This study compared outcomes of 120 burn patients who underwent either early excision and grafting (E&G) within 4-7 days, or delayed excision and grafting (D&G) within 1-4 weeks. Significant differences favored the E&G group: fewer culture-positive wounds, better graft take, shorter post-graft hospital stay, and no mortality. While early excision improves outcomes, the optimal timing requires further study. However, this study supports performing excision as early as possible when stabilization has occurred.
The document discusses cryosurgery techniques for treating common warts. It recommends using a liquid nitrogen spray gun with the timed-spot freeze technique, freezing the wart for 10 seconds and treating in 2-3 sessions spaced 3-4 weeks apart. For plantar warts, it advises using the spray gun with a double freeze-thaw cycle to fully destroy the wart. Margin sizes of 2mm for common warts are sufficient.
Single staged surgical procedure for recurrent incisional hernia with trophic...KETAN VAGHOLKAR
Incisional hernia by itself is a very challenging surgical disease to treat. Recurrent incisional hernia with trophic ulceration adds to the complexity of the problem making surgical treatment more difficult. A case of a recurrent incisional hernia with trophic ulceration treated by a single staged procedure comprising of wide excision of the trophic ulcer with repair of the incisional hernia is presented to highlight the applicability of a single staged procedure as a viable option for managing such complex hernias.
COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...KETAN VAGHOLKAR
Background: Skin approximation is a very important step in a surgical operation. The quality of skin
approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications.
Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare
traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound
complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients
are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation).
The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation)
had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction.
Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.
1) The initial management of open fractures, including timing of debridement, choice of antibiotics, and timing of wound coverage, involves several controversies with little consensus in the literature.
2) While early antibiotic administration and debridement are agreed upon, there is no evidence that debridement must occur within 6 hours as was once believed; many surgeons now find urgent rather than emergency debridement acceptable.
3) Timing of wound coverage is also debated, but most evidence suggests covering Type III wounds within 7 days is appropriate once tissues have stabilized and debridement is complete.
The document discusses hand hygiene and efforts to reduce healthcare-associated infections. While hand hygiene compliance has improved due to numerous interventions, evidence shows infections have not significantly decreased. Other factors like overcrowding, understaffing, and contamination of the hospital environment may negate the benefits of hand hygiene. Strict enforcement of hand hygiene policies alone may not be effective and a balanced approach is needed that addresses systemic issues in healthcare systems.
Development of Best Practice Guidelines for Cutaneous T-Cell Lymphoma (CTCL) ...DUNCAN RASUGU
The use of the traditional method of whirlpools in controlling ulcerations in MF remains a great challenge. According to research, removal of the gross contaminants and toxic debris from the wounds together with the dilution of the surface bacteria is a threat that has been observed among many patients that undergo the traditional treatment. The purpose of this work is to develop the guidelines for an alternative treatment of wounds using Vashe Solution Therapy.
The document discusses cryosurgery techniques for treating common warts. It recommends using a liquid nitrogen spray gun with the timed-spot freeze technique, freezing the wart for 10 seconds and treating in 2-3 sessions spaced 3-4 weeks apart. For plantar warts, it advises using the spray gun with a double freeze-thaw cycle to fully destroy the wart. Margin sizes of 2mm for common warts are sufficient.
Single staged surgical procedure for recurrent incisional hernia with trophic...KETAN VAGHOLKAR
Incisional hernia by itself is a very challenging surgical disease to treat. Recurrent incisional hernia with trophic ulceration adds to the complexity of the problem making surgical treatment more difficult. A case of a recurrent incisional hernia with trophic ulceration treated by a single staged procedure comprising of wide excision of the trophic ulcer with repair of the incisional hernia is presented to highlight the applicability of a single staged procedure as a viable option for managing such complex hernias.
COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...KETAN VAGHOLKAR
Background: Skin approximation is a very important step in a surgical operation. The quality of skin
approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications.
Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare
traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound
complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients
are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation).
The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation)
had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction.
Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.
1) The initial management of open fractures, including timing of debridement, choice of antibiotics, and timing of wound coverage, involves several controversies with little consensus in the literature.
2) While early antibiotic administration and debridement are agreed upon, there is no evidence that debridement must occur within 6 hours as was once believed; many surgeons now find urgent rather than emergency debridement acceptable.
3) Timing of wound coverage is also debated, but most evidence suggests covering Type III wounds within 7 days is appropriate once tissues have stabilized and debridement is complete.
The document discusses hand hygiene and efforts to reduce healthcare-associated infections. While hand hygiene compliance has improved due to numerous interventions, evidence shows infections have not significantly decreased. Other factors like overcrowding, understaffing, and contamination of the hospital environment may negate the benefits of hand hygiene. Strict enforcement of hand hygiene policies alone may not be effective and a balanced approach is needed that addresses systemic issues in healthcare systems.
Development of Best Practice Guidelines for Cutaneous T-Cell Lymphoma (CTCL) ...DUNCAN RASUGU
The use of the traditional method of whirlpools in controlling ulcerations in MF remains a great challenge. According to research, removal of the gross contaminants and toxic debris from the wounds together with the dilution of the surface bacteria is a threat that has been observed among many patients that undergo the traditional treatment. The purpose of this work is to develop the guidelines for an alternative treatment of wounds using Vashe Solution Therapy.
