Rate Of Skin Complications Research Articles

Impact of medical adhesives on persistent fluid extravasation at needle injection sites in patients with severe edema: a randomized controlled trial.

To investigate the efficacy of medical glue in halting fluid extravasation at needle insertion sites in patients with severe edema. Sixty patients with severe edema were recruited between June 2022 and June 2023 and randomly allocated into either the control group or the experimental group, with 30 cases in each. In the experimental group, after intramuscular injection, medical glue was administered at the needle insertion site, and covered with gauze dressing upon curing, and subsequently subjected to pressure bandaging. Patients were instructed to limit their activity. Meanwhile, the control group received conventional nursing procedures involving pressure bandaging and activity restriction. The effectiveness of nursing interventions in halting exudation, duration of hospitalization, duration of exudation, nursing expenses, skin complications (infection, rash, abrasion, abnormal sensation, etc.), and patient satisfaction with nursing care were monitored. Comparison between the two groups revealed statistically significant differences in several aspects: the success rate of halting exudation, duration of exudation, total skin complication rate, and overall satisfaction [83.3% vs. 20.0%, (2.20 ± 2.76) days vs. (7.33 ± 3.28) days, 6.67% vs. 33.33%, 80.00% vs. 36.67%, P < 0.05]. However, there were no statistically significant differences in hospitalization time and nursing expenses [(14.50 ± 5.17) days vs. (14.00 ± 3.95) days, (537.53 ± 264.19) yuan vs. (661.97 ± 305.55) yuan, P > 0.05]. Medical glue demonstrates effectiveness in halting fluid extravasation at needle insertion sites among patients experiencing severe edema. Additionally, it reduces the duration of exudation, diminishes skin complications resulting from exudation, and significantly enhances patient satisfaction with nursing care. Given these benefits, its clinical adoption and application are highly recommended.

Rate of skin and nerve complications as a result of cutaneous traction with modern foam boots

IntroductionCutaneous traction is used to temporize lower extremity fractures and relies on friction between the skin and surrounding material to apply a longitudinal force. This circumferential compressive force can lead to pressure sores, skin sloughing, or compressive neuropathies. These complications have been reported in up to 11% of patients when the cutaneous traction relies on adhesive tapes, plaster, and rubber bandages being in immediate contact with the skin. The rates of these complications are not well documented when using modern foam boots. MethodsA retrospective chart review was performed on all orthopedic trauma patients who suffered pelvic or lower extremity injuries between March 1st, 2020 and April 30th, 2021 at a single Level-1 trauma center. We included all patients with femoral fractures, axially unstable pelvic ring and/or acetabular fractures, and unstable hip dislocations temporized with the use of cutaneous traction. All patients had intact skin and lower extremity nerve function prior to application. ResultsThere were 138 patients identified with 141 lower extremities. The average patient age was 50.7 (6–100) years. Mean traction weight of 9.8 (5–20) pounds. Average traction duration was 20.9 (2.3–243.5) hours. At the time of traction removal, there was 1 (0.7%) new skin wound and 0 nerve palsies. The new skin wound was a stage one heel pressure sore and did not require further treatment. ConclusionCutaneous traction with a modern foam boot was found to have a skin complication rate of 0.7% and a nerve palsy complication rate of 0% for an overall complication rate of 0.7%, which has not been previously established and is lower than historically reported complication rates of 11% when utilizing adhesive and plaster directly on skin. Foam boot Cutaneous traction may be considered a safe option for traction placement.

Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis.

This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare. This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post-insertion device-associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device-associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported. This review synthesized 114 studies (30,782 devices; 1,635,649 device-days). Skin complications were reported in 40 studies, but none exclusively reported individual device-related pressure injuries. Mechanical dysfunctions were well-reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices. This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device-related complications, particularly for understudied device types. Device-related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications. Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device-related complications. MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist. No Patient or Public Contribution.

