with people who have a low cuff-induced discomfort tolerance.

Using an automated tail movement sensor device to predict calving time in dairy cows

This study aimed to evaluate the effectiveness of an automated tail movement sensor device (Moocall; Bluebell, Dublin, Ireland) to predict time of calving in dairy cows. At a commercial dairy farm in southern Ontario, Moocall (MC) devices were attached with the device's strap, and an additional elastic wrap, to the tail of cows approximately 3 d before their expected calving date. The MC has 2 types of alarm, a high activity alarm in the previous hour (1HA), and a high activity alarm in the previous 2 h (2HA); these alarms were sent and registered to the MC software. The calving and close-up pens were video monitored to determine the exact time of the onset of stage II of calving (amniotic sac visible at the vulva) and the end of stage II of calving (total expulsion of the calf). A total of 49 cows were enrolled, but we excluded 13 animals from the analysis as they had 3 or more MC drops from the tail (n = 6), a swollen tail (n = 3), or the MC device was lost (n = 4); this left 36 cows. In total, the device dropped off 21 (42%) cows. The average number of alarms (1HA and 2HA) per cow before stage II of calving was 2.7 ± 2.3 (± standard error). The first alarm after fitting the device on the tail was used to determine the device's sensitivity and specificity. Depending on the interval before the onset of parturition (i.e., 2, 4, 8, 12 h) in which the alarm was triggered, sensitivity varied from 5% to 72% and specificity from 50% to 93%. The false positive rate varied between 6% and 50% depending on the interval from the alarm to the onset of parturition. The high false positive and device drop rates (despite the addition of the elastic wrap) may compromise the applicability of this sensor device in a commercial setting.

Personalized statistical modeling of soft tissue structures in the knee.

Background and Objective: As in vivo measurements of knee joint contact forces remain challenging, computational musculoskeletal modeling has been popularized as an encouraging solution for non-invasive estimation of joint mechanical loading. Computational musculoskeletal modeling typically relies on laborious manual segmentation as it requires reliable osseous and soft tissue geometry. To improve on feasibility and accuracy of patient-specific geometry predictions, a generic computational approach that can easily be scaled, morphed and fitted to patient-specific knee joint anatomy is presented. Methods: A personalized prediction algorithm was established to derive soft tissue geometry of the knee, originating solely from skeletal anatomy. Based on a MRI dataset (n = 53), manual identification of soft-tissue anatomy and landmarks served as input for our model by use of geometric morphometrics. Topographic distance maps were generated for cartilage thickness predictions. Meniscal modeling relied on wrapping a triangular geometry with varying height and width from the anterior to the posterior root. Elastic mesh wrapping was applied for ligamentous and patellar tendon path modeling. Leave-one-out validation experiments were conducted for accuracy assessment. Results: The Root Mean Square Error (RMSE) for the cartilage layers of the medial tibial plateau, the lateral tibial plateau, the femur and the patella equaled respectively 0.32mm (range 0.14-0.48), 0.35mm (range 0.16-0.53), 0.39mm (range 0.15-0.80) and 0.75mm (range 0.16-1.11). Similarly, the RMSE equaled respectively 1.16mm (range 0.99-1.59), 0.91mm (0.75-1.33), 2.93mm (range 1.85-4.66) and 2.04mm (1.88-3.29), calculated over the course of the anterior cruciate ligament, posterior cruciate ligament, the medial and the lateral meniscus. Conclusion: A methodological workflow is presented for patient-specific, morphological knee joint modeling that avoids laborious segmentation. By allowing to accurately predict personalized geometry this method has the potential for generating large (virtual) sample sizes applicable for biomechanical research and improving personalized, computer-assisted medicine.

Extremity Pressure in Splints Wrapped With an Elastic Bandage Versus Bias Cut Stockinette: An Experimental Model.

Many variables affect the pressure caused by splinting or casting. The purpose of this study was to compare pressure underlying a splint wrapped with either an elastic bandage or a bias cut stockinette. Thirty-two plaster volar resting splints were applied to a simulated extremity with a saline bag secured to it. A pressure transducer was connected to the saline bag to monitor changes in pressure once splints were applied, and 15 mL increments of saline were added to the bag to simulate swelling. Each dressing type was tested with normal application and tight application. Normal application splints wrapped with either bias cut stockinette or an elastic bandage demonstrated similar initial splint pressures (P = .81). With simulated swelling, splints wrapped with bias cut stockinette demonstrated a 15 mmHg (95% confidence interval [CI], 1.5-28.5) higher average pressure than those wrapped with an elastic bandage (P = .035). Tight application splints with an elastic bandage wrap demonstrated a 46 mmHg (95% CI, 16-77) higher initial splint pressure than those wrapped with bias cut stockinette (P = .009). Splints wrapped using either an elastic bandage or bias cut stockinette appear to have a similar safety profile, although in cases of excessive swelling, an elastic bandage may provide additional compliance. Tight splint application appears to be more hazardous with the use of an elastic bandage compared with a bias cut stockinette. Further study of the use of elastic bandages and bias cut stockinettes in the clinical setting may be warranted.

