Skin Lacerations Research Articles

Efficacy of Topical Anesthetics for Pain Control During Skin Laceration Repair.

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.

Salter-Harris Fractures of the Distal Phalanx: Treatment Algorithm and Surgical Outcomes.

Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated. A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016. Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients. The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration. Therapeutic, IV.

Genipin crosslinked microspheres as an effective hemostatic agent

Efficient hemorrhage control is of extreme importance to decrease mortality rates arising from traumatic bleeding. However, traditional hemostatic agents are limited to unsatisfied biocompatibility, inconvenient usage, and high cost. To this end, we have devised a novel hemostatic microsphere from chitosan and gelatin by using appropriate amount of genipin as a crosslinker. The performance of these Cs/Gel MPs was evaluated with experiments in vitro and in vivo. Results in vitro showed that the best hemostatic efficacy was achieved by Cs/Gel‐0.75 MPs (the mass fraction of genipin in Cs/Gel mixture is 8.6 × 10−6). Skin laceration model indicated that the hemostatic time of Cs/Gel‐0.75 MPs was within 12 seconds, which has been significantly shortened in comparison with commercial available products. Moreover, cytocompatibility results displayed that Cs/Gel‐0.75 MPs caused no obvious cytotoxicity even at the high concentration of 40 μg/ml. Cs/Gel‐0.75 MPs also possess satisfactory fluid absorption ratio and low hemolysis. Therefore, these Cs/Gel‐0.75 MPs are promising candidates for further surgical wound hemostatic agent.

Graft of Small Patch of Partial Thickness in Equine Wound

Background: Cutaneous wounds in locomotor limbs represent one of the most frequent disorders in equine medicine. Wounds in equines are distinguished from those in other species by unique characteristics, including different healing rates among breeds, wound location and high propensity to formation of exuberant granulation tissue during the healing process. The wound healing process that cannot be sutured can be accelerated by the use of skin grafts, lowering the treatment cost.The objective of this report was to divulgate the success upon treatment of an extensive lacerated wound in the metatarsal region of a horse using autologous skin grafts.Case: A 3-year-old, female, American quarter horse weighting 450 kg was brought to veterinary hospital with lower limb injury. According to the owner’s report, the animal had one of its limbs stuck in a plain wire fence. A wound was observed in the metatarsal region during physical examination, the lesion caused an extensive skin laceration that showed the dorsal surface of the metatarsal bone and the digital extensor tendon. After injury assessment, wound debridement was carried out by surgery intervention followed by antisepsis and application of autologous plasma every two days as post-surgical care and wound preparation to receive the graft. Forty-five days after the first intervention, grafts were collected from the neck and implanted in the wound. The procedure achieved 70% of success. After approximately 75 days, transplantation was performed in other regions of the wound using the same technique. The duration of treatment at the Veterinary Hospital of the Universidade Paranaense (UNIPAR) was eight months, and then the animal returned home, where dressings were applied for two months to avoid the risk of contamination and until complete recovery.Discussion: The debridement of the wound and edges approximation were of great value in order to begin the process of wound granulation. The established therapy with scarring with gauze and use of antiseptics only in the initial stages of treatment, the frequent exchange of bandages every two days, preventing the accumulation of exudate and the use of autologous plasma favored the formation of the granulation bed and was sufficient to avoid infection and the formation of exuberant granulation tissue. Factors such as excessive movement and local infection were also attributed as responsible for the longer healing period, so the use of the spring coupled to the horseshoe decreased the joint movement, proving tobe effective in patients with severe extensor tendon lacerations. The use of the spring coupled to the horseshoe promoted a correct biomechanical alignment and no walking complication or deficiency was observed. The correct anatomical structural positioning prevents the formation of flexural deformities and fibrosis of the joint capsule. The use of micrografts wasbeneficial and simple to perform and the use of grafts contributed to a better cosmetic result. The main factor contributed to the grafting success was the use of dressing, which was regularly changed, and topical antimicrobial therapy correctly applied to avoid contamination. Based on the clinical result of this patient, it was concluded that the use of small autologous grafts can provide good recovery and healing of extensive wounds in horses when proper care with dressings and antimicrobial medication is provided after surgical interventions.Keywords: equine, surgery, graft, healing.

Performance of Local Anesthesia with Lidocaine among Opium Addicts and Non-Addicts; a Case Control Study.