Comparison of Adverse Event Profiles of Rituximab, Rituximab Hycela and Rituximab Biosimilars: A Real-World Pharmacovigilance Database Analysis

Background: Rituximab is a chimeric monoclonal antibody which targets CD20 and is used for treatment of CD20 associated oncologic/hematologic conditions. Murine-derived variable regions of the antibody contribute to immunogenicity of rituximab products. Clinical trials have shown minor differences in the safety profile of biosimilars and Rituxan-hycela compared to rituximab. Rituxan-hycela and biosimilars were approved recently and real-world adverse drug reaction (ADR) data is lacking. Methods: We reviewed ADRs of rituximab, Rituxan-hycela and biosimilars between 2018 and 2022 using the U.S. Food and Drug Administration Adverse Events Reporting System (FAERS) database. We calculated the reporting odds ratio (ROR) with 95% confidence interval for these drugs. Results: A total of 39,664 respiratory, dermatological, and immune reactions were noted from Rituximab and its biosimilars. Rituximab/Rituxan had RORs of 5.92 (5.81-6.03), 9.01 (8.84-9.19) and 7.22 (7.07-7.37) in respiratory, skin and immune-related ADRs. Rituximab-hycela had higher odds of causing skin events (ROR 13.25, 9.94-17.68) but had much lesser odds of causing respiratory (ROR 3.34, 1.87-5.97) or immune-related complications (ROR 1.67, 0.86-3.25) compared to rituximab/rituximab-biosimilars. Rituximab-abbs had the lowest odds of causing respiratory (ROR 3.34, 2.90-3.85), skin (ROR 4.80, 4.15-5.55) and immune-related events (ROR 1.76, 1.40-2.22) compared to other biosimilars and rituximab/Rituxan. Conclusions: Rituximab-abbs showed lower incidence of ADRs in all categories but it is unknown if patients had previously received rituximab. Rituximab-hycela is administered subcutaneously which may explain the lower incidence of respiratory/immune events and higher rate of skin complications. It may be useful in patients at high-risk for allergic reactions to chimeric antibodies. Additional reporting on Rituximab-pvvr and Rituximab-arrx should also exhibit lower reaction rates as compared to Rituximab. Large scale clinical trials are necessary to establish if there is a real difference in ADR rates between different rituximab products. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effect of Protective Padding in Pneumatic Tourniquet Applications on the Prevention of Skin Complications.

The use of pneumatic tourniquets in orthopaedic surgery has become essential as they create a bloodless surgical field in lower and upper limb applications and allow the anatomical structures to be better visualized. This aim of this study, which was conducted on 60 patients, was to determine the effect of protective padding on preventing skin complications in pneumatic tourniquet applications. Patients were divided into 3 groups of cotton-cast padding, protection sleeve, or no/without protective padding underneath the tourniquet cuff. Mean values were as follows: age: 27.7 ± 6.9 years, tourniquet pressure: 307.5 ± 31.7 mmHg, and tourniquet duration: 87.8 ± 15.3 minutes. There was a significant difference between the groups in terms of the rate of skin complications (p < .05) immediately after survey, 30 minutes after surgery, and 180 minutes after surgery. Protective padding underneath pneumatic tourniquet cuff can be recommended during anterior cruciate ligament reconstruction.

Application of Self-Adhesive Soft Silicone Common Foam Dressing in Reducing Intraoperative Pressure Ulcers in Elderly ICU Patients.