81 Post-operative Self-adherent Compression Wrapping of the Hand and Its Impact on Skin-graft Viability

IntroductionPotential complications of autografting for burn wound coverage of the hand include edema, hematoma formation, and bleeding; all of which can lead to graft failure. Self-adherent elastic wraps are commonly used by burn rehabilitation clinicians to minimize complications by providing graft protection and decreasing edema post-operatively; however, there is a lack of evidence on its impact on graft healing. The purpose of this study was to determine if the application of self-adherent elastic wraps to the hand in the operating room after autografting improves the percentage of graft viability.MethodsA retrospective chart review was performed for 37 patients with burned hands who underwent autografting from January 2017 to July 2021. Grafted hands were categorized into 2 groups: post-operative dressings with and without self-adherent elastic wraps. Post-operative day 4 pictures for both groups were collected from the medical record and a blinded digital photograph analysis of graft viability was performed by 5 expert raters including 3 Burn Surgery Fellows,1 Burn Attending Surgeon and 1 Hand Attending Surgeon. A rating system was developed based on percentage of graft take as seen in Table 1 and presence of hematomas were assessed.ResultsPatients who received self-adherent elastic wraps suffered burns with significantly larger TBSA (p=0.007) and were admitted for a longer duration (p=0.009) than patients who did not. Patients with elastic wrap had a higher percentage of grafts with >95% take (64.0% vs 41.7%, p=0.227) and a lower rate of hematoma formation (24.0% vs. 41.7%, p=0.443). Intra-class correlation coefficient across raters was 0.90 for graft take and 0.87 for determining presence of hematomas, indicating excellent interrater reliability.ConclusionsDespite suffering larger burns requiring longer hospitalizations, patients who received elastic wrap had a higher rate of >95% graft take than those without. This study is limited by a relatively small sample size, however these findings warrant continued research in the use of self-adherent elastic wrap to maximize graft take in hand burns.

Wetted Ice With Elastic Wrap Decreases Intramuscular Temperature More Quickly Than Game Ready®

Cryotherapy is a popular treatment chosen by health care providers to treat musculoskeletal injuries. The purpose of this study was to determine which cryotherapy method, Game Ready® or a wetted ice bag with elastic wrap, caused a greater and faster decline in tissue temperature during a 30-min treatment. At 2 cm below adipose, intramuscular tissue temperatures decreased more and faster with the wetted ice treatment compared with the Game Ready® treatment at all three time points: 10 min, 20 min, and 30 min. Furthermore, wetted ice significantly decreased temperature more than Game Ready® at 20 min (peak change [Ca]GR = 3.40 °C, [Ca]WI = 6.14 °C, p = .03) and 30 min ([Ca]GR = 5.62 °C, [Ca]WI = 8.67 °C, p = .02). One of the primary goals after injury is to lower tissue temperature to decrease cellular metabolism to reduce the risk of secondary ischemic injury. No evidence exists to support the optimal tissue temperature decrease for specific physiological results with cryotherapy. However, the literature is consistent with modalities producing colder temperatures are considered a better immediate care modality to decrease cell metabolism as much as possible. Therefore, these findings suggest wetted ice with an ACE wrap would be the more effective treatment in the immediate care phase.