This study analyzed burn wound swabs collected from 187 hospitalized patients over 3 years to identify aerobic bacterial pathogens and their antibiotic resistance patterns. The most common isolate was Pseudomonas aeruginosa (49.4% of isolates), followed by Staphylococcus aureus (22.2%) and various Enterobacteriaceae species. P. aeruginosa demonstrated high resistance to many commonly used antibiotics but was most susceptible to piperacillin/tazobactam and imipenem. 59% of S. aureus isolates were methicillin-resistant but all were susceptible to vancomycin and linezolid. The high prevalence of multidrug-resistant bacteria indicates a need for improved infection control and empiric antibiotic strategies tailored to
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneo...KETAN VAGHOLKAR
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
no, n (%) 102 (84.3) 98 (82.4) 0.66
(42.2%) as not visible. Veins were palpable in 67 (64.4%)
Age, y 1.4 (1.6) 1.4 (1.6) 0.88 and not palpable in 37 (35.6%). The Veinlite group had a
Gauge: success rate of 75.2% (91/121) within 2 attempts com-
20, n (%) 12 (9.9) 11 (9.2) 0.02 pared with 60.5% (72/119) in
This study compared outcomes of fasciocutaneous flaps versus biplanar (muscle and fasciocutaneous) flaps for reconstructing pressure ulcers in 90 immobile patients with spinal cord injuries. The biplanar flap group had a significantly lower wound recurrence rate of 25% compared to 53% for the fasciocutaneous flap group. Both groups had similar follow-up times and times to recurrence. While postoperative complications like infection were similar, the addition of muscle flaps in biplanar reconstruction significantly reduced recurrence of pressure ulcers in this high-risk patient population.
This study compared two methods of fixing polypropylene mesh during open inguinal hernia repair surgery: fibrin glue fixation versus suture fixation. The study included 60 patients undergoing unilateral inguinal hernia repair who were divided into two groups. The results showed that surgery time was significantly shorter when using fibrin glue fixation compared to suture fixation. Patients who received fibrin glue fixation also reported significantly less pain in the first post-operative day, first post-operative week, and one month after surgery. There were no significant differences in complications between the two groups. The study concluded that fibrin glue provided an effective alternative to sutures for fixing mesh with benefits including shorter surgery time and less post-operative pain.
EWMA 2013 - Ep534 - Prevention of pressure ulcers in cardiac surgery patientsEWMAConference
The document discusses prevention of pressure ulcers in cardiac surgery patients. It conducted a study using soft silicone dressings placed before surgery to preserve skin integrity in high-risk patients. Of the 26 patients monitored, 9 were high risk. For the high risk patients in the first post-operative period, 70% could not move and 100% had decreased hemoglobin, risk factors for pressure ulcers. Using the soft silicone dressings, the high risk patients did not develop any pressure ulcers and found the dressings comfortable. The study concludes the dressings were an effective prevention measure but more needs to be done to increase pressure ulcer prevention care.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
This document discusses the role of physician attire, such as white coats, in the transmission of pathogens in healthcare settings. It summarizes evidence that white coats and other articles of clothing, like neckties, can become contaminated with pathogens like MRSA and C. difficile. While removing white coats has not been definitively proven to reduce infection rates, there is biological plausibility that contaminated clothing can transmit pathogens between patients. The document concludes that given the potential benefits and lack of risks, changing attire policies to "bare below the elbows" is a reasonable precautionary measure.
A Comparative Study of Hyfrecator Ablation to that of Cryosurgery in the Mana...inventionjournals
: 605 patients in a Tertiary care center during a period of one year with benign skin growths were treated with either Electro surgery or Cryo surgery. 314 were treated with Hyfrecator and 291 were treated with Cryo surgery. Both procedures were done as op procedures without much complications and they were very much cost effective. There were no recurrences in both groups with a follow up period of 30 days. Hyfrecator scores slightly better compared to Cryo-surgery in this study with regards to scar formation and costwise.
A proposal for classifying peristomal skin disorders: results of a multicente...Mario Antonini
The challenges of caring for abdominal ostomy disorders have grown over the years. Because the literature shows no evidence of a tool to classify peristomal skin disorders, a study group comprised of seven enterostomal therapy nurses and four surgeons sought to provide an objective, reproducible, standardized classification instrument. A prospective, observational study was conducted
among eight ostomy centers across Italy. The 339 patient participants (272 men, 67 women, average age 63 [25 to 85] years) were divided into two groups according to onset of complications (less than or greater than 1 year); 800 digital photographs were taken to enhance observation and blood samples were drawn for additional data. From the data obtained, a classification scheme was created
and subsequently tested using four non-study group experts. The resulting instrument facilitated lesion interpretation and detection, including topography. Thus far, this is the first validated classification attempt not based on assessments of lesions attributable to entirely different etiopathogenetic factors. Further research to refine the tool and to correlate the additional data obtained from blood samples with the classification system is underway.
Periprosthetic infection is becoming more and more common and devastating.Better treatment modality of two staged antibiotic cement spacer is becoming more and more common with excellent results.Antibiotic Cement Spacer for Infected Hip Joint Replacement (THR) Surgery, Dr.Sandeep Agrawal,Agrasen Hospital,Gondia,Maharashtra,India
This study assessed characteristics of patients with foreign body injuries to the hands at a specialist plastic surgery facility in Pakistan over 6 years. It found that sewing machine needles were the most common foreign bodies, and the majority of sufferers were young females and housewives. Plain x-rays reliably detected metallic and glass foreign bodies but not wooden ones. Surgical exploration and careful retrieval under local anesthesia was successful in all cases. The study concludes foreign body injuries are common in the hand, often from sewing machines, and surgery is usually needed for removal.