Pressure ulcer (PU), also called pressure injury, is localized damage to the skin and underlying soft tissues, usually over bony prominences, as a result of sustained mechanical loads applied to the tissues. However, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. We for the first time reported the application of Meipicang in the prevention and treatment of intraoperative pressure ulcers in elderly ICU patients with severe illness. We found that the pressure ulcer risk score (20.15 ± 2.17) in the dressing group after intervention was higher than that (17.42 ± 3.62) in the regular group. The incidence of pressure sores in the dressing group was 3.77% lower than the 18.88% in the regular group. The psychological concern score (31.41 ± 3.15) of the dressing group was higher than that (26.92 ± 3.43) of the regular group. The trust score (29.57 ± 2.61) of the dressing group was higher than the score (24.28 ± 2.29) of the regular group. The score of physiological problems in the dressing group (34.69 ± 3.82) is higher than that in the regular group (29.88 ± 3.54). The skin complication rate of the dressing group was 5.56% lower than that of the regular group (22.64%). The comfort score (92.46 ± 4.15) of the dressing group was higher than that (80.59 ± 5.43) of the regular group. The nursing satisfaction score (94.53 ± 3.72) of the dressing group was higher than that (81.79 ± 4.61) of the regular group. To conclude, in this study, we found that the Meipicang dressing can reduce the incidence of pressure ulcers in ICU patients with severe ICU and improve the comfort and nursing satisfaction of elderly ICU patients with severe ICU, which is worthy of promotion.

Effect of Self-Adhesive Soft Silicone Foam Dressing Combined with Clustered Nursing Strategy on Prevent Pressure Injury in Patients after Pancreaticoduodenal Surgery

Background and purpose: Pancreaticoduodenectomy is a kind of abdominal surgery with large trauma, complicated operation and high incidence of postoperative complications especially for elderly patients. Pressure injury is one of its common complications. This study explored the preventive effect of self-adhesive soft silicone foam dressing combined with clustered nursing strategy on patients with pressure injury after pancreaticoduodenal surgery. Methods: From November 2018 to November 2020,120 elderly patients who underwent pancreaticoduodenectomy in the Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital were selected and randomly divided into a control group and an observation group. The control group was treated with routine care, and the observation group was treated with self-adhesive soft silicone foam dressing combined with clustered care. The pressure injury risk score, pressure injury incidence rate, skin complication rate, psychological concern score, and sense of trust score, comfort score, physiological problem score and nursing satisfaction score were compared between the two groups. Results: Compared with the control group, the pressure injury risk score, pressure injury incidence rate, and skin complications incidence rate of the observation group were lower (P &lt; 0.05), while the psychological concern score, trust score, comfort score, the scores of physiological problems and nursing satisfaction were higher (P &lt; 0.05). Conclusion: Self-adhesive soft silicone foam dressing combined with clustered nursing strategy can reduce the risk score and incidence of pressure injury in elderly patients after pancreaticoduodenal surgery, reduce the occurrence of complications, and improve nursing comfort and satisfaction. It is worthy of promotion

Securing Orogastic and Nasogastric Tubes in Intubated Patients

Securing Orogastic and Nasogastric Tubes in Intubated Patients

BAHA Skin Complications in the Pediatric Population: Systematic Review With Meta-analysis.

Compare the incidence of skin and surgical site complications for children undergoing percutaneous and transcutaneous bone conduction implant (pBCI and tBCI) surgery via systematic review and meta-analysis of the available data. 1) Search of PubMed, Web of Science, and EBSCOhost databases from January 2012 to April 2017. 2) References of studies meeting initial criteria. Inclusion criteria were studies that involved patients less than 18 years old undergoing tBCI or pBCI surgery with a BI300 implant and reported skin complications, implant loss, and need for revision surgery. Exclusion criterion was use of a previous generation implant. Implants used, number of patients, age, surgical technique, Holgers score, incidence of skin complication, implant loss, and reoperation. Bias assessment performed with the Newcastle-Ottawa Scale. Twenty-two studies (14 tBCI, 8 pBCI) met criteria. Meta-analysis was performed using a random effects model. Cochran's Q score and I inconsistency were used to assess for heterogeneity. Overall estimated skin complication rate for tBCIs was 6.3% versus 30% for pBCIs (p = 4 × 10). Implant loss was 0% for tBCIs and 5.3% for pBCIs (p = 0.004). Reoperation rate was 3.0% and 6.2% for tBCIs and pBCIs respectively (p = 0.00002). There is strong evidence to suggest that in pediatric patients, the incidence of skin complications, implant loss, and rate of reoperation are higher for pBCIs compared with tBCIs. This information should be part of any discussion about BCI surgery on a pediatric patient.

