Treatment Of Soft Tissue Injuries Research Articles

Wartime Soft Tissue Coverage Techniques for the Deployed Surgeon.

Since the start of the conflict in the Middle East in 2001, military orthopedic surgeons have faced complex orthopedic injuries including high-energy soft tissue wounds, traumatic amputations, and open fractures. Although orthopedic surgeons are well trained in the management of osseous injuries, the treatment of soft tissue injuries can be technically challenging and unfamiliar. Early washout, debridement of devitalized tissue, external fixation of bony injuries, and antibiotic therapy remain the foundation of early wound management. However, these unique extremity injuries have no standard plan of care, and definitive treatment options continue to evolve. The following report highlights the typical cases seen in the wartime setting and offers possible solutions for the associated soft tissue injuries. A single orthopedic surgeon at a Role 3 combat support hospital performed all cases in this series. This study is a report of the cases that the orthopedic surgeon encountered while deployed and the various techniques that can be used to manage the complex wounds seen in a deployed setting. Twelve patients were included in this report and the data are shown. Of the 12 patients, 6 were injured by an improvised explosive device (IED), 4 were injured by a high-velocity gunshot wound (HVGSW), 1 was injured by a gunshot wound (GSW), and 1 was injured in an auto versus pedestrian motor vehicle crash. The wound sizes ranged from 10 to 300 cm2. All patients required more than one irrigation and debridement before wound closure. There was a successful outcome in 11 of the 12 patients. The only patient without a known successful outcome was lost to follow up. Six patients were treated with split thickness skin graft (STSG) alone. Four patients were treated with STSG plus an additional means of coverage. One patient was treated with a random flap and one patient was treated with a full thickness skin graft. Integra was used in two of the patients. Each of the patients in whom integra was used had exposed bone and had a successful outcome with respect to tissue coverage. This study details different soft tissue coverage techniques that must be learned and possibly employed by the deployed surgeon. Limitations of this study include its retrospective nature and the selected sampling of cases. At initial presentation, the management of war wounds secondary to high-velocity gunshot wounds and improvised explosive devices can be quite daunting. Adhering to firm surgical principles of thorough and meticulous debridement is the foundation of later soft tissue reconstructive options. Once the tissue is deemed clear of infection and contamination, there are myriad treatment options utilizing flaps, synthetic materials, and skin grafting. These are relatively straightforward techniques that the general orthopedic surgeon can utilize while deployed in a combat setting. In the end, it is critical for deployed surgeons to learn multiple techniques to provide definitive soft tissue coverage in a wartime theater.

Oral paracetamol and/or ibuprofen for treating pain after soft tissue injuries: Single centre double-blind, randomised controlled clinical trial.

BackgroundSoft tissue injuries commonly present to the emergency department (ED), often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control.ObjectivesTo investigate the analgesic effect of paracetamol, ibuprofen and the combination of both in the treatment of soft tissue injury in an ED, and the side effect profile of these drugs.MethodsDouble-blind, double dummy, placebo-controlled randomised controlled trial. 782 adult patients presenting with soft tissue injury without obvious fractures attending the ED of a university hospital in the New Territories of Hong Kong were recruited. Patients were randomised using a random number table into three parallel arms of paracetamol only, ibuprofen only and a combination of paracetamol and ibuprofen in a 1:1:1 ratio. The primary outcome measure was pain score at rest and on activity in the first 2 hours and first 3 days. Data was analysed on an intention to treat basis.ResultsThere was no statistically significant difference in pain score in the initial two hours between the three groups, and no clinically significant difference in pain score in the first three days.ConclusionThere was no difference in analgesic effects or side effects observed using oral paracetamol, ibuprofen or a combination of both in patients with mild to moderate pain after soft tissue injuries attending the ED.Trial registrationThe study is registered with ClinicalTrials.gov (no. NCT00528658).