This document summarizes a study on surgical site infections (SSIs) following elective general surgery cases. The study aimed to identify the incidence and risk factors of SSIs, common causative organisms, and antibiotic sensitivity patterns. The overall SSI rate was 4.57%. The most common type of SSI was superficial infections. Staphylococcus aureus was the most commonly isolated organism. Antibiotics like linezolid, amikacin and cefotaxim were generally effective. SSIs increased hospital stay by an average of 10 days and posed significant morbidity.
Fagernes & lingaas (2011) Factors interfering with the microflora on hands. j...Nursing Quality Concept
This study analyzed samples from 465 healthcare workers' hands to determine factors that interfere with normal hand microflora. Multiple regression analysis found that wearing a wristwatch was associated with higher total bacterial counts. Wearing one plain finger ring increased rates of Enterobacteriaceae carriage. Longer fingernails (>2 mm) and recent hand lotion use increased Staphylococcus aureus carriage rates. Occupation also associated with S. aureus and Enterobacteriaceae carriage. The study concludes healthcare workers should remove watches and rings at work and keep fingernails short, and nail polish may be used.
Perforation of the hollow viscus by a foreign body is seldom observed in clinical practice. Ileo-ileal fistula secondary to perforation by ingested plastic material is rare entity. Accidental ingestion of a foreign body is often encountered in clinical practice. However, intestinal perforation due to such a cause develops rarely, because the swallowed foreign body usually advances through the gastrointestinal tract without any problems and is excreted with faeces. Only 1% of ingested objects result in gastrointestinal system perforation [1].Commonly the material should be plastic, glass or iron with sharp edge. However, in our case it was a plastic sheath. Herein, we present a prisoner patient which admitted from casualty with suspected of having strangulated incisional hernia in view of history of previous surgery done. However, on-table a plastic sheath was discovered causing an ileo-ileal fistulation with perforation. This case stands out due to the rarity of its entity, peculiarity of its clinical presentation and complexity of managing this case. This case highlights the suspicion of foreign body ingestion is imperative in diagnosing and managing acute abdominal pain cases among prisoners and drug abusers.
A comparative study of intralesional injection of triamcinolone acetonide alo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Cutimed® Epiona is a new 3D MatrixTM technology that was shown to fast-track healing in a clinical study of 31 patients with chronic wounds. After 3 weeks, the mean reduction in wound area was almost 40% and 14 wounds were reduced by 50% or more. Complete wound healing occurred in 3 wounds within 3 weeks. The study demonstrated Cutimed® Epiona's ability to enhance tissue generation and promote healing in stalled wounds through its unique porous structure and scaffold that mimics the extracellular matrix.
This study evaluated the treatment of 89 stable total hip and knee replacements with deep postoperative or hematogenous infections using debridement, prosthesis retention, and local antibiotics. The treatment involved multiple debridement surgeries with implantation of gentamicin-loaded PMMA beads or collagen fleeces for 2-week periods. Staphylococcus aureus was the most common causative organism. The results showed that treatment success decreased as the postoperative infection interval increased, with a failure rate below 50% considered acceptable up to 8 weeks postoperatively. Treatment of hematogenous infections with short durations of symptoms was also largely successful.
This study evaluated the effect of vacuum-assisted closure (VAC) therapy on wound management outcomes for patients undergoing reconstruction with split-thickness skin grafts. The study involved 100 patients randomized to either a VAC therapy group or control group treated with normal saline dressings. Results showed significantly better outcomes for the VAC therapy group, including greater graft take (>95% for 90% of patients), shorter wound healing time (2 weeks for 90% of patients), no need for re-grafting, and shorter hospital stays (<3 weeks for 90% of patients). The study concluded that VAC therapy improves wound bed preparation and is advantageous compared to traditional dressings when reconstructing wounds with skin grafts.
This study examined 213 patients presenting with post-burn contractures in Pakistan over four years. The commonest site of contracture was the neck. Most patients (92) had received initial burn injury management in general surgery units rather than plastic surgery units, and few (26) received appropriate treatment like skin grafts, splinting, or physiotherapy. None of the patients received proper anti-deformity splinting or physiotherapy during acute burn treatment. This highlights the need for improved initial burn management to prevent severe, long-standing contractures in developing countries like Pakistan.
This document summarizes a study on using maggot debridement therapy (MDT) to treat necrotizing fasciitis. 15 patients with necrotizing fasciitis were treated with surgical debridement, antibiotics, and MDT. MDT involved applying sterile maggots to wounds to remove dead tissue. Patients who started MDT within 9 days of diagnosis needed fewer surgical debridements than those treated later. The study concludes that early use of MDT may reduce surgical interventions and help wounds heal for patients with necrotizing fasciitis.