Compared to ordinary people, addicts usually have a lower pain threshold. The current work attempts to compare the performance of local analgesia with lidocaine among opium addicts and non-addicts. In this case-control study, opium addicts and healthy patients with skin laceration referring to emergency departments of two educational hospitals were compared regarding the response to local anesthesia with lidocaine, as well as side effects. 197 cases with the mean age of 43.44 ± 20.12 years were studied (72.1% male). 98 (49.8%) cases were addicts and 99 (50.2%) were healthy people. Two groups were similar regarding age (p = 0.281), sex (p = 0.666), and wound size (p = 0.272). The amount of pain reduction 5 (df =1.5, F=0.38, p = 0.88) and 10 (df =1.5, F=0.58, p = 0.72) minutes after lidocaine injection was not different between the groups. Subgroup analysis based on sex and age of patient did not show any differences between the groups (p > 0.1 for all analysis). The mean duration of analgesia was 16.4 ± 5.37 minutes in addicts and 16.95±1.79 in control group (p = 0.334). Lidocaine, as a commonly used local anesthetic agents, does not show different effects in addicts and non-addicts in repairing skin laceration.

Anesthesia for collagenase clostridium histolyticum injection in patients with dupuytren disease: A cohort analysis

Procedural pain is one of the most common adverse effects reported by patients with Dupuytren disease (DD) treated with collagenase clostridium histolyticum (CCH). The aim of this study was to assess the effectiveness of wrist block before CCH injection in reducing procedural pain and to analyze its impact on adverse effects. We performed a prospective, single-center study in which we compared two groups of patients in a consecutive cohort. In the first group (NO-BLOCK), wrist block was only performed before finger extension, whereas in the second group (BLOCK), it was performed before CCH injection and finger extension. Pain was assessed on a 10-item numerical rating scale. Our results show that pain scores were clearlylower in the BLOCK group than in the NO-BLOCK group: 4.72 vs. 0.61 for CCH injection and 3.43 vs. 0.82 for finger extension. Patients who rated CCH injection pain with a score of 4 or higher were 11 times more likely to experience pain during extension. There was a weak correlation between the use of wrist block for CCH injection and the occurrence of skin lacerations (Spearman's rho = -0.222, p < 0.01) and the presence of pruritus (Spearman's rho = 0.183, p < 0.07). In conclusion, wrist block before CCH injection is an effective measure of decreasing perceived pain throughout the different stages of CCH treatment in patients with DD.

Sub-occipital ligature knot in a case of long drop suicidal hanging with rare autopsy finding of cervical spine fracture

BackgroundHangman’s fracture (Fracture of cervical vertebrae) in hanging is usually described into the context of judicial type of hanging where the individual is dropped from a calculated height with sub-mental or sub-aural position of ligature knot. Such a long drop with typical upper cervical vertebral fracture is a rare entity in a case of suicidal hanging.Case presentationWe have described such a case where an average built deceased weighing 62 kg hang himself with a nylon rope by jumping from a branch of tree with a drop length of 6.3 m, which was sufficiently long enough to cause soft tissue injuries, transection of larynx along with fracture and dislocation of cervical spine at C2-C3 level contrary to the fact that position of ligature knot was in sub-occipital area. Hence, this rare case is discussed with reference to the probable mechanism involved in causation of such internal injuries.ConclusionIn our case of long drop hanging, we found fracture of cervical spine when ligature knot was placed at sub-occipital position which is a rare autopsy finding. We also noticed deep laceration of skin and transection of larynx as extremely rare finding in hanging caused by flexible and blunt nylon rope used as ligature material.

Skin Laceration in Collagenase Clostridium histolyticum Treatment for Dupuytren's Contracture.

Dupuytren's contracture produces a progressive flexion contracture of the affected fingers. Collagenase Clostridium histolyticum produces breakdown of the cord in the hand and/or finger(s) that tightens as a result of the disease creating a contracture, allowing manual traction and cord rupture. One of the side effects is spontaneous skin laceration when the finger is extended. To evaluate the development of skin lacerations in Dupuytren's contracture treated with collagenase Clostridium histolyticum, to determine predisposing factors, and evaluate the effectiveness of 2 different treatments (antiseptic and non-antiseptic dressings). Included 157 patients diagnosed with Dupuytren's contracture and treated with collagenase Clostridium histolyticum. Analysis of variables and logistic regression model were applied to determine their possible relationship with skin lacerations. The effectiveness of the type of treatment used was evaluated by comparing the amount of time required for healing. Skin lacerations were present in 33.1% (n = 52) of patients, with an average laceration length of 1.12 (SD: 0.70) cm. Characteristics that were significant predisposing factors for lacerations were disease bilateralism (p = .002), previous surgical intervention (p = .003), and initial matacarpophalangeal joint contracture (p < .001). Worse initial contracture (Z = 5.94; p < .001) had a greater risk of laceration as did those who had prior hand surgery, or whose little finger was affected. Average treatment length of healing was 11.24 days (SD: 8.13). All wounds healed successfully. There were no significant differences (p = .511) in healing between different dressings evaluated. Skin lacerations as a consequence of treating Dupuytren's contracture with collagenase Clostridium histolyticum occur often and are moderately serious. For all cases, evolution is satisfactory in less than 2 weeks, and the type of treatment does not appear to make any difference in healing time.