The Use of Physical Therapy Procedures in the Treatment of Soft Tissue Injuries in a Horse: A Case Study

Objective: Sports training of the horse requires from the animal a high level of strength, coordination and endurance. Therefore sport specific training carries a considerable risk of overload Injury, especially in muscular and skeletal systems. Soft tissue lesions (of tendons, ligaments and muscles) are a very frequent type of an injury in sports horses.Study Design: The study is aimed at presenting the original project of physiotherapeutic measures including complex therapy methods, applicable after the injury of rupture of tendon fibers of the accessory head of the deep digital flex or muscle.Animal: Horse.Material and Methods: The therapeutic program was employed in a sports horse. The therapy lasted five weeks. Applied treatments: the Cito instant cold compress, kinesio taping - a lymphatic application, kinesio taping with the ligament technique, cryotherapy,deep transverse friction massage, ultraphonophoresis and restoring soft tissues elasticity and joint mobility.Results: All of the offered physiotherapeutic procedures turned out to be effective in treating.Conclusion: The complex application of therapeutic procedures offer allows the horse to come back to participation in show jump competitions.

The application of diode laser in the treatment of oral soft tissues lesions. A literature review.

BackgroundSince its appearance in the dental area, the laser has become a treatment of choice in the removal of lesions in the oral soft tissues, due to the numerous advantages they offer, being one of the most used currently the diode laser. The aim of this review was to determine the efficacy and predictability of diode laser as a treatment of soft tissue injuries compared to other surgical methods.Material and MethodsA literature review of articles published in PubMed/MEDLINE, Scopus and the Cochrane Library databases between 2007 and 2017 was performed. “Diode laser”, “soft tissue”, “oral cavity” and “oral surgery” were employed for the search strategy. Only articles published English or Spanish were selected.ResultsThe diode laser is a minimally invasive technology that offers great advantages, superior to those of the conventional scalpel, such as reduction of bleeding, inflammation and the lower probability of scars. Its effectiveness is comparable to that of other types of lasers, in addition to being an option of lower cost and greater ease of use. Its application in the soft tissues has been evaluated, being a safe and effective method for the excision of lesions like fibromas, epulis fissuratum and the accomplishment of frenectomies.ConclusionsThe diode laser can be used with very good results for the removal of lesions in soft tissues, being used in small exophytic lesions due to their easy application, adequate coagulation, no need to suture and the slightest inflammation and pain. Key words:Diode laser, soft tissues, oral cavity, oral surgery.

Injuries to the Face and Jaw

The human face is vulnerable to injury most frequently as the target of interpersonal violence or when inadequately restrained within a motor vehicle collision. Injuries to both the soft tissues and skeleton of the face are common reasons of emergency department admissions and consultations. Isolated maxillofacial trauma is rarely life threatening or an immediate cause of death unless associated with airway compromise; however, approximately 20% of all patients with facial soft tissue, dentoalveolar, or facial fracture trauma have associated injury to additional body systems. In particular, motor vehicle crash victims, personal assault, occupational injuries, and motorcycle crash victims may have associated injuries to additional body systems. This review covers the assessment and management of maxillofacial fractures, initial evaluation, comprehensive survey, treatment of soft tissue injuries, and treatment of maxillofacial fractures. Figures show a patient with a combination of blunt and penetrating trauma to the central face; fractured mandible; fractured zygoma; infraorbital fracture; broken nose; soft tissue injuries involving the facial nerve distal to the vertical line, likely too small for primary repair; injuries to the parotid duct repaired by passing a catheter through the Stensen duct and through the area of laceration and then repairing the parotid duct over the catheter; mandibular fracture; Le Fort I, Le Fort II, and Le Fort III fractures; findings in patients with Le Fort III maxillary fractures immediately after injury, before obliterative edema develops; and preoperative and postoperative right-sided orbitozygomatic fracture. This review contains 12 highly rendered figures, and 29 references Key words: Jaw injuries; Face injuries; Maxillofacial injuries; Le Fort level; Facial fractures; Orbital fractures; Maxillary fractures;