This study analyzed burn wound swabs collected from 187 hospitalized patients over 3 years to identify aerobic bacterial pathogens and their antibiotic resistance patterns. The most common isolate was Pseudomonas aeruginosa (49.4% of isolates), followed by Staphylococcus aureus (22.2%) and various Enterobacteriaceae species. P. aeruginosa demonstrated high resistance to many commonly used antibiotics but was most susceptible to piperacillin/tazobactam and imipenem. 59% of S. aureus isolates were methicillin-resistant but all were susceptible to vancomycin and linezolid. The high prevalence of multidrug-resistant bacteria indicates a need for improved infection control and empiric antibiotic strategies tailored to
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneo...KETAN VAGHOLKAR
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
no, n (%) 102 (84.3) 98 (82.4) 0.66
(42.2%) as not visible. Veins were palpable in 67 (64.4%)
Age, y 1.4 (1.6) 1.4 (1.6) 0.88 and not palpable in 37 (35.6%). The Veinlite group had a
Gauge: success rate of 75.2% (91/121) within 2 attempts com-
20, n (%) 12 (9.9) 11 (9.2) 0.02 pared with 60.5% (72/119) in
This study compared outcomes of fasciocutaneous flaps versus biplanar (muscle and fasciocutaneous) flaps for reconstructing pressure ulcers in 90 immobile patients with spinal cord injuries. The biplanar flap group had a significantly lower wound recurrence rate of 25% compared to 53% for the fasciocutaneous flap group. Both groups had similar follow-up times and times to recurrence. While postoperative complications like infection were similar, the addition of muscle flaps in biplanar reconstruction significantly reduced recurrence of pressure ulcers in this high-risk patient population.
This study compared two methods of fixing polypropylene mesh during open inguinal hernia repair surgery: fibrin glue fixation versus suture fixation. The study included 60 patients undergoing unilateral inguinal hernia repair who were divided into two groups. The results showed that surgery time was significantly shorter when using fibrin glue fixation compared to suture fixation. Patients who received fibrin glue fixation also reported significantly less pain in the first post-operative day, first post-operative week, and one month after surgery. There were no significant differences in complications between the two groups. The study concluded that fibrin glue provided an effective alternative to sutures for fixing mesh with benefits including shorter surgery time and less post-operative pain.
EWMA 2013 - Ep534 - Prevention of pressure ulcers in cardiac surgery patientsEWMAConference
The document discusses prevention of pressure ulcers in cardiac surgery patients. It conducted a study using soft silicone dressings placed before surgery to preserve skin integrity in high-risk patients. Of the 26 patients monitored, 9 were high risk. For the high risk patients in the first post-operative period, 70% could not move and 100% had decreased hemoglobin, risk factors for pressure ulcers. Using the soft silicone dressings, the high risk patients did not develop any pressure ulcers and found the dressings comfortable. The study concludes the dressings were an effective prevention measure but more needs to be done to increase pressure ulcer prevention care.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
This document discusses the role of physician attire, such as white coats, in the transmission of pathogens in healthcare settings. It summarizes evidence that white coats and other articles of clothing, like neckties, can become contaminated with pathogens like MRSA and C. difficile. While removing white coats has not been definitively proven to reduce infection rates, there is biological plausibility that contaminated clothing can transmit pathogens between patients. The document concludes that given the potential benefits and lack of risks, changing attire policies to "bare below the elbows" is a reasonable precautionary measure.
A Comparative Study of Hyfrecator Ablation to that of Cryosurgery in the Mana...inventionjournals
: 605 patients in a Tertiary care center during a period of one year with benign skin growths were treated with either Electro surgery or Cryo surgery. 314 were treated with Hyfrecator and 291 were treated with Cryo surgery. Both procedures were done as op procedures without much complications and they were very much cost effective. There were no recurrences in both groups with a follow up period of 30 days. Hyfrecator scores slightly better compared to Cryo-surgery in this study with regards to scar formation and costwise.
A proposal for classifying peristomal skin disorders: results of a multicente...Mario Antonini
The challenges of caring for abdominal ostomy disorders have grown over the years. Because the literature shows no evidence of a tool to classify peristomal skin disorders, a study group comprised of seven enterostomal therapy nurses and four surgeons sought to provide an objective, reproducible, standardized classification instrument. A prospective, observational study was conducted
among eight ostomy centers across Italy. The 339 patient participants (272 men, 67 women, average age 63 [25 to 85] years) were divided into two groups according to onset of complications (less than or greater than 1 year); 800 digital photographs were taken to enhance observation and blood samples were drawn for additional data. From the data obtained, a classification scheme was created
and subsequently tested using four non-study group experts. The resulting instrument facilitated lesion interpretation and detection, including topography. Thus far, this is the first validated classification attempt not based on assessments of lesions attributable to entirely different etiopathogenetic factors. Further research to refine the tool and to correlate the additional data obtained from blood samples with the classification system is underway.
Periprosthetic infection is becoming more and more common and devastating.Better treatment modality of two staged antibiotic cement spacer is becoming more and more common with excellent results.Antibiotic Cement Spacer for Infected Hip Joint Replacement (THR) Surgery, Dr.Sandeep Agrawal,Agrasen Hospital,Gondia,Maharashtra,India
This study assessed characteristics of patients with foreign body injuries to the hands at a specialist plastic surgery facility in Pakistan over 6 years. It found that sewing machine needles were the most common foreign bodies, and the majority of sufferers were young females and housewives. Plain x-rays reliably detected metallic and glass foreign bodies but not wooden ones. Surgical exploration and careful retrieval under local anesthesia was successful in all cases. The study concludes foreign body injuries are common in the hand, often from sewing machines, and surgery is usually needed for removal.