28 A comparison among equine boots and legwraps on leg surface temperature during and after exercise

Boots and legwraps are commonly used to protect the lower limbs of the horse from trauma during exercise. However, previous research suggests such use can result in increased limb temperature that may be detrimental to underlying tendons. This study was designed to explore limb surface temperature during and after exercise when common leg protection was applied, hypothesizing that boots and wraps would increase temperature over the bare limb during exercise, yet show differences in the time required to return to baseline temperature. Six clinically-sound, mature horses (age 15 ± 2 yr; mean ± SEM) were used to test 6 boots or wraps: a neoprene boot, a perforated neoprene boot, an alternative neoprene boot, a cross country boot, a combination fleece and elastic wrap, and a polo wrap. The booted forelimb was selected randomly and the other forelimb served as a bare limb control in each test of a 6 × 6 Latin square design. An iButton hygrochron data logger was placed immediately palmar to the midpoint of the lateral splint bone on both the booted and bare limbs. The data logger recorded temperature and humidity every min during a 20-min standard exercise test and 180-min standing recovery during moderate ambient conditions (22.8 ± 0.9°C; humidity: 53.3 ± 4.8%). Data were analyzed using a mixed model design with repeated measures; significance was set at P < 0.05. The bare limb temperature was lowest (27.7 ± 1°C) at min 9 of the SET, then peaked and plateaued (33 ± 1°C; P < 0.05) during recovery. Conversely, treated limbs increased during exercise from 32 ± 1°C (min 0) to 36 ± 1°C at min 15, then plateaued during recovery. All treatment temperatures were greater than the bare limb (P < 0.0001) across all times. The polo wrap was hotter than the alternative neoprene sports medicine boot (P = 0.02), but neither was different from any other treatments. The humidity of the polo wrap was higher (P < 0.05) than all other treatments at 94%. All treatments failed to return to baseline temperature and humidity after 180 min (P = 0.01). The results support the hypothesis that convection cooling is impaired by boots and wraps during exercise. Given that skin temperature of the lower leg has been correlated as to underlying tendon surface temperature, this suggests that even in a moderate intensity exercise bout in moderate ambient conditions, a booted or wrapped limb may reach damaging temperatures. Contrary to our hypothesis, no boot or wrap nor the bare limb returned to baseline temperature in as much as 180 min of recovery, necessitating further research into the time required for passive cooling of the equine limb after exercise and verification of strategies to reduce cooling time.

Exploring Tourniquet Conversion in Simulation to Develop Concepts and Hypotheses.

Compared with those of tourniquet application, tourniquet conversion concepts are underdeveloped. The purpose of this project was to develop tourniquet conversion concepts and generate hypotheses. One person performed 100 tests of tourniquet application and conversion. Testing varied by conversion types, materials, and assessments. Conversions were from improvised or Combat Application Tourniquets (C-A-T) to another C-A-T, a new site (with initial C-A-T only), a pneumatic Emergency and Military Tourniquet (EMT), or a pressure dressing (compression bandage or a roll gauze and an elastic wrap). Simulated limbs were created using plastic bottle-based manikins, pool noodle-based manikins, plastic pipes, glass bottles, a rain downspout, and a cardboard poster tube. Tourniquet application, conversion, and total times averaged 105, 132, and 237 seconds, respectively. Improvised tourniquet time was longer than that of C-A-T (p ≤ .05, all three). By initial tourniquet site, the 2-3 inches site had longer conversion and total time (p ≤ .02, both) compared with highest site. By whether initial tourniquets placed were also used in conversion, total time was shorter if yes (p = .05). Conversion to a pressure dressing was longer in conversion and total time (p ≤ .02, both) compared with conversion to a tourniquet. One wrap was short; we switched to those longer to cover limbs better. Limb types varied for indentation. Conversion communications improved when we used abbreviations and symbols. This preliminary project simulated tourniquet conversion to develop clinical concepts and research hypotheses to build a better basis for later research.

A New Orthotic Device for Maintaining Neck Flexion Following Tracheal and Cricotracheal Resection.

View Video S1 Laryngoscope, 131:1805–1809, 2021

Self-Adherent Elastic Wrap Dressing Injury in a Neonate

Due to delicate skin, injuries secondary to the use of peripheral intravenous (PIV) catheters are not uncommon in neonates. We present a case of hand injury secondary to the use of a tight elastic band used to secure the PIV.

How We Do It: Pressure-Padded Dressing With Self-Adherent Elastic Wrap for Wound Care After Nail Surgery.

How We Do It: Pressure-Padded Dressing With Self-Adherent Elastic Wrap for Wound Care After Nail Surgery.

Hemodynamic changes under spinal anesthesia after elastic wrapping or pneumatic compression of lower limbs in elective cesarean section: A randomized control trial.