Dermatoporosis: a further step to recognition.

Skin ageing has long been considered only as a cosmetic issue. However, with increasing lifespan, we experience a functional dimension of skin ageing which extends beyond cosmetics and appearance. Ten years ago, we proposed the neologism dermatoporosis to cover different characteristics of a chronic cutaneous insufficiency/fragility syndrome, to understand underlying molecular mechanisms and to develop preventative or therapeutic strategies.

Falls among Hospitalized Patients in an Acute Care Hospital: Analyses of Incident Reports.

Falls cause injuries such as fractures, skin lacerations, bleeding, and head injury, and could result in more severe medical conditions in hospitalized patients. We retrospectively investigated the incidence and characteristics of falls among hospitalized patients in an acute care hospital from incident reports by hospital staff between January and June 2013. There were 154 falls in 135 patients, 2 of which resulted in fracture. The average age of patients who fell was 63.9 (range 0 to 91) years. Many falls occurred at the bedside (68.2%). Approximately half of all falls were related to elimination (46.6%). The most common time of discovery of falls was 2:00-2:59 AM (14/154;9.1%), followed by early in the morning when patients would actively move. Fall rates in our hospital were 1.39 falls per 1,000 patient days. The department of respiratory medicine and rheumatology had the highest fall rate (3.08 falls per 1,000 patient days), followed by the departments of neurosurgery and neurology (2.98 falls per 1,000 patient days). This study revealed the characteristics of falls in an acute care hospital, and suggests that their notification in the hospital might help reduce the incidence of falls in hospitalized patients. J. Med. Invest. 65:81-84, February, 2018.

A case report of patella tendon complete rupture with skin laceration

A case report of patella tendon complete rupture with skin laceration

Injuries sustained in falling fatalities in relation to different distances of falls

BackgroundFalling from a distance is an important issue worldwide, which happens in different ages, genders and circumstances. It is usually not considered a medicolegal case in many countries hence no autopsy is performed. This study focused on analyzing injuries sustained in victims of falling in relation to different distances of fall. MethodsRetrospective study of 352 autopsy reports of falling victims brought to the forensic pathology department at Jordan University Hospital during the period from January 1990 to March 2016. ResultsAmong 352 cases, 256 (72.7%) were males and 96 (27.3%) were females. 303 (86.1%) cases showed accidental fall, 31 (8.8%) were suicidal, 2 (0.6%) were homicidal and un-clarified death in 16 (4.5%). Time of death was directly proportionate with the distance of fall. Victims fell from distances less than 3 m were 123 (35%), most of them were children less than 7 years 50 (40.5%) and unemployed adults more than 45 years were 48 (39.1%). They showed multiple abrasions (62.6%), few contusions (64.2%) and absent laceration of the skin (84.5%). Victims fell from distances of 3–9 m were 123 (35%), most of them were male workers 56 (60.2%). They showed multiple abrasions (63.5%), few contusions (71%) and few lacerations of skin (50.5%). Victims fell from distances more than 9 m were 136 (38.6%), most of them were male workers 71 (52.2%) and female servants 23 (17%). They showed few abrasions (80.9%), multiple contusions (64.7%) and few lacerations of skin (48.5%). The number of fractured limbs increases obviously with distances more than 3 m. Skull vault fractures were found in all distances, while skull base fractures showed in distances of 3–9 m and more than 9 m. Head injury was the most common fatal injury in all distances. Chest injuries were prominent mainly in distances more than 3 m. While abdominal injuries were mainly prominent in distances more than 9 m. ConclusionsThis study showed the effect of different distances of fall in causing different types of injuries in falling fatalities. Internal injuries were in a direct proportion with distances of fall, while external injuries showed a great importance in interpretation of the way of fall.