How to use PRICE treatment for soft tissue injuries

Rationale and key points This article assists nurses to use the acronym PRICE (protection, rest, ice, compression and elevation) to guide the treatment of patients with uncomplicated soft tissue injuries to their upper or lower limbs. » Treatment of soft tissue injuries to limbs is important to reduce complications following injury, alleviate pain and ensure normal limb function is restored promptly. » Nurses should have an understanding of the rationale and evidence base supporting PRICE treatment of soft tissue injuries. » Providing accurate information to patients and carers about the management of soft tissue injuries and anticipated recovery time is an important aspect of treatment. » Further research is required to develop best practice in the treatment of soft tissue injuries. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when managing patients with soft tissue injuries to upper or lower limbs. 2. Positive elements of your current practice and those that could be enhanced. Subscribers can upload their reflective accounts at: rcni.com/portfolio.

A systematic review and meta-analysis of the application of platelet rich plasma in sports medicine.

IntroductionIn recent years, platelet rich plasma (PRP) has been receiving increasing attention for the treatment of soft tissue injuries. These numerous applications have raised a great deal of questions and debate about the effectiveness of this method. This study aimed to determine the efficacy of PRP in improving sports injuries and subsequently throw some light on these controversies.MethodsA systematic review of the literature and meta-analysis of results were undertaken. All related databases, such as PubMed, Cochrane Database of Systematic Reviews, DARE, and EMBASE, were searched on the use of PRP on athletes and in sports medicine. The search was conducted from June 2013 to February 2014.ResultsOur search retrieved 905 studies, of which 13 randomized control trials (RCT) met our inclusion criteria for systematic review and meta-analysis. All articles were appraised by Critical Appraisal Skills Program (CASP) checklist for RCT studies. The analysis of the results of pain scores and physical activity/functions did not show any superiority for PRP as opposed to the other options.ConclusionsThe meta-analysis showed no more effectiveness for PRP application in sports-related injuries in terms of physical function improvement and pain relief. Therefore, the extensive use of PRP for such injuries should be limited. Well-designed RCTs are needed to support the findings.

Near-Infrared Photobiomodulation in Retinal Injury and Disease.

Evidence is growing that exposure of tissue to low energy photon irradiation in the far-red (FR) to near-infrared (NIR) range of the spectrum, collectively termed "photobiomodulation" (PBM) can restore the function of damaged mitochondria, upregulate the production of cytoprotective factors and prevent apoptotic cell death. PBM has been applied clinically in the treatment of soft tissue injuries and acceleration of wound healing for more than 40 years. Recent studies have demonstrated that FR/NIR photons penetrate diseased tissues including the retina. The therapeutic effects of PBM have been hypothesized to result from intracellular signaling pathways triggered when FR/NIR photons are absorbed by the mitochondrial photoacceptor molecule, cytochrome c oxidase, culminating in improved mitochondrial energy metabolism, increased cytoprotective factor production and cell survival. Investigations in rodent models of methanol-induced ocular toxicity, light damage, retinitis pigmentosa and age-related macular degeneration have demonstrated the PBM attenuates photoreceptor cell death, protects retinal function and exerts anti-inflammatory actions.

Оценка эффективности комплексного лечения ран мягких тканей с применением окситоцина и аквакомплекса глицеросольвата титана в эксперименте

Purpose of the study is to assess the efficiency use of oxytocin and titanium aquacomplex glycerosol-vate in the treatment of soft tissue wounds. The study was carried out on 72 white mongrel male rats weighing 210 ± 10 g with simulated aseptic wounds. The sampling was carried out for 1, 3, 5 and 7 days from the beginning of the experiment. To assess the course of wound process in the clinical study, planimetric and histological methods were applied. The comparison of obtained results has allowed to reveal the high efficacy of combined use of oxytocin and glycerosolvate titanium. On the basis of clinical and planimetric methods of investigation it was established that reduction of the area of the wound is significantly faster in animals treated with the use of oxytocin and glycerosolvate titanium. This treatment has a stimulating effect on the activity of connective tissue - accelerates the appearance and maturation of granulation tissue, occur earlier replacement of a number of inflammatory cells into cells, which provide proliferation; earlier appearance of collagen fibers and the prevalence among them horizontally. The use of oxytocin and titanium aquacomplex glycerosolvate in laboratory animals with aseptic wounds influences positively on the dynamic of wounded process, allows to accelerate the appearance of granulation tissue and epithelialization.