Treatment of Displaced Intra-articular Calcaneal Fractures with the Intramedullary Nail

Category: Trauma Introduction/Purpose: In 2010, a new closed reduction, internal fixation procedure for displaced intra-articular calcaneus fractures (DIACF) was developed with an intramedullary nail introduces through a channel in the calcaneal tuberosity. The goal was to reduce the rate of skin complications following principles of open reduction procedures. The aim of this prospective mono-centric study was to assess the occurrence of complications and the functional results using the AOFAS-AHS score. The secondary objectives were to assess first the restoration of the Böhler and Gissane angles on X-ray and shape of the calcaneus (Height, length, width) on CT scans, then thalamic reduction on 3D CT scans based on Goldzak’s global articular reduction classification. Methods: 26 Patients were included prospectively between 2014 and 2016 with analysis of X-rays and CT scans. Two were lost to follow-up and 2 patients sustained a secondary subtalar arthrodesis. After positioning a distractor and drilling, reduction was done with tamps and spatula. The nail was then introduced and locked with screws in the tuberosity and the constant fragment. After 3 weeks of non-weight bearing and 3 weeks with hindfoot off-loading shoe, full weight bearing was allowed. The functional outcome and restoration of the radiographic angles were evaluated postoperatively, at 3 months, 1 year and at the last follow-up. Global calcaneal shape and thalamic surface were evaluated postoperatively, at 1 year and at the last follow-up. The following early complications (delayed healing, infection, annoyed material, sural nerve lesion) and later complications (painful stiffness of the subtalar joint, hindfoot varus malalignment and calcaneofibular conflict) were recorded. Results: Mean follow up was 2.4 years. The mean AOFAS-AHS score was 79 ± 12 [100; 61] in the 22 patients examined. The mean Böhler angle rose from -1.29°± 18° [-35; 28] pre-operatively to 33°± 6° [22; 44] post-operatively. The mean calcaneal height index and length rose respectively from 0.44± 0,18 [0,12; 0,83] to 0.86± 0,22 [0,46; 1,1] and 82,4± 5,4 [72; 93] mm to 86,7mm ±4,6 [76; 97], and the width decreased from 49,8± 4,8 [38; 59] to 46,3± 3,7 [38; 55] mm. The Goldzak global articular reduction assessment was excellent in 39% of cases, good in 42% of cases and poor in 19% of cases. One case of deep infection was reported. Three patients needed device removal and two sustained a secondary subtalar arthrodesis. Conclusion: Our prospective study on this new device has the longest time of follow-up. The results confirm the effectiveness and the reliability over time of the procedure to restore the global shape and the thalamic surface with a low rate of complications and quick return to activities. It appears to be an excellent compromise between the respect of the principles of reduction as applied in the ORIF procedures, and the low cutaneous risk of percutaneous procedures. A subsequent study, with a larger number of patients, will enable analysis of the correlation between the radiological markers and the AOFAS-AHS.

Reducing the Incidence of Cast-related Skin Complications in Children Treated With Cast Immobilization.

Cast immobilization remains the mainstay of pediatric orthopaedic care, yet little is known about the incidence of cast-related skin complications in children treated with cast immobilization. The purposes of this quality improvement project were to: (1) establish a baseline rate of cast-related skin complications in children treated with cast immobilization, (2) identify trends in children who experienced cast-related skin complications, (3) design an intervention aimed at decreasing the rate of cast-related skin complications, and (4) determine the effectiveness of the intervention. A prospective interrupted time-series design was used to determine the incidence of cast-related skin complications overtime and compare the rates of skin complications before and after an intervention designed to decrease the incidence of cast-related heel complications. All consecutive patients who were treated with cast immobilization from September 2012 to September 2014 were included. A cast-related skin complications data collection tool was used to capture all cast-related skin complications. A high rate of heel events was noted in our preliminary analysis and an intervention was designed to decrease the rate of cast-related skin complications, including the addition of padding during casting and respective provider education. The estimated cast-related skin events rate for all patients was 8.9 per 1000 casts applied. The rate for the total preintervention sample was 13.6 per 1000 casts which decreased to 6.6 in the postintervention sample. When examining the heel-only group, the rate was 17.1 per 1000 lower extremity casts applied in the preintervention group and 6.8 in the postintervention group. Incorporating padding to the heel of lower extremity cast was an effective intervention in decreasing the incidence of cast-related skin complications in patients treated with cast immobilization. Level II.