INVESTIGATION OF SKIN LACERATION THRESHOLD UNDER A SPECIFIC CONDITION: BLADE PENETRATION TEST ON PORCINE SKIN

Skin lacerations are not fatal but constitute one of the most common injuries in daily life. There is a need, therefore, for measures to prevent skin lacerations caused by accidents; however, since only a few engineering studies have been undertaken, the threshold of skin laceration is still unclear. In this study, the thresholds of skin laceration under moderate loading rate are proposed according to the results of penetration tests on porcine skin using a knife or blunt blade. In the tests, a sharp blade (knife) and blunt blade with an edge having a small radius of curvature were applied to the external surfaces of dorsal and ventral porcine skin specimens. Penetration tests using sharp blades showed that the average rupture load was 39.0[Formula: see text]N for dorsal skin and 36.0[Formula: see text]N for ventral skin. On the other hand, the results of the penetration tests using the blunt blade were statistically analyzed by ordinal logistic regression, because the rupture load could not be defined precisely based on the load sequence data. The regression curves show that the rupture loads for a 50% probability were within the range of 123.7[Formula: see text]N to 214.4[Formula: see text]N for dorsal region skin and 80.1[Formula: see text]N to 160.0[Formula: see text]N for ventral region skin.

Development of a test method for assessing laceration injury risk of individual cleats during game-relevant loading conditions

Professional rugby union players experience an injury once every 10 matches, and up to 23% of these injuries are skin lacerations. Current regulations to assess laceration injury risk of cleated footwear involve two optional mechanical tests for manufacturers: a drop test and a pendulum test. However, there is limited rationale for these tests and associated impact parameters. A questionnaire among 191 rugby players showed that the ruck is the most prevalent game scenario in which skin laceration injuries occur. During the ruck, laceration injuries result from stamping movements by players wearing cleated footwear. A biomechanical study was conducted to obtain game-relevant impact parameters of stamping in the ruck. Eight participants were asked to perform 10 stamps on an anthropomorphic test device. Kinetic and kinematic data were clustered – identifying two distinct phases of the stamp motion – providing test parameters for mechanical assessment of skin laceration risk. A two-phase mechanical test was designed to quantify laceration injury risk of individual cleats. Phase one represents initial impact and phase two represents the subsequent raking motion as observed in the biomechanical study. Each phase is based on the impact parameters of observed stamping impacts. The developed test method has the potential to be adapted as an international standard for assessing laceration injury risk of cleated footwear. Future research is required to assess the repeatability of this method and its sensitivity to laceration injury.

Do Skin Lacerations Imply Tissue Transfer From Surgeon to Patient During Arthroscopic Knot Tying?

To use simulated arthroscopic knot tying to assess (1) whether epithelial cells from the surgeon's hands were transmitted to the suture and (2) whether the number of knots tied or the presence of glove tears would correlate with the number of cells transmitted. Knots were tied in a simulated arthroscopic environment using a nonabsorbable No. 2 suture over a metal hook. The surgeon was double gloved for each knot tied. For each "anchor," a surgeon's knot was tied, followed by 3 reversed half-hitches on alternating posts. Multiple skin lacerations were sustained by the surgeon during each knot-tying session. Gloves were collected after tying 2, 4, or 6 anchors. Gloves were tested for perforation by (1) electroconductivity and (2) saline solution load testing. Cytopathologic ThinPrep analysis was applied and allowed for the number of epithelial cells found on each suture (within 10 high-powered fields) to be counted. Statistical analysis included analysis of variance and logistic regression. There was no significant difference in the number of epithelial cells identified in any of the groups compared with the negative control groups (P > .05) or with each other (P>.05). Glove tears were present in 3.3% of gloves (50% in inner and 50% in outer gloves) and 1.7% of gloves (50% in inner and 50% in outer gloves) by electroconductivity and saline solution load testing, respectively. There was no significant association between glove tears and the number of epithelial cells found on the suture (P > .05). Epithelial cells were transmitted to the suture during simulated arthroscopic knot tying. However, despite multiple skin lacerations produced during knot-tying sessions, the number of cells transmitted was not significantly different when compared with the negative controls. The number of cells transmitted did not correlate with the number of knots tied and/or the presence of glove tears. Skin lacerations on the surgeon's fingers are often noted after arthroscopic knot tying. However, despite these skin lacerations, no skin tissue is transferred across the surgical gloves to the suture itself.

