Management Of Soft Tissue Injuries Research Articles

Management of soft tissue injury in the open tibia fractures

Management of soft tissue injury in the open tibia fractures

Barriers to Performing Soft Tissue Reconstruction Procedures among Orthopedic Surgeons in Low- and Middle-income Countries: Results of a Surgical Skills Training Course.

Background:Appropriate management of soft tissue injury associated with orthopedic trauma is challenging in low- and middle-income countries (LMICs) due to the lack of available reconstructive surgeons. The Surgical Management and Reconstructive Training (SMART) course teaches orthopedic surgeons reconstructive techniques aimed at improving soft tissue management. This study aims to identify additional barriers to implementing these techniques for surgeons in LMICs who have attended SMART courses.Methods:This is a mixed-methods study including a Likert-scale-based survey administered to 150 surgeons from LMICs attending the 2018 SMART courses in Tanzania and San Francisco and key informant interviews with 20 surgeons who perform soft tissue coverage procedures.Results:In surveys, respondents reported inadequate local plastic surgeon availability for lower extremity fracture requiring muscle flaps (88%). Surgeons agreed that flap surgeries are important for patients with significant soft tissue injury following open fractures (97%). They reported inadequate access to instruments, such as dermatomes (59%) and Humby knives (32%), and senior-level support (31%). Fewer than half of surgeons with flap experience (n = 85) felt confident in training peers (45%). In interviews, delays in returning patients to operating rooms were frequently cited as a barrier (90%).Conclusions:Our study demonstrates that soft tissue procedures are perceived as a high priority among orthopedic surgeons, but there are multiple barriers, including a lack of plastic surgeons, and many modifiable barriers including a lack of surgical equipment, peer training, and senior colleague support.

Complex Maxillofacial Trauma with Wide-Spread Soft-Tissue Defects

The management of soft tissue injury after complex facial trаumа poses unique chаllenges to the plаstic surgeon, given the speciаlized nаture of fаciаl tissue аnd the аesthetic importаnce of the fаce. We report 8 cаses with wide-spreаd soft-tissue defects due to complex fаciаl trаumаwho presented аt Odonto-stomаtology center - Hue centrаl hospitаl during the yeаr 2018. Of these cаses were surgicаlly mаnаged by fixаtion аnd fаciаl reconstructionаt Odonto-stomаtology center - Hue centrаl hospitаl; аnd they were very well recovery in function аnd аesthetics. The generаl principles of trаumа mаnаgement аnd wound cаre аre аpplied in аll cаses. The mаnаgement of severe injuries to the fаce is discussed in relаtion to the locаtion аnd the mechаnism of injury.

Functional outcome of conservative management of acute soft tissue injury of ankle joint in adults

Functional outcome of conservative management of acute soft tissue injury of ankle joint in adults

The management of soft tissue injuries in open tibial fractures: the 'soft tissue tug test'.

The management of soft tissue injuries in open tibial fractures: the 'soft tissue tug test'.

Training Australian General Surgeons for Humanitarian Emergencies: A Comparison Between Trainee Logbooks and Emergency Medical Team Caseloads

Introduction:Emergency medical teams (EMTs) have helped to provide surgical care in many recent sudden onset disasters (SODs), especially in low- and middle-income countries (LMICs). General surgical training in Australia has undergone considerable change in recent years, and it is not known whether the new generation of general surgeons is equipped with the broad surgical skills needed to operate as part of EMTs.Aim:To analyze the differences between the procedures performed by contemporary Australian general surgeons during training and the procedures performed by EMTs responding to SODs in low- and middle-income countries (LMICs).Methods:General surgical trainee logbooks between February 2008 and January 2017 were obtained from General Surgeons Australia. Operating theatre logs from EMTs working during the 2010 earthquake in Haiti, 2014 typhoon in the Philippines, and 2015 earthquake in Nepal were also obtained. These caseloads were collated and compared.Results:A total of 1,396,383 procedures were performed by Australian general surgical trainees in the study period. The most common procedure categories were abdominal wall hernia procedures (12.7%), cholecystectomy (11.7%), and specialist colorectal procedures (11.5%). Of note, Caesarean sections, hysterectomy, fracture repair, specialist neurosurgical, and specialist pediatric surgical procedures all made up <1% of procedures each. There were a total of 3,542 procedures recorded in the EMT case logs. The most common procedures were wound debridement (31.5%), other trauma (13.3%), and Caesarean section (12.5%). Specialist colorectal, hepato-pancreaticobiliary, upper gastrointestinal, urological, vascular, neurosurgical, and pediatric surgical procedures all made up <1% each.Discussion:Australian general surgical trainees get limited exposure to the obstetric, gynecological, and orthopedic procedures that are common during EMT responses to SODs. However, there is considerable exposure to the soft tissue wound management and abdominal procedures.