Background and Aims:In spite of adequate fluid loading and left lateral tilt, parturients develop hypotension under spinal anesthesia during cesarean section. Elastic crepe bandage (CB) or pneumatic compression device (PCD) can be utilized to prevent the pooling of blood in lower limbs and thereby it may reduce the incidence of hypotension in these patients. This study was formulated to analyze the hemodynamic effects of leg wrapping with elastic CB and PCD in parturients undergoing for cesarean section under anesthesia.Material and Methods:Ninety term obstetric patients posted for elective cesarean section under spinal anesthesia were randomized into 3 groups: Group 1 (control), Group 2 (CB), and Group 3 (PCD). All the parturients had their legs wrapped with an elastic bandage and pneumatic sleeve applied over it. In Group 1 (Control), patients had their legs wrapped with CB loosely and pneumatic sleeve also applied was switched on. In Group 2, patients the CB was applied by stretching the bandage (15 cm width and 4 m stretched length). The PCD was not switched on in this group. In Group 3, the legs were wrapped with the CB loosely. The pneumatic sleeve was applied over the bandage, and the machine was switched on with a preset pressure of 40–50 mmHg after spinal anesthesia. Incidence of maternal hypotension and ephedrine requirement to maintain systolic blood pressure, neonatal Apgar score were recorded.Results:The incidence of hypotension was significantly lower in Group 2 and 3 than the control group. Similarly, the requirement of ephedrine was significantly high in control group compared to CB and PCD. The incidence of hypotension was lower in group CB than group PCD. Meantime to receive the first dose of ephedrine was significantly low in control (7.37 ± 4.94 min) as compared to CB (10 ± 2.8 min) and PCD (13.88 ± 9.23).Conclusion:Leg-wrapping with CB is cost-effective, non-invasive, non-pharmacological, and effective tool to reduce the incidence of hypotension after spinal anesthesia in a parturient.

Computational evaluation of an extra-aortic elastic-wrap applied to simulated aging anisotropic human aorta models

Structural changes occurring to the aortic wall can result in vascular stiffening. This is represented by a loss of vascular compliance during pulsatile flow, resulting in increased systolic and pulse blood pressure, particularly in populations aged 50 and over. Aortic stiffness is thought to be permanent and an active de-stiffening strategy is yet to be developed. Extra aortic elastic wrapping has been proposed as a surgical technique to boost aortic distensibility and treat hypertension in the elderly. Previously, in-vivo and in-vitro testing have suggested a pulse-pressure reduction potential of elastic wrapping in the stiffened aortas. Herein, we explore the feasibility of elastic aortic wrapping to improve simulated aortic compliance across the age span. Detailed computational studies of the anisotropic aortic wall mechanics, using data from human subjects, were performed, evaluating key performance properties for the interaction between the aortic wall and elastic aortic wrap procedure. Main determinants of the procedure’s efficiency are identified using a pre-defined aortic stiffness and wrap elasticity. Finite element analysis predicts that segmental aortic distensibility can be increased if elastic wrapping is applied to a simulated stiff aorta. Elastic aortic wrapping is calculated to have little impact on the compliance of an initially distensible aorta.

A Novel Elastic Wrap for Syndesmotic Reduction with Post-Operative CT Scan Analysis

Category:Ankle, TraumaIntroduction/Purpose:Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification.Methods:Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification.Results:In a grossly unstable cadaver ankle model the ankle wrap achieved a perfect reduction every time it was trialed. The pressure film component of this study confirmed a uniform reduction force circumferentially at the ankle under the ankle wrap device of 5-9 pounds per square inch. Post-operative CT scans in 5 cases confirmed anatomic reduction of the syndesmosis in those cases treated surgically with the wrap and screw fixation.Conclusion:Malreduction of the syndesmosis can be avoided by using an elastic wrap instead of the standard peri-articular clamp in common clinical practice today.

Sliding-cupping along meridian for lymphedema after breast cancer surgery: A randomized controlled trial