Effectiveness of Oral and Topical Hydrogen for Sports-Related Soft Tissue Injuries

Background: Because hydrogen therapy has been found beneficial for the treatment of inflammation, ischemia-reperfusion injury, and oxidative stress in humans, it seems useful to evaluate the effects of exogenously administered hydrogen as an element in the immediate management of sports-related soft tissue injuries. The main aim of this pilot study was to examine the effects of 2-week administration of hydrogen on the biochemical markers of inflammation and functional recovery in male professional athletes after acute soft tissue injury. Method: During the 2013 season (from March to May), 36 professional athletes were recruited as participants and examined by a certified sports medicine specialist in the first 24 hours after an injury was sustained. Subjects were allocated to 3 randomly assigned trials in a single-blind design. Those in the control group received a traditional treatment protocol for soft tissue injury. Subjects in the first experimental group followed the same procedures as the control group but with additional administration throughout the study of oral hydrogen-rich tablets (2 g per day). Subjects in the second experimental group also followed the procedures of the control group, with additional administration throughout the study of both oral hydrogen-rich tablets (2 g per day) and topical hydrogen-rich packs (6 times per day for 20 minutes). Participants were evaluated at the time of the injury report and at 7 and 14 days after baseline testing. Results: Oral and topical hydrogen intervention was found to augment plasma viscosity decrease as compared with the control group (P = 0.04). Differences were found for range-of-motion recovery between the 3 groups; oral and topical hydrogen intervention resulted in a faster return to normal joint range of motion for both flexion and extension of the injured limb as compared with the control intervention (P < 0.05). Conclusion: These preliminary results support the hypothesis that the addition of hydrogen to traditional treatment protocols is potentially effective in the treatment of soft tissue injuries in male professional athletes. Trial identification: Clinicaltrials.gov number NCT01759498.

Comparing the Antiswelling and Analgesic Effects of Three Different Ice Pack Therapy Durations

Ice pack therapy has been widely used in treatment for soft tissue injuries. However, no studies have yet explored the most appropriate and effective duration for ice therapy with ice packs. This study explored the antiswelling and analgesic effects of different ice pack therapy durations on soft tissue injuries as well as patient discomfort. An experimental design including pretest and three posttests with three groups was used in this study. Using convenience sampling and randomized block assignment, 99 participants with soft tissue injuries from the emergency department of a medical center in southern Taiwan were included in this study. With 33 participants in each group, three groups with ice pack therapy for 10, 20, and 30 minutes were indicated to compare skin temperature, swelling, and pain differences in ice-treated areas as well as participant discomfort. This study found no significant differences in the effect of different ice pack therapy durations among the three groups. However, this study identified significant differences between pretest and each posttest in terms of changes in skin temperature, pain, and numbness and rash-related discomfort in each group. Research results found that the three different ice pack therapy durations could lower skin temperature and reduce partial pain. The different ice pack therapy durations would cause similar discomfort incidence rates in the three groups. Ice pack therapy for 10 minutes could reduce partial swelling and pain effectively. Accordingly, we suggest that 10 minutes is the optimal ice pack therapy duration for persons with soft tissue injuries. However, the ice pack therapy duration should be adjusted according to individual needs and situation.