Retrospective descriptive observational study of patients who presented to an Australian hospital emergency department with neck soft tissue injury

To describe clinical presentation and management of neck soft tissue injury in an Australian ED. This is a retrospective cohort study conducted in a tertiary hospital ED in Queensland, Australia. This study included all patients aged 18-65 years presenting with neck sprain/strain in 2016. Main outcome measures are patient demographics, comorbidities, presentation, acute management and follow up. Of 339 patients, 176 (52%) had cervical computed tomography (CT) scans and 3% plain radiographs. Two had fractures (CT yield of 2/176; 1.1%) and three were admitted with neurological symptoms, leaving 334 patients. Of 264 patients receiving medications in the ED, simple analgesia + oral opioid (146, 55.3%) was most frequently used, followed by simple analgesia (89, 33.7%) and opioid + benzodiazepine +/- simple analgesia (16, 6%). Opioids were prescribed for 169 (64%) (including i.v. opioids for 34 [12.9%] and for 85/97 (88%) with pain scores ≤4), and benzodiazepines for 22 (8.3%). Ten (3%) were referred for physiotherapy management in ED and eight (2.4%) for outpatient physiotherapy follow up. Of 113/334 (33.8%) receiving discharge prescription, 60 (53.1%) were prescribed oral opioid + simple analgesia, 37 (32.7%) oral opioids and seven (6.2%) opioids + benzodiazepines; 205 (61%) were discharged without a recorded follow-up plan. There is large practice variation in management of neck soft tissue injury in ED. Over half of the patients received CT scans with modest yield. Opioids were commonly used both in ED and on discharge. There is need for a standard management plan to be developed for patients presenting with acute neck soft tissue injury.

Flexor Tendon Lacerations Secondary to Closed Proximal Phalangeal Fracture

We report a case of complete laceration of both flexor tendons in the dominant ring finger of a young male caused by a closed volar fracture fragment of the proximal phalanx. Careful clinical examination, reasonable index of suspicion and ultrasound confirmation play a pivotal role in the diagnosis and surgical planning of this rare yet consequential injury. Good outcomes can be achieved from the surgical management and rehabilitation of both soft tissue and bony injuries when planning of surgical approaches and fixation techniques are facilitated by an accurate pre-operative diagnosis.

Surgical Procedures Performed by Emergency Medical Teams in Sudden‐Onset Disasters: A Systematic Review

Emergency medical teams (EMTs) frequently provide surgical care after sudden-onset disasters (SODs) in low- and middle-income countries. The purpose of this review is to describe the types of surgical procedures performed by EMTs with general surgical capability in order to aid the recruitment and training of surgeons for these teams. A search of electronic databases (PubMed, MEDLINE, and EMBASE) was carried out to identify articles published between 1990 and 2018 that describe the type of surgical procedures performed by EMTs in the impact and post-impact phases of a SOD. Further relevant articles were obtained by hand searching reference lists. A total of 16 articles met the inclusion criteria. Articles reporting on EMTs from a number of different countries and responding to a variety of SODs were included. There was a high prevalence of procedures for extremity soft tissue injuries (46.8%) and fractures (28.3%), although a number of abdominal and genitourinary/obstetric procedures were also reported. Based upon this review, deployment of surgeons or teams with experience in the management of soft tissue wounds, orthopaedic trauma, abdominal surgery, and obstetrics is recommended.

Level of Cutaneous Blood Flow Depression During Cryotherapy Depends on Applied Temperature: Criteria for Protocol Design.