ObjectiveTo observe the clinical efficacy difference between sliding-cupping along meridian combined with short-stretch elastic bandage wrapping and comprehensive detumescence therapy in treating lymphedema after breast cancer surgery. MethodsSixty patients with lymphedema after breast cancer surgery were randomly divided into the sliding-cupping group and the comprehensive detumescence therapy (CDT) group, with 30 cases in each one. The sliding-cupping group used the sliding-cupping along meridian therapy, and the sliding-cupping was applied along the three yin meridians and three yang meridians on the hand of the affected-side upper limbs, continuing for 25–30 min. After the sliding-cupping was finished, the affected limb was wrapped with the short-stretch elastic bandage. The CDT group was treated with comprehensive detumescence therapy (CDT). Both groups were treated once a day, with14 times as one course of treatment, and there was totally 1 course of treatment. The changes of circumferences before and after treatment of the affected limb were measured by a flexible ruler, and the efficacy was evaluated. The subcutaneous tissue thickness and the full skin layer thickness of the patients with moderate to severe edema in sliding-cupping group were measured by color Doppler ultrasound. ResultsAfter treatment, the circumferences at the cubital crease, 5 cm above olecranon, and 10 cm above the olecranon of the affected limbs in the sliding-cupping group were (26.02 ± 2.42) cm, (28.43 ± 3.13) cm, and (30.05 ± 2.80) cm respectively, which were all reduced compared with the pre-treatment circumference (27.95 ± 3.00) cm, (30.80 ± 3.38) cm, and (32.17 ± 2.96 cm). In the sliding-cupping group, the post-treatment subcutaneous tissue thicknesses at 5 cm above the olecranon, 10 cm above the olecranon and 5 cm below the olecranon, and full skin layer thickness at 10 cm below the olecranon of the 15 patients with moderate to severe edema were (8.71 ± 2.83) cm, (8.53 ± 2.4) cm, (6.46 ± 1.38) cm, and (1.61 ± 0.17) cm respectively, which were all reduced compared with pre-treatment (11.90 ± 3.56) cm, (11.84 ± 3.27) cm, (9.12 ± 1.84) cm, and (1.87 ± 0.23) cm, and the difference was statistically significant (all P < 0.05). The total effective rate of the sliding-cupping group was 86.6%, and the total effective rate of the CDT group was 80%, and the difference was statistically significant (P < 0.05). ConclusionCompared with CDT, the sliding-cupping along meridian combined with short-stretch elastic bandage wrapping for the treatment of lymphedema after breast cancer surgery was more effective.

Elastic Wrapping of Lower Extremity Free Flaps during Dangling Improves Microcirculation and Reduces Pain as well as Edema

Free tissue transfer has become a common and safe reconstructive procedure. However, total or partial flap losses remain a looming threat, especially for lower extremity free flaps due to the gravitational challenge associated with dependency. Thus, the majority of microsurgical centers apply some kind of structured flap training. However, due to the lack of evidence, these differ greatly, for example, in the application of an elastic wrapping during dangling. Therefore, the aim of this study was to assess the impact of an elastic wrapping on free flap microcirculation, edema, and pain during dangling. Standardized dangling was performed from postoperative day (POD) 6 to 9 in 30 patients with microvascular reconstruction of the lower extremity. The first dangling per day was performed without elastic wrapping, followed by another session with 30 mm Hg of elastic wrapping. Tissue oxygen saturation (StO2), regional hemoglobin content (rHb), and blood flow (BF) were continuously measured in the free flap; the circumference of the flap as well as pain was assessed. During wrapped dangling, BF as well as StO2 was significantly increased, while rHb was significantly lower on all PODs. Wrapped dangling was rated significantly more comfortable and the girth of the free flaps was significantly less after wrapped dependency when compared with unwrapped dangling. Dangling with an elastic wrapping with 30 mm Hg pressure improved flap microcirculation and reduced pain and edema formation.

Abstract 192: Pressure Methods for Primary Hemorrhage Control

Introduction: Hemorrhage is the primary cause of death in 35% of traumatic mortalities. However, guidelines give little guidance regarding the best method of applying direct pressure including the mechanics of applying the pressure. Hypothesis: The purpose of this study is to compare the force generated using different techniques of force application. Additionally, we aimed to measure the pressure generated by a pressure wrap using two commonly used types of bandages in comparison to manual pressure. Methods: In this IRB approved study, subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) with a flat force sensitive resistor was used in this study to measure force. Subjects were randomized to application order of each of the following techniques: the finger pads of 3 digits of the right hand, 3 fingers of the right hand with the opposing hand applying counter pressure, or 3 digits of each of two hands on top of the other. The subjects were asked to hold pressure at each application for 10 seconds and all completed each method sequentially. Subjects then applied a compression wrap using either an elastic wrap or self-adhesive wrap. Researchers were not blinded during data collection, but data analysts were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age was 34.2 years (range 26-63). Two hand pressure application generated the most amount of force averaging a constant of 3.75 (SD 1.54) lbs. This was statistically different from one hand application which generated an average of 3.00 (SD 1.29) lbs of force (p &lt;0.001). Comparison of opposing hands to single hand and two hands to opposing hands did not reach statistical significance. Neither pressure wrap technique generated a comparable amount of force to that of manual pressure [0.70 (SD 0.49) lbs vs 1 hand with 10 4x4” gauze pads (p &lt;0.001)]. Conclusions: In this model of bleeding, medical personnel generated the most force when two hands were used to apply pressure over the wound. This study also demonstrated direct manual pressure generated much higher pressures than a pressure dressing.

Surgical treatment of bites

Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. Acute traumatic and late presented bite injuries. General contraindication for anesthesia or surgery. Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery. Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.