EVALUATION OF TITANIUM AQUACOMPLEXGLITSEROSOLVATE AND OXYTOCIN IN THE TREATMENT OF SOFT TISSUE WOUNDS IN EXPERIMENT

In the context of the above properties of titaniumaquacompleхglycerosolvate and oxytocin we have studied their joint application in order to increase the efficiency of treatment of soft tissue wounds. In the investigation performed, 144 experimental animals (white rats) with simulated aseptic wounds were studied. This study will contribute to develop a new treatment for soft tissue wounds, based on the application of aquaglitserosolvatetitanium and oxytocin, examine and assess the effectiveness of aquaglitserosolvatetitanium and oxytocin in the treatment of experimental soft tissue wounds. To assess the process of wound healing in the experiment, methods of clinical, planimetric progressive examinations of wounds, as well as strength characteristics of the scar formed were used. One of the objective measures of wound healing is the study of changes in the area in the healing process. The wound area was calculated by the method of L. N. Popovoy (1942). On the basis of clinical and planimetric methods of investigation, it was found that the decrease in the wound area is significantly faster under the influence of oxytocin and titanium aquacomplexglycerosolvate.

Scintigraphic evaluation of intra‐arterial and intravenous regional limb perfusion of allogeneic bone marrow‐derived mesenchymal stem cells in the normal equine distal limb using99mTc‐HMPAO

Mesenchymal stem cells (MSCs) are commonly injected intralesionally for treatment of soft tissue injuries in the horse. Alternative routes of administration would be beneficial for treatment of lesions that cannot be accessed directly or to limit needle-induced iatrogenic damage to the surrounding tissue. The purpose of our study was to evaluate MSC distribution after intra-arterial (IA) and intravenous (IV) regional limb perfusions (RLP) using scintigraphy. We hypothesised that MSCs would persist in the distal limb after tourniquet removal and that both techniques would lead to diffuse MSC distribution. Six horses were used in the study. MSCs were labelled with hexamethyl propylene amine oxime (HMPAO) and technetium-99m. RLP was performed through the median artery of one forelimb and the cephalic vein of the opposite limb under general anaesthesia. The tourniquet was left in place for 45 min. Scintigraphic images were obtained at 0, 45, 75 min, 6 h and 24 h post injection. Distribution of labelled MSCs through the entire distal limb was achieved with all 6 IA RLP, but 3 out of 6 IV RLP showed poor or absent uptake distal to the metacarpus. Mesenchymal stem cell persistence was 39% (30-60%) and 28% (14-50%) (median [minimum-maximum]) at 6 h for IA and IV RLP, respectively. Severe arterial thrombosis occurred in one horse after IA RLP. Both IA and IV RLP of the distal limb result in MSC persistence in perfused tissues. The IA perfusion resulted in more reliable cell distribution to the pastern and foot area. Regional limb perfusion of MSCs might be used in cases where intralesional injection is not possible or in order to avoid iatrogenic needle damage. Further work is needed to assess the safety of IA RLP before its clinical use.

A traditional Chinese medicine therapy warming meridians to nourish blood in treating chronic pain due to soft tissue injury of the neck and shoulder: a randomized controlled trial

Pain due to chronic soft tissue injury of the neck and shoulder is a commonly encountered and frequently occurring condition. Traditional Chinese medicine is a common course of treatment for soft tissue injury and may have better therapeutic effects than biomedical options. To evaluate the clinical therapeutic effects of Chinese herbal medicine warming meridians to nourish blood on chronic pain due to soft tissue injury in the neck and shoulder. A random and control method was adopted. Sixty-three patients with pain of the neck and shoulder due to chronic soft tissue injury, presenting with blood deficiency and cold coagulation syndrome, were randomly divided into treatment group (n=32) and control group (n=31). There was a drop-out case in treatment group. All the patients were collected from the clinic service of the Department of Rehabilitation at the General Hospital of the People's Liberation Army. Patients received oral and written information about clinical procedures before signing their written informed consent. Patients in the treatment group were treated with Chinese herbal decoctions for warming meridians to nourish blood and cervical traction. Patients in the control group were treated with cervical traction. The course of treatment was 14 days. A visual analog scale (VAS) was used to record test data in the two groups before and after treatment, and therapeutic effect was compared after treatment between the two groups. After treatment, VAS scores of the treatment group and the control group were decreased as compared with before treatment (t=5.01, P<0.01; t=4.91, P<0.01). Difference of VAS scores between before and after treatment in the treatment group was higher than that in the control group (t=2.44, P0.05). The treatment method of warming meridians to nourish blood combined with cervical traction has better therapeutic effect than only applying traction for chronic pain due to soft tissue injury of the neck and shoulder.