Cryotherapy is commonly used for the management of soft tissue injury. The dose effect of the applied cooling temperature has not been quantified previously. Six subjects were exposed during five different experiments to local skin temperatures of 16.6 °C, 19.8 °C, 24.7 °C, 27.3 °C, and 37.2 °C for 1 h of active heat transfer followed by 2 h of passive environmental interaction. Skin blood perfusion and temperature were measured continuously at treatment and control sites. All treatments resulted in significant changes in cutaneous vascular conductance (CVC, skin perfusion/mean arterial pressure) compared to baseline values. The drop in CVC for cooling to both 19.8 °C and 16.6 °C was significantly larger than for 27.3 °C (P < 0.05 and P < 0.0005, respectively). The depression of CVC for cooling to 16.6 °C was significantly larger than at 24.7 °C (P < 0.05). Active warming at 37.2 °C produced more than a twofold increase in CVC (P < 0.05). A simulation model was developed to describe the coupled effects of exposure time and temperature on skin perfusion. The model was applied to define an equivalent cooling dose defined by exposure time and temperature that produced equivalent changes in skin perfusion. The model was verified with data from 22 independent cryotherapy experiments. The equivalent doses were applied to develop a nomogram to identify therapeutic time and temperature combinations that would produce a targeted vascular response. The nomogram may be applied to design cryotherapy protocols that will yield a desired vascular response history that may combine the benefits of tissue temperature reduction while diminishing the risk of collateral ischemic injury.

Reconstruction of the Abdominal Wall after Oncologic Resection: Defect Classification and Management Strategies.

Compared with conventional ventral hernia repair, there are several additional considerations germane to the oncologic abdominal wall reconstruction, including the management of radiation soft-tissue injury, the management of bacterial contamination, and the location and extent of the defect. Herein, we review some of the unique challenges associated with oncologic abdominal wall reconstruction and introduce a new classification schema to assist the reconstructive surgeon in performing these complex cases.

Mid term results of staged management of high-energy proximal tibia fractures

Background: Proximal tibial fractures with high energy trauma are extremely complex injuries with significant associated soft-tissue damage. This Retrospective study was used to evaluate the results of staged management of high-energy proximal tibia fractures regards of soft-tissue management, development of complications and functional outcomes. Materials and Methods: This retrospective study includes 50 patients who had sustained high energy Proximal tibial fractures were managed at our institute. In all patients, we placed immediate temporary distraction external fixation with management of soft-tissue injuries with delayed definitive fixation. The mean clinical and radiographic follow-up was 4 year (range 36-72 months) and functional outcome was assessed by knee society score. Results: The mean follow-up is minimum 4 year (range 36-72 months) with KSS was good in 33 cases (66%), fair in 12 cases (24%) and poor in 5 (10%) at latest follow-up. The complications includes 7 patients (14%) suffered superficial infection, deep infection was observed in 5 patients (10%), 2 patients had developed compartment syndrome. 2 patients had deep venous thrombosis. Malalignment included 5 (10%) cases of residual varus and 4 (8%) cases of residual valgus deformity. Conclusion: Mid-term results shows use of staged management protocol, with the initial application of a temporary distraction external fixator followed by delayed internal fixation, is suggested for treatment of high energy tibial plateau fractures. The benefit of this protocol includes bony stabilization, access to soft tissues and prevention of further articular damage and relatively low rates of complications in patients who sustain high-energy proximal tibia fractures.

Iontophoresis: as a new treatment modality in the management of acute soft tissue injuries in the emergency department