Evaluation of the effect of a new fixation tape for tracheal catheter in intensive care patients

To evaluate the effect of a new type of fixation tape for tracheal catheter in intensive care patients. A purposive sampling study was conducted. Ninety patients experienced oral tracheal intubation for mechanical ventilation, and admitted to respiratory intensive care unit (ICU) of the Second Affiliated Hospital of Nantong University from November 2015 to February 2017 were enrolled. All the patients were randomly (random number) divided into the control group and the observation group with 45 patients in each group. The patients in control group was treated with the traditional medical adhesive tape and fixation belt to fix endotracheal tube, while the patients in observation group was treated with a new type of tracheal catheter fixation tape. The fixation effect, skin complication rate, patient's comfort level, nursing workload and satisfaction were evaluated in both groups. There were 6 patients with mild displacement, 2 patients with moderate displacement and 1 patient with severe displacement in the control group, while there was no catheter displacement or detachment occurred in the observation group, and the difference between the two groups was statistically significant (χ2 = 2.944, P = 0.003). In the control group, there were 39 patients with facial skin redness, 6 patients with facial skin damage, 36 patients with neck skin redness, and 2 patients with neck skin damage. In the observation group, there were no facial skin complications and only 2 patients with neck skin redness, and the skin complication rate was significantly higher than that of the control group (facial skin: Z = 9.173, P = 0.000; neck skin: Z = 7.549, P = 0.000). Compared with the control group, the patients' comfort levels were significantly elevated in the observation group (the intolerance patients: 9 vs. 24, the extreme discomfort patients: 4 vs. 8, Z = 3.695, P = 0.000). The total changing times of the fixation belt and operating time for each change in the observation group were significantly decreased as compared with those of control group [changing times of the fixation belt (times): 1.89±0.77 vs. 3.86±1.18, operating time for each change (minutes): 10.31±1.47 vs. 15.78±1.89, both P < 0.01]. Nursing satisfaction in the observation group was significantly higher than that of the control group (100% vs. 33.3%, P < 0.01). The new fixation tape for tracheal catheter could significantly reduce the catheter displacement and detachment rate, and decrease the incidence of facial skin injury. It is easy to learn and worth to generalize clinically.

The Efficacy of Licorice Root (Glycyrrhiza glabra) and Yarrow (Achillea millefolium) in Preventing Radiation Dermatitis in Patients with Breast Cancer: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Background: Radiation dermatitis is one of the most common side effects of radiotherapy for breast cancer, affecting approximately 85 percent of patients. The aim of this study is to assess the effect of Licorice root (Glycyrrhizin glabra) and Yarrow (Achillea millefolium) on preventing radiotherapy-induced dermatitis in breast cancer patients.Methods: Seventy-five patients with breast cancer who had undergone mastectomy and were planned to receive radiotherapy (RT) were enrolled in this randomized, double-blind, placebo-controlled study. The extract of Achillea millefolium and Glycyrrhizin glabra root were incorporated into a vanishing cream base. Patients were randomly divided into three groups and received Glycyrrhizin glabra cream, placebo or Achillea millefolium cream for five weeks during RT. The rate and grade of radiation dermatitis were recorded at baseline, at the end of third week and at the end of treatment using a modified Radiation Therapy Oncology Group (RTOG) grading tool.Results: At the end of the third week, the group receiving Achillea millefolium cream showed milder skin complications than other groups. At the end of treatment, rate of skin complications in groups receiving herbal drugs was lower than placebo group but it was not statistically significant. Conclusions: In conclusion, the results of this study did not present a significant difference between Glycyrrhiza glabra, Achillea millefolium and placebo on preventing radiation dermatitis.