Evaluation of a filter-prepared platelet concentrate for the treatment of suspensory branch injuries in horses.

Platelet preparations have become a treatment for soft tissue injuries in horses. This study evaluated a novel filter-based system to concentrate platelets and assesses its value in the treatment of suspensory ligament branch desmitis. Filtered platelet concentrate was prepared from 55 ml of venous blood obtained from 21 normal horses. Platelets and white blood cells in whole blood and filtered platelet concentrate were measured, as was platelet activating factor (PAF)-induced platelet-derived growth factor-BB (PDGF-BB) release. Eleven horses with 18 focal acute suspensory ligament branch injuries were treated intra-lesionally with autologous filtered platelet concentrate and evaluated clinically and ultrasonographically for one to three years. The increase in concentration of platelets in the filtered concentrate in comparison with whole blood (6.9 ± 1.9-fold) was significantly greater than the increase in white blood cells (3.8 ± 0.8-fold) (p <0.0001). There was no effect of sex or breed on platelet concentration. Platelets were responsive to PAF with >100-fold higher levels of PDGF release over basal levels. All hypoechoic lesions re-evaluated within three months had resolved. Five of the 11 horses returned to their previous level of work, one was exercising at a lower level, three were retired, one died for unrelated reasons, and one was still convalescing. Filtered platelet concentrate was easily and reliably prepared and injected into suspensory ligament branch injuries without short-term complications. This treatment was associated with rapid resolution of ultrasonographic lesions and lameness. Filtered platelet concentrate represents a convenient alternative for the treatment of suspensory ligament branch injuries.

The Prominent Role of Plastic Surgery in the Wenchuan Earthquake Disaster

: On May 12, 2008, an earthquake of magnitude 8.0 on Richter scale struck Sichuan Province of China and destroyed Wenchuan County. Two days later, a field hospital from the Second Military Medical University (Shanghai, China) arrived at Anxian County near the epicenter as a reinforcement hospital before rehabilitation of the local medical facilities. Surgical services in the field hospital were supplied by general, orthopedic, plastic, anesthetic, obstetrical surgeons, and two physicians. The plastic surgeons were responsible for assessment of all soft tissue injuries at the hospital and patient needs for plastic surgery services in a crisis intervention field hospital. : Information was gathered regarding soft tissue injuries throughout the activities of the hospital. In addition, patient charts, operation reports, and entry and evacuation logs were reviewed for all patients who were admitted and treated in the field hospital. : Of 1,013 patients who were treated in the field hospital in Wenchuan; 102 (10.07%) sought aid for soft tissue injuries, all of which were earthquake related. Twenty-one percent of the operations performed in the hospital were concerned with the treatment of soft tissue injuries, and 15% of the hospital beds were reserved for plastic surgery patients. : Plastic surgery services at a field hospital play a prominent and irreplaceable role in rescuing casualties in formidable conditions especially in a serious earthquake situation.

Extracorporeal shock waves enhance normal fibroblast proliferation in vitro and activate mRNA expression for TGF-β1 and for collagen types I and III

Background and purpose Extracorporeal shock waves (ESWs) are used to good effect in the treatment of soft tissue injuries, but the underlying mechanisms are still unknown. We therefore determined the effects of ESWs on normal fibroblasts in vitro, in order to assess treatment-induced cell response.Methods A normal human fibroblast cell line (NHDF-12519) was treated with ESWs generated by a piezoelectric device (Piezoson 100; Richard Wolfe) using different protocols of impulses (300, 1,000, or 2,000 shots) and energy (0.11 or 0.22 mJ/mm2). Untreated controls and treated cells were cultivated for 12 days following a single shock-wave treatment. Viability, growth rate, and expression of mRNA for TGFβ -1 and collagen types I and III were evaluated at days 3, 6, 9, and 12.Results 1 hour after shock-wave treatment, cell viability showed a decrease related mainly to impulse numbers applied. Fibroblasts treated with energy of 0.22 mJ/mm2 subsequently showed an increase in proliferation from day 6 to day 9 that was higher than in untreated controls, without interference with the normal cell kinetic profile. mRNA expression was also higher in treated fibroblasts than in untreated controls for TGFβ -1 on day 6 and day 9, for collagen type I on day 6, and for collagen type III on day 9.Interpretation These in vitro data confirm that the main factors involved in the repair process of connective tissues are activated by ESWs. The study gives the rationale for, and may provide schedules for, ESW treatment of tendonopathies.