This document summarizes a study on surgical site infections (SSIs) following elective general surgery cases. The study aimed to identify the incidence and risk factors of SSIs, common causative organisms, and antibiotic sensitivity patterns. The overall SSI rate was 4.57%. The most common type of SSI was superficial infections. Staphylococcus aureus was the most commonly isolated organism. Antibiotics like linezolid, amikacin and cefotaxim were generally effective. SSIs increased hospital stay by an average of 10 days and posed significant morbidity.
Fagernes & lingaas (2011) Factors interfering with the microflora on hands. j...Nursing Quality Concept
This study analyzed samples from 465 healthcare workers' hands to determine factors that interfere with normal hand microflora. Multiple regression analysis found that wearing a wristwatch was associated with higher total bacterial counts. Wearing one plain finger ring increased rates of Enterobacteriaceae carriage. Longer fingernails (>2 mm) and recent hand lotion use increased Staphylococcus aureus carriage rates. Occupation also associated with S. aureus and Enterobacteriaceae carriage. The study concludes healthcare workers should remove watches and rings at work and keep fingernails short, and nail polish may be used.
Perforation of the hollow viscus by a foreign body is seldom observed in clinical practice. Ileo-ileal fistula secondary to perforation by ingested plastic material is rare entity. Accidental ingestion of a foreign body is often encountered in clinical practice. However, intestinal perforation due to such a cause develops rarely, because the swallowed foreign body usually advances through the gastrointestinal tract without any problems and is excreted with faeces. Only 1% of ingested objects result in gastrointestinal system perforation [1].Commonly the material should be plastic, glass or iron with sharp edge. However, in our case it was a plastic sheath. Herein, we present a prisoner patient which admitted from casualty with suspected of having strangulated incisional hernia in view of history of previous surgery done. However, on-table a plastic sheath was discovered causing an ileo-ileal fistulation with perforation. This case stands out due to the rarity of its entity, peculiarity of its clinical presentation and complexity of managing this case. This case highlights the suspicion of foreign body ingestion is imperative in diagnosing and managing acute abdominal pain cases among prisoners and drug abusers.
A comparative study of intralesional injection of triamcinolone acetonide alo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Cutimed® Epiona is a new 3D MatrixTM technology that was shown to fast-track healing in a clinical study of 31 patients with chronic wounds. After 3 weeks, the mean reduction in wound area was almost 40% and 14 wounds were reduced by 50% or more. Complete wound healing occurred in 3 wounds within 3 weeks. The study demonstrated Cutimed® Epiona's ability to enhance tissue generation and promote healing in stalled wounds through its unique porous structure and scaffold that mimics the extracellular matrix.
This study evaluated the treatment of 89 stable total hip and knee replacements with deep postoperative or hematogenous infections using debridement, prosthesis retention, and local antibiotics. The treatment involved multiple debridement surgeries with implantation of gentamicin-loaded PMMA beads or collagen fleeces for 2-week periods. Staphylococcus aureus was the most common causative organism. The results showed that treatment success decreased as the postoperative infection interval increased, with a failure rate below 50% considered acceptable up to 8 weeks postoperatively. Treatment of hematogenous infections with short durations of symptoms was also largely successful.
This study evaluated the effect of vacuum-assisted closure (VAC) therapy on wound management outcomes for patients undergoing reconstruction with split-thickness skin grafts. The study involved 100 patients randomized to either a VAC therapy group or control group treated with normal saline dressings. Results showed significantly better outcomes for the VAC therapy group, including greater graft take (>95% for 90% of patients), shorter wound healing time (2 weeks for 90% of patients), no need for re-grafting, and shorter hospital stays (<3 weeks for 90% of patients). The study concluded that VAC therapy improves wound bed preparation and is advantageous compared to traditional dressings when reconstructing wounds with skin grafts.
This study examined 213 patients presenting with post-burn contractures in Pakistan over four years. The commonest site of contracture was the neck. Most patients (92) had received initial burn injury management in general surgery units rather than plastic surgery units, and few (26) received appropriate treatment like skin grafts, splinting, or physiotherapy. None of the patients received proper anti-deformity splinting or physiotherapy during acute burn treatment. This highlights the need for improved initial burn management to prevent severe, long-standing contractures in developing countries like Pakistan.
This document summarizes a study on using maggot debridement therapy (MDT) to treat necrotizing fasciitis. 15 patients with necrotizing fasciitis were treated with surgical debridement, antibiotics, and MDT. MDT involved applying sterile maggots to wounds to remove dead tissue. Patients who started MDT within 9 days of diagnosis needed fewer surgical debridements than those treated later. The study concludes that early use of MDT may reduce surgical interventions and help wounds heal for patients with necrotizing fasciitis.
Low back pain remains the common reason to see the doctors in the clinics and in United states
it remains the second most common reason to see neurosurgeon or orthopedic doctor in their respective outpatient departments. However as the presentation is common so is the surgery for the
disease is common and as with all surgeries this also carries a small risk of complications. Bowel
perforation is a rare yet documented complication following a spinal surgery and in our case it was
diagnosed within 18 hours of the laminectomy which was performed via left sided anterolateral
approach
Pilonidal sinus disease is a soft tissue infection. It presents either acutely with abscess or the chronic form of sinus formation. The disease affects multiple body regions but the commonest is the sacrococcygeal region. There are different treatment strategies ranging from simple incision and
drainage of an abscess to complex constructive procedures.