OC-006 Anti-TNF Therapy Alters Dendritic Cell Trafficking and Cytokine Production in Crohn’s Disease

Introduction Dendritic cells (DC) act as a bridge between the innate and adaptive immune system, sensing and presenting antigen to lymphocytes and mounting either a tolerogenic or inflammatory response. They are able to imprint homing capacity on T-cells, directing them into specific tissues. Abnormal DC function contributes to the pathogenesis of Crohn’s disease and thus DC represent a potential therapeutic target. In this study we have investigated the effect of anti-TNFα therapy on circulating DC of patients with Crohn’s disease. Methods We recruited 13 consecutive patients with active luminal Crohn’s due to start anti-TNFα therapy. Clinical parameters including the Harvey-Bradshaw index, C-reactive protein and faecal calprotectin were measured. Peripheral blood mononuclear cells were isolated from each patient immediately before and six weeks after commencing anti-TNFα therapy. At both time points flow cytometry was performed to assess DC phenotype and function. We also analysed subsets of DC: myeloid (mDC, CD11c + CD123 − ) and plasmacytoid (pDC, CD11c − CD123 + ). Expression of phenotypic markers (including maturation and homing markers and pattern recognition receptors) and intra-cellular on-going DC cytokine production were determined. Results Treatment with anti-TNFα resulted in an alteration of the phenotype of mDC in Crohn’s disease. The gut homing phenotype of mDC in Crohn’s disease was down-regulated with anti-TNFα (CLA − β7 + p = 0.0056 Fig A) whilst the non-tissue specific phenotype (CLA + β7 + p = 0.0026 Fig not shown) and skin homing phenotype were up-regulated (CLA + β7 − p = 0.0055 Fig B). Production of TNFα and IL-6 by mDC and pDC respectively, shown to be increased in Crohn’s disease, was significantly reduced by anti-TNFα therapy (p = 0.033 and p = 0.014 Fig C and Fig D respectively). Production of IL-10 was increased following therapy (p = 0.051). There were no changes in IL-12, IL-23 and IFN-α production. Significant improvements in clinical markers were observed following treatment. Conclusion The reversal of inflammatory DC phenotype and function by anti-TNFα further highlights the potential role this antigen presenting cell may play in the pathogenesis of Crohn’s disease. DC are a promising therapeutic target in Crohn’s because they can be modulated to express a non-gut homing phenotype and direct T cells away from the gut and promote tolerogenic effects. The increase in skin homing DC following anti-TNFα treatment may explain the high rate of skin complications. The reduction in gut homing DC may offer an explanation for reduced treatment success with vedolizumab (α4β7 blocker) after previous anti-TNFα therapy (reduction of vedolizumab treatment target). Disclosure of Interest None Declared

PMD66 - HEARING RESTORATION, QUALITY OF LIFE, AND SAFETY OUTCOMES IN BONE-CONDUCTION DEVICES FOR PATIENTS WITH CONDUCTIVE OR MIXED HEARING LOSS OR SINGLE-SIDE DEAFNESS

To provide a comprehensive literature review on the various bone-conduction devices (BCDs) available, including bone-anchored hearing aids (BAHAs). A comprehensive search strategy was defined to perform a literature review of the data available to date on the different types of marketed BCDs for hearing rehabilitation in patients presenting with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-side deafness (SSD). A search was conducted on December 22nd, 2015 on the PubMed, EMBASE and Google Scholar databases. Search criteria included patients presenting with CHL, MHL or SSD, and implanted with percutaneous (pBCI) or transcutaneous (tBCI) bone conduction implants. Non-systematic reviews, case reports and clinical studies on <5 patients were excluded. The literature analysis specifically examined the type of implantation (pBCI vs. tBCI), the principle of operation (active device, i.e. direct drive to the skull bone vs. passive device, i.e. skin drive), or by indication. 1,223 potentially relevant publications were identified; on full review, 95 studies met eligibility criteria. Hearing restoration, QoL and patient-reported outcomes measures have been increasingly documented for each technology in recent years. While the tBCIs seemed to be associated with a lower rate of skin complications than pBCIs, all the other parameters (clinical outcomes and QoL) seemed to be similarly distributed across all devices. The available data are still insufficient and the measurements’ sensitivities do not allow for a robust comparison between the different types of implants. The evidence base to support any differentiation between ‘passive’ and ‘active’ implants is insufficient, and direct comparison data is scarce. Future clinical studies and case reports should continue to investigate the clinical efficacy and safety outcomes related to the use of these devices, so as to provide physicians a more refined patient selection rationale and evidence-based practice pathways according to each device’s characteristics.