The Role of the Plastic Surgeon in Disaster Relief

Awareness of large-scale disasters among members of the medical community and the public at large has been heightened by recent events such as the 1995 Oklahoma City bombing incident, the 2001 World Trade Center attack, and the 2005 London Underground bombings. Experience with these events has highlighted the critical role of surgical specialists, including plastic surgeons. As part of their residency, plastic surgeons are trained in acute trauma management. In addition, they also are required to demonstrate expertise in the assessment and treatment of soft-tissue injuries, upper extremity trauma, facial fractures, and both operative and nonoperative burn management. Accordingly, the plastic surgeon is among the most qualified of physicians to provide specialized injury care, especially in the disaster medicine setting. In turn, training programs should include key elements of incident command and catastrophe relief.

The Effect of Back Reflections on the Acoustic Power Delivered by Physiotherapy Ultrasound Machines

Physiotherapy ultrasound is used widely for the treatment of soft tissue injuries. The ultrasonic treatment heads are all highly resonant devices and may therefore be sensitive to the levels of acoustic back reflection that they experience. However, the extent to which reflections affect acoustic power during clinical use has not been reported in the literature and is not addressed in current technical standards. This study investigated the effect of physiological levels of acoustic reflection on 29 physiotherapy treatment heads from a total of 21 machines and 6 manufacturers. A range of membranes were constructed and used to mimic the levels of acoustic reflections that occur during treatment. The results obtained showed that almost half of the heads tested (45%) had deviations in acoustic power of more than 15% compared with free-field measurements. Four heads (17%) had deviations in power of more than 25%. We recommend that the susceptibility of physiotherapy ultrasound machines to acoustic reflections be addressed in the relevant technical standards. Also, it is appropriate for tests to be carried out during design and manufacture, and by the purchaser during their acceptance testing. (E-mail: karne.mcbride@luht.scot.nhs.uk)

071 Connective Tissue Growth Factor (CTGF) Content and Bioactivity of Small Intestinal Submucosa (SIS)

Bioactive, resorbable materials can be useful in the treatment of surgical injury where biomaterial incorporation followed by tissue-specific remodeling is desired. Bioactive growth factors may be useful in the treatment of chronic ulcerative wounds, shifting the static wound environment to a more active acute phase. Small intestinal submucosa (SIS) is a naturally occurring extracellular matrix used as a biomaterial for the treatment of soft tissue injury, as well as pressure, venous, and diabetic ulcers. Preclinical and clinical studies have demonstrated that SIS induces host tissue infiltration, site-specific remodeling, and repair. Although SIS consists primarily of collagen, the presence of other proteins, glycosaminoglycans, proteoglycans, and the growth factors FGF-2, VEGF, and TGF-β have been reported. Recent experiments have demonstrated the presence of connective tissue growth factor (CTGF) in SIS. Immunohistochemical staining for CTGF was positive in mechanically isolated, disinfected, and ethylene oxide (EO) sterilized SIS. Lyophilized SIS samples were ground in ice cold PBS and CTGF concentration was measured using ELISA. The results are summarized in the following table: Sample [CTGF](ng/g) Mechanically isolated SIS 39.88 ± 5.4 Disinfected SIS 11.31 ± 7.2 Ethylene oxide sterilized SIS 7.96 ± 1.3 CTGF, secreted by fibroblasts after activation with TGF-β, stimulates cell proliferation and extracellular matrix synthesis. In vitro cell culture bioactivity experiments are planned. This work was supported by Cook Biotech Incorporated.