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
anaerobic
► Blood culture
► Wound swab/tissue biopsy
► ESR, CRP
► X-ray, CT scan
► Ultrasound
1. This document provides an overview of surgical site infections, including their history, epidemiology, pathophysiology, definitions, types, risk assessment, prophylactic antibiotic use, workup, and treatment guidelines.
2. Surgical site infections contribute significantly to hospital-acquired infections and can increase the risk of death, with proper definitions provided for superficial, deep, and organ/space infections.
3. Risk is assessed based on patient comorbidities, operative
This document summarizes a study on using maggot debridement therapy (MDT) to treat necrotizing fasciitis. It found that among 15 patients treated with surgery, antibiotics, and MDT: 1) MDT reduced the number of surgical debridements needed, especially when started within 9 days of diagnosis; and 2) the wounds eventually healed in all patients except two who died from unrelated causes. It also describes in detail one patient's case of necrotizing fasciitis that was successfully treated with multiple debridements and 19 days of MDT.
Novel Technique Combining Tissue and Mesh Repair for Umbilical Hernia in AdultsKETAN VAGHOLKAR
This document describes a new surgical technique for repairing umbilical hernias in adults that combines tissue repair with mesh reinforcement. The study evaluated 20 adult patients who underwent the novel procedure. Key aspects of the technique include reconstructing the abdominal wall midline using flaps of anterior rectus sheath, placing a mesh over the newly formed midline for reinforcement, and approximating surrounding tissues. None of the 20 patients who underwent the procedure developed a hernia recurrence in the follow-up period ranging from 10 to 18 months. The authors conclude that this combined tissue and mesh repair technique provides an effective option for umbilical hernia repair in adults.
Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolu- tion and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small stud- ies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs.
Combined Tissue and Mesh repair for Midline Incisional HerniaKETAN VAGHOLKAR
Repair of incisional hernia continues to pose a challenge to the general surgeon. A combination technique best suited for mid line incisional hernias with loss of domain is presented.
Negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC) therapy, uses controlled suction to promote wound healing. The study explored using VAC therapy to control orthopedic infections. Patients underwent surgical debridement and VAC application for 5-7 days. Early results showed formation of new granulation tissue and improved healing with continuous therapy at 120 mmHg using standard large pore foam sponges over necrotic soft tissue for 7 days. Further research is still needed to determine the optimal duration of therapy and effects of different dressing types under NPWT.
— The microbiological content of Lettuce (a vegetable), commonly vended in the Benin metropolis of Edo state were evaluated. Five vending locations were chosen for the study. Whole and soft rot samples were purchased and analysed for microbiological composition. Results showed high counts in soft rot samples in lettuce. Nutrient agar plated lettuce samples had bacterial counts in the range of 2.0x 103 to 4.7x10 7. Pseudomonas species was the dominant species found in lettuce samples. Bacillus species was isolated from one location in the lettuce samples. Mac Conkey agar plated lettuce plated had bacterial counts in the range of 2.3 x 10 3 to 5.7x 10 7. Enterobacter species, E. coli, and Klebsiella species were the dominant species isolated. Though, Proteus species was isolated from lettuce samples obtained from location five only. The study observes that consuming soft rot samples could pose a risk of introducing pathogens to the consumer due to their high microbial counts and could be detrimental to the health of the consumer.
ABSTRACT- The treatment of carbuncle is early administration of antibiotics and surgery. The commonest surgical approach is Saucerization and Incision & Drainage (I&D). Two cases are presented here, one underwent Saucerization and then primary split thickness skin grafting. Another un-derwent I&D for her carbuncle. They were followed up for 8 weeks to assess their outcome. Saucerization produced the shortest length of hospital stay while I&D resulted in shortest wound healing. As a new modality of treatment now-a-days two new modalities gaining popularity for better cosmetic purpose: primary split thickness skin grafting & transposition of local skin/musculocutaneous flap.
Keywords: carbuncle, surgery, good glycemic control
This document summarizes a study on burn wound infections and antibiotic susceptibility patterns at Pakistan Institute of Medical Sciences from 2010 to 2012. The most common bacteria found in burn wound cultures were Pseudomonas aeruginosa (35.29%), Klebsiella pneumoniae (20.58%), and Staphylococcus aureus (18.62%). Positive cultures were more frequent in patients with burn wounds of over two weeks duration. Variable antibiotic susceptibility was observed among the isolated bacteria, with P. aeruginosa showing higher resistance. Early excision and grafting of deep burns along with infection control measures can help reduce burn wound infections.
This document discusses surgical site infections (SSIs), including definitions, risk factors, prevention, and treatment. Some key points:
- SSIs are infections that occur within 30 days of surgery (1 year if an implant is used) and are classified by location and time of onset.
- Risk factors include patient characteristics (age, diabetes), surgical factors (duration, contamination), and environmental factors (operating room quality).
- Prevention includes preoperative skin antisepsis, proper antimicrobial prophylaxis during surgery, and maintaining normothermia. Postoperative wound care and surveillance are also important.