A systematic review on skin complications of bone anchored hearing aids in relation to surgical techniques

A systematic review to study the skin complications associated with the bone-anchored hearing aid in relation to surgical techniques. The following databases have been searched: MEDLINE, EMBASE, the Cochrane Library , Google scholar and the PubMed. The literature search date was from January 1977 until November 2013. Randomised controlled trials and retrospective studies were included. Initial search identified 420 publications. Thirty articles met the inclusion criteria of this review. The most common surgical techniques identified were full-thickness skin graft, Dermatome and linear incision techniques. The result shows that dermatome technique is associated with higher rate of skin complications when compared to linear incision and skin graft techniques. Based on the available literature, the use of a linear incision technique appears to be associated with lower skin complications; however, there is limited data available supporting this. Higher quality studies would allow a more reliable comparison between the surgical techniques.

A systematic review on skin complications of bone-anchored hearing aids in relation to surgical techniques.

A systematic review to study the skin complications associated with the bone-anchored hearing aid in relation to surgical techniques. The following databases have been searched: MEDLINE, EMBASE, the Cochrane Library , Google scholar and the PubMed. The literature search date was from January 1977 until November 2013. Randomised controlled trials and retrospective studies were included. Initial search identified 420 publications. Thirty articles met the inclusion criteria of this review. The most common surgical techniques identified were full-thickness skin graft, Dermatome and linear incision techniques. The result shows that dermatome technique is associated with higher rate of skin complications when compared to linear incision and skin graft techniques. Based on the available literature, the use of a linear incision technique appears to be associated with lower skin complications; however, there is limited data available supporting this. Higher quality studies would allow a more reliable comparison between the surgical techniques.

Patient Outcomes in Magnet-Based Implantable Auditory Assist Devices

Magnet-based implantable auditory assist devices (MIAADs) are a recent development in bone-anchored hearing devices. This report increases the number of children studied with specific outcome criteria and provides detailed solutions to avoid device use difficulties in other centers considering this device. To assess hearing thresholds, use rates, and complications in children implanted with a MIAAD for conductive hearing loss. Retrospective analysis of children implanted with an MIAAD at an ambulatory care quaternary referral center since the Food and Drug Administration approved the Sophono device (Sophono Inc) for use in the United States (May 2011 through January 2013). Ten pediatric patients were implanted for conductive hearing loss (14 ears; mean age at implantation, 9 years [range, 3.8-17.2 years]). Diagnoses included aural atresia (n = 7) and chronic ear disease and cholesteatoma (n = 3). Implantation of MIAAD and management of skin complications. Demographics, hearing thresholds, use rates, and complications were assessed. After fitting with the magnetic baseplate and sound processor, the mean (SD) aided pure-tone average was 20.2 (6.0) dB hearing level (HL), with a mean (SD) functional gain of 39.9 (12.4) dB HL. There were no surgical complications. Negative outcomes were assessed following fitting of the sound processor. The skin complication rate was 35.7%, including skin breakdown (n = 2) and pain and erythema (n = 5), which resulted in decreased use of the device for these patients. Intervention included decreasing the magnet strength, graduated wearing schedule, antibiotic ointment, barrier protection, and reoperation for well widening with Alloderm (LifeCell Corporation) placement. Patients without skin complications are consistent users of their device, with an average daily use of 8 to 10 hours. The MIAAD device has equivalent levels of hearing restoration to other previously described methods of intervention for children with conductive hearing loss. This early report indicates high rates of skin difficulties and a need for improved methods of implantation, magnetic baseplate fitting, and device use. We suggest decreased magnet strength at the initial fitting, a graduated wearing schedule, caution with patients who have a history of skin issues from a bone-anchored hearing aid or multiple surgical procedures, and parent counseling regarding potential skin irritation.