Background: Iontophoresis utilizes a transcutaneous process to deliver charged medication to a localized area of injury via an electrical current to remedy pain symptoms. Although this practice is largely used in the physical and occupational therapy settings, there is little evidence showing its use and efficacy in the emergency department as a therapeutic modality. Methods: Through the voluntary enrollment of 39-participants, 21 in the treatment group and 18 serving as controls, subjects were treated via iontophoresis using lidocaine-HCl and dexamethasone or oral NSAID therapy alone. Measurements of pain were numerated in person on the visual-analogue scale (VAS) using a 0-10 range immediately prior to treatment, 30 minutes after treatment, and via phone at 24 and 72-hours after treatment for both groups. Results: At the initiation of treatment, average pain scores for the treatment and control groups were 7.29 and 6.50, respectively. Greater reduction in pain was seen in the iontophoresis group compared to the control group; 62% pain reduction in the iontophoresis group and only 8% reduction in the control group at 30-minutes post-treatment (p&lt;0.001). Similar results were seen at 24 and 72-hours with reductions of 71% and 73% in the experimental group at the respective times versus 18% and 40% reduction in the control group. Further, participants in the control group consumed over 4-times as many oral NSAIDs 24-hours after visiting the emergency department and almost 5-times more oral NSAIDs at 72-hours. At 24-hours the treatment group utilized, on average, less than 1-tablet while the control group had used over 3. At 72-hours, the control group averaged over 6-tablets compared to the less than 2-tablets, on average, for the treatment group. Conclusions: These results are promising in using iontophoresis as an effective treatment modality in the management of acute soft tissue injuries in the emergency department. They not only show greater pain reduction, but iontophoresis reduced the number of oral NSAIDs required for pain relief, lowering the complications associated with these medications.

Open fractures of the lower extremity: Current management and clinical outcomes.

Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate.This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management.The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility.Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type.Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality.Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072

Surgical treatment and functional outcomes of multicomponent soft tissue injuries of the wrist

The aim of this study was to emphasize the importance of early surgical treatment of multicomponent soft tissue injuries of the wrist. A retrospective review was performed on 156 patients with multicomponent soft tissue injuries of the wrist who were treated between July 2007 and July 2015. All the patients included in the study were operated within the first 36hours of the injury and were hospitalized after the surgery based on the extent of their injury. The patients were evaluated in terms of age, gender, etiology, injured structures, total number of damaged structures, mean follow-up time, complications and reoperation. The results were evaluated based on tendon function, opposition, intrinsic muscles, deformities and sensation. According to these criteria, excellent results were obtained in 81.6% to 88.8% of the patients. Poor results were found in less than 4 percent of the patients. In conclusion, we believe that early surgical management of multicomponent soft tissue injuries of the wrist, a meticulous approach and regular physical therapy are required to achieve good functional outcomes.

Management of Complex Soft Tissue Injury

Introduction: Complex facial lacerations can affect aesthetic outcomes, compromise function and can be life threatening. The psychological impact can be detrimental to patient quality of life.

Soft Tissue Management in Facial Trauma.

The management of soft tissue injury after facial trauma poses unique challenges to the plastic surgeon, given the specialized nature of facial tissue and the aesthetic importance of the face. The general principles of trauma management and wound care are applied in all cases. The management of severe injuries to the face is discussed in relation to the location and the mechanism of injury. Facial transplants have arisen in the past decade for the management of catastrophic soft tissue defects, although high morbidity and mortality after these non-life-saving operations must be considered in patient selection.

Le fratture del pilone tibiale

Unlike usual ankle fractures, tibial pilon fractures result from high-energy trauma. Their management provides numerous challenges to the orthopaedic surgeon, including obtaining anatomic reduction of articular surface and the management of associate soft-tissue injuries. The degree of trauma to the surrounding soft-tissue envelope cannot be underestimated. Open fractures are common, and even in the absence of an open lesion, significant soft tissue damage must be appreciated in closed injuries. Treatment objectives include restoration of articular congruency and mechanical alignment, and early functional rehabilitation whilst minimising soft-tissue complications. As is apparent from the revision of the most-recent international literature, external fixation is as an effective treatment in tibial pilon fractures, as a temporary stabilization in two-steps treatment and as a definitive management for these injuries.

Are Passive Physical Modalities Effective for the Management of Common Soft Tissue Injuries of the Elbow?: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis. We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis. Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.

Current Concepts in the Treatment of Maxillofacial Soft Tissue Trauma

The maxillofacial soft tissue trauma is one of the major causes to visit the emergency room. For the past few decades, however, the basic concept of the repairing the soft tissue wound have not been changed. Therefore, it could be worthwhile to remind the fundamental concepts and practical information belong to the soft tissue injury management. Among the many types of soft tissue trauma, laceration wound which is most frequently met in the clinic will be discussed in this review.