- Signs of an SSI include wound erythema, pain, swelling or discharge. Treatment
A comparative study of Diathermy Vs Scalpel skin incision in abdominal surgeriesiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Hastened Attachment Of A Superficial Inf Epigastric Flapguest1c9ac82
This case report describes using the vacuum-assisted closure (VAC) device to hasten the attachment of a superficial inferior-epigastric artery flap used to reconstruct a third-degree burn injury on the hand of a 33-year-old patient. The VAC system was applied in a glove-like shape beneath the flap. After 4 days, hastened attachment of the flap to the exposed fingers was observed. The author reports that using the VAC system may decrease the typical 2-3 week attachment period for such flaps by promoting wound granulation and vascularization.
This document summarizes infection control strategies and outcomes at an orthopedic hospital. It discusses screening patients for MRSA colonization and decolonization protocols, changes to surgical dressings and antibiotics, hand hygiene initiatives, and reductions in surgical site infections after implementing a multidisciplinary approach focused on preventing healthcare-associated infections. Key metrics like MRSA colonization rates and reductions in infection rates post-implementation are highlighted.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
Similar to Early excision and grafting for deep burns (20)
This document lists and acknowledges the contributions of over 50 reviewers who helped improve the quality of manuscripts published or evaluated in the Journal of the Dow University of Health Sciences in 2012. The reviewers are professors, associate professors, and assistant professors from medical colleges, universities, and hospitals across Pakistan, including Karachi, Islamabad, Lahore, Peshawar, and Zahedan, Iran.
The document acknowledges and thanks numerous reviewers who helped improve the quality of manuscripts published or evaluated in the Journal of the Dow University of Health Sciences in 2011. It lists over 50 reviewers from various academic institutions across Pakistan who contributed their expertise and guidance.
This document lists the names and specialties of 217 reviewers for the Khyber Medical University Journal (KMUJ) in 2016. The reviewers come from various medical and surgical specialties and are located in Pakistan as well as other countries including the United States, United Kingdom, India, Saudi Arabia, and Croatia. This list provides an overview of the diverse pool of international experts across multiple fields that evaluate articles submitted for publication in KMUJ.
This document lists 217 reviewers from various medical and surgical specialties that review submissions for the Khyber Medical University Journal (KMUJ). The reviewers come from Pakistan and other countries and have expertise in fields such as internal medicine, surgery, psychiatry, pediatrics, obstetrics/gynecology and more. The list provides the reviewer's name, specialty, and country for each entry.
This document lists the names and specialties of 217 reviewers for the Khyber Medical University Journal (KMUJ). The reviewers come from various medical and surgical specialties and are located in Pakistan as well as other countries including the United States, United Kingdom, Saudi Arabia, and others. Their specialties span fields including internal medicine, surgery, psychiatry, obstetrics/gynecology, cardiology, and many others.
This document lists 218 reviewers for the Khyber Medical University Journal (KMUJ) from various medical and surgical specialties. The reviewers are from Pakistan and several other countries including the UK, USA, Saudi Arabia, India, Croatia, Bangladesh, Nigeria, Malaysia, Bosnia and Herzegovina, Nepal, Canada, Egypt, Taiwan and Iran. The specialties represented include internal medicine, cardiology, surgery, pediatrics, psychiatry, dermatology, orthopedics, ophthalmology, ENT, neurology, gastroenterology, pulmonology, oncology, anesthesiology, radiology, physiology, biochemistry, pathology, dentistry, pharmacology and rehabilitation medicine.
This document lists 201 reviewers for the Khyber Medical University Journal (KMUJ) along with their specialties and locations. The reviewers come from a variety of medical and surgical specialties and are located in countries around the world including Pakistan, the UK, Saudi Arabia, Canada, and others.
1. This document lists over 200 peer reviewers who contributed to the journal Clinical Epidemiology during 2013.
2. The peer reviewers are from around the world and include doctors, professors, and researchers in clinical epidemiology and related fields.
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This document acknowledges and thanks all the reviewers who contributed their time reviewing submissions for BMC Surgery Volume 15 in 2015. It lists over 200 reviewers alphabetically with their country of affiliation. The purpose is to recognize the valuable contribution of reviewers for the journal.
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Muhammad Saaiq received a certificate for 3 hours of CME credit for peer reviewing a manuscript for Clinical Infectious Diseases. The review was accepted and met the criteria for CME credit. IDSA thanked Muhammad for his work and hoped he would participate in peer reviewing again in the future. The certificate was included in the email and can be printed for his records.
This certificate recognizes Muhammad Saaiq as a valued Editorial Board Member for the Journal of Surgical Research Updates. Saaiq is affiliated with the Pakistan Institute of Medical Sciences and Shaheed Zulfiqar Ali Bhutto Medical University, both located in Islamabad, Pakistan. The CEO of Synergy Publishers has issued this certificate.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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1. Annals of Burns and Fire Disasters - vol. XXV - n. 3 - September 2012
143
Introduction
Deep burns constitute a challenging form of surgical
lesion, typically characterized by three vertical zones of
tissue insult. The area closest to the heat source coagu-
lates, and the tissue in this zone is either necrotic at the
very outset or it undergoes severe protein denaturation and
becomes irreversibly damaged. Just below this coagulation
zone is a zone of stasis and oedema. Further underneath
is an area of hyperaemia, where blood flow gradually in-
creases, peaking at about 7 days post-injury. A burn that
appears superficial at the outset may become deeper over
the next of 48-72 h, with the zone of stasis becoming
necrotic. This will ensue particularly if the wound becomes
infected or there is poor perfusion of the affected area.