A Comparative Study of Low-Profile and Regular Type Totally Implantable Venous Access Devices in Patients with Malignant Tumors: Retrospective Analysis of 4501 Implantations.

The purpose of this study was to evaluate safety and efficacy of image-guided radiological totally implantable venous access devices with special reference to rate of skin complications of both regular and low-profile types. 4395 patients were referred to Interventional Radiology Unit between March 2003-September 2013. 4501 implantations of totally implantable venous access device were performed in patients under sonography and fluoroscopy. During this period 2299 regular-type and 2202 low-profile type totally implantable venous access devices were used. Success rate, periprocedural early and long-term complications were evaluated. Periprocedural and early complications of totally implantable venous access devices included 16 (0.4%) arterial punctures, 101 (2.2%) minor hematoma, 1 (%0.02) disconnection of the catheter, 4 (0.09%) septum separation, 38(0.8%) minor erythema-pain and tenderness, 23 (0.5%) short term fever without bacteriemia and 25 (0.6%) inversion of the port. Late complications included 6(0.1%) cellulitis, 8 (0.2%) bacteriemia and sepsis, 305 (6.8%) venous thrombosis, 62 (1.4%) catheter thrombosis, 6 (0.1%) catheter migration and 3 (0.07%) catheter fracture. A total of 53 (1.18%) skin perforation were seen. There was statistically significant difference between regular and low-profile totally implantable venous access devices particularly in patients with normal and thinner subcutaneous fat tissue (p= 0.024 and <0.001 respectively). The present study is the largest series in the literature in patients with malignant tumors. Image-guided radiological totally implantable venous access device placement is safe and reliable method with a low risk of complications and the results of this study further justify the use of low profile totally implantable venous access device based on lower skin complications.

Incidence of Skin Complications and Associated Charges in Children Treated With Hip Spica Casts for Femur Fractures

Spica cast immobilization remains the treatment of choice for femur fractures in children aged 6 months to 6 years. The incidence of skin complications and their associated charges have not been well described. This study's purposes were to: (1) determine the rate of skin complications in children treated with spica casts for femur fractures, (2) identify predictors, and (3) calculate the charges associated with skin complications. Health records for all patients treated with immediate spica casting for a femur fracture at a major tertiary-care children's hospital from 2003 to 2009 were reviewed and relevant data were abstracted. Descriptive statistics and univariate and multiple logistic regression analyses were used to compare children with and without skin complications and to identify predictors of skin complications. The total charges for skin complications leading to a cast change and early bivalving and lining were calculated. Of the 300 spica cast applications in 297 patients, 77 subjects (28%) had skin complications. Twenty-four (31%) of these 77 patients underwent a cast change in the operating room, 34 (44%) required early bivalving and lining and 19 (25%) required cast trimming and/or skin care. Predictors of skin complications included: child abuse as mechanism of injury, younger age, and cast time more than 40 days. Sex, weight, fracture location, and total number of clinic visits were not statistically significant predictors of skin complications. The median charge for patients who required cast changes for skin complications was $12,719 ($8632 to $53,768), whereas the median charge for bivalving and lining was $416.51 ($403.32 to $449.00). Spica cast treatment is associated with numerous skin complications and additional charges. Victims of child abuse may benefit from additional clinical oversight. Future research needs to investigate patient education and casting interventions that reduce skin complications. Prognostic Level III-case-control study with patient identified based on outcome-skin complications versus no skin complications.