Application of 3M steri-strip in the eyelid and periorbital skin laceration of children

Objective To evaluate the therapeutic efficacy of 3M steri-strip in children's eyelid and periorbital skin laceration. Methods The total of 142 eyes of 142 children with eyelid and periorbital skin laceration were randomly divided into 3M steri-strip group and surgical suture group. Laceration healing and satisfaction degree of wound appearance 1 week and 3 months after treatment were observed and campared between the two groups. Results Laceration healing was good 1 week after treatment, the difference was not statistically significant between the two groups (χ2=0.038, P=0.845) .Three months after laceration treatment, the satisfaction degree of wound appearance in 3M steri-strip group was higher than that in surgical suture group, the difference was statistically significant (χ2=6.096, P=0.014). Conclusion 3M steri-strip can make the eyelid and periorbital skin laceration of children healed well. Key words: Laceration, skin, eyelid and periorbital, children; Steri-strip, 3M

E-waste: the problem persists after recycling

e-waste: the problem persists after recycling

TO EVALUATE THE OUTCOME OF THE EXTERNAL EAR TRAUMA TREATMENT AT HUE CENTRAL HOSPITAL AND HUE UNIVERSITY HOSPITAL

Background: The external ear trauma is the most common in emergencies. Early diagnosis and treatment lead to the better outcome. Aim: To evaluate the outcome of the external ear trauma treatment. Patients and methods: A prospective descriptive study on 64 patients with 67 ears diagnosed with the external ear trauma by clinical intervention. Results: Ages 16-30 accounted for 46.9% majority. Males (84.4%) more than females (15.6%). Most of patients wereearly treated ≤ 6 hours (76.6%). Auricular trauma (68.7%) were more common than external auditory canal trauma (31.3%). The most common sites of auricular trauma were the upper haft of auricular (43.5%). Cartilage auditory canal trauma were more common with 57.1%. The most common type of injuries were skin lacerations revealed cartilage, bone (43.3%). Minor injuries were the most common with 52.2%. The mainly treatment was excision, suture (55.2%). The time for healing with &lt;7 dayswas the most (65.7%). The majority of the external ear trauma without complications (91%). Most of the symptoms improved after 1 week and 1 month of treatment. Good results were the most common after 1 week of treatment (65.7%), and increased after 1 month of treatment (77.6%). Conclusions: The more minor of the injuries and the earlier treatment of the external ear trauma lead to the better outcome of 1 month treatment. Key words: The external ear trauma, the auricular trauma, the external auditory canal trauma

Identifying representative test parameters to assess skin laceration injury risk for individual studs

Skin injuries account for ∼6% of all injuries in rugby union. Skin lacerations resulting from stud–skin interactions in rugby union are frequently caused by stamping in the ruck (Oudshoorn, Driscoll, Dunn, & James, 2016 Oudshoorn, B. Y., Driscoll, H. F., Dunn, M., & James, D. (2016). Procedia Engineering, 147, 496–500. [CrossRef], [Google Scholar] ). Stud design is regulated by World Rugby's Regulation 12, but no supporting evidence currently exists for the selected test parameters used in these standards. Ideally, mechanical tests that assess injury risk should replicate conditions observed during play (Ura & Carre, 2016 Ura, D., & Carre, M. (2016). Procedia Engineering, 147, 550–555. [CrossRef], [Google Scholar] ). Relevant mechanical test parameters, such as foot inbound velocity, stud impact energy, inclination angle and effective mass, can be derived through biomechanical analysis of rugby stamping. However, due to human movement variability, the measured kinetics and kinematics of stamping impacts can have a large range and replicating all possible parameters within a mechanical test device is unfeasible. Identifying different stamp techniques by clustering provides an economical solution.

Table Saw Injuries: Are Our Safety Features Really Keeping Us Safe?

Currently, table saws sold in the United States have 3 safety features (riving knife, blade guard, and antikickback device) designed to prevent personal injury; however, these features can hinder the user's movements and are often disabled or removed. Despite the frequency of table saw injuries, there is relatively limited literature regarding them. We performed a retrospective, observational study of characteristics associated with injuries incurred while using a table saw. Electronic medical records from Bassett Medical Center were reviewed from 2002 to 2014 to identify patients who sustained table saw injury, and surveys were sent to the patients. Tests of association between survey variables (eg, presence/absence of safety device vs severity of injury) were carried out using chi-square or Fisher exact test. Seventy-three percent of those injured had disabled their safety features or had no safety features present; 27% of those injured had one or more safety features enabled when they sustained the injury. Of those injured, 18% sustained a "mild" injury (skin laceration), 39% sustained a "moderate" injury (nerve or tendon injury), and 43% sustained a "severe" injury (partial or complete amputation). There was no statistically significant association between severity of the injury and presence/absence of safety features. This study highlights 2 major problems with the current safety features: People are dissatisfied with current safety features, disabling them and sustaining injuries, and even when they are enabled, people are still getting injured-suggesting inadequacy of the current features.