1-3
Cope et al.
4
pioneered the concept of early excision and
autografting of burn wounds after treating patients from the
Cocoanut Grove fire in Boston in 1942. Janzekovic
5
gener-
ated renewed interest in early excision in 1970 when she
reintroduced the concept of tangential excision of the necrot-
ic tissue and immediate resurfacing with split-thickness skin
grafts. Excision and grafting is now the standard surgical
management of deep burns. The goal is to excise all devi-
talized tissue and render the wound suitable for skin graft-
ing. All layers of necrotic tissue are excised until a viable
wound bed is reached, as indicated by capillary bleeding.
6-8
At our burn centre, we routinely practise early exci-
sion of deep burns in patients who present to us directly.
In addition to these patients, we also manage delayed re-
ferrals from other hospitals located in far-flung areas of
the country. This group of patients has often received ini-
tial resuscitation and conservative treatment with traditional
dressings for over a week, before being referred to us. In
those patient, we perform delayed excision and grafting.
The aim of this study is to compare the outcome in pa-
tients managed with early excision and auto-grafting ver-
sus delayed excision and autografting.
Materials and Methods
This prospective observational study was carried out
at The Burn Care Centre, Pakistan Institute of Medical Sci-
ences (PIMS), Islamabad, over a period of two years (June
2010-May 2012). It included a total of 120 patients of both
genders and all ages who had sustained deep thermal burns
of up to 40% of the total body surface area (TBSA) and
undergone excision followed by skin autografting. Patients
with an inhalation injury, electrical, chemical, and radia-
tion burns, and those with any pre-existent chronic illness
were excluded. Initial assessment was made by history,
physical examination and necessary investigations. As per
hospital protocol, informed consent was taken from all pa-
tients or their attendants to undergo surgical management
and participate in the study. Convenience sampling tech-
EARLY EXCISION AND GRAFTING VERSUS DELAYED EXCISION
AND GRAFTING OF DEEP THERMAL BURNS UP TO 40% TOTAL
BODY SURFACE AREA: A COMPARISON OF OUTCOME
Saaiq M.,* Zaib S., Ahmad S.
Burn Care Centre, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
SUMMARY. This is a study of 120 patients of either sex and all ages who had sustained deep burns of up to 40% of the total
body surface area. Half the patients underwent early excision and skin autografting (i.e., within 4-7 days of sustaining burn injury)
while the rest underwent delayed excision and skin autografting (i.e., within 1-4 weeks post-burn). Significant differences were
found in favour of the early excision and grafting group with regard to the various burn management outcome parameters taken
into consideration, i.e. culture positivity of wounds, graft take, duration of post-graft hospitalization, and mortality.
Keywords: deep thermal burns, early excision and grafting, delayed excision and grafting
* Corresponding author: Assistant Professor, Room 20, Medical Officers Hostel, Burn Care Centre, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
Tel.: 923415105173; e-mail: muhammadsaaiq5@gmail.com
2. Annals of Burns and Fire Disasters - vol. XXV - n. 3 - September 2012
144
nique was employed: patients presenting early had early
excision and grafting (E&G), while those presenting late
had delayed excision and grafting (D&G). As the study
was observational and did not involve any new interven-
tion, it was conducted in accordance with the Declaration
of Helsinki of 1975, as revised in 2008, and anonymity of
the participants was ensured.
Half the patients underwent early excision and skin
autografting E&G (i.e., within 4-7 days of sustaining burn
injury). These made up the E&G group of the study. The
remaining half were managed with delayed excision and
skin autografting (i.e., within 1-4 weeks of sustaining burn
injury). They made up the D&G group of the study. The
two groups matched for age, gender, and TBSA burned
(Table I). Initially, all patients were resuscitated and opti-
mized on standard management outlines. At the time of
surgery, a power dermatome was used to perform thor-
ough surgical excision of all devitalized tissue and tissue
specimens were collected for cultures.
Split thickness skin grafts were harvested from unaf-
fected areas, especially the lower limbs and abdomen. All
excised wounds were reconstructed with intermediate thick-
ness STSG (0.012-0.015 inch). All skin grafts were meshed
in a 1.5-3:1 ratio. The skin grafts were applied on the wound
beds and secured in place with staples. The skin grafts were
covered with non-adherent Sofratulles and bulky absorbent
dressings. Dressings were maintained until day 5 post-op.
In order to avoid the development of shearing forces on
the grafted wounds, patients were kept on strict bed rest.
On day 5, the dressings were removed and the wounds were
inspected macroscopically to establish the graft take pat-
tern. Graft take was measured as the percentage of grafted
surface area where the graft had taken in relation to the
burn wound bed, and the graft take pattern was stratified
in the following three categories: “Good take” (≥ 95%),
“Fair take” (80-95%), and “Poor take” (<80%).
Statistical analysis
The data were analysed by SPSS version 10. Various
descriptive statistics were used to calculate frequencies,
percentages, means, and standard deviation. Numerical da-
ta, such as age and duration of post-graft hospital stay,
were expressed as mean ± standard deviation, while cate-
gorical data, such as the organisms cultured, were expressed
as frequencies and percentages. The percentages of vari-
ous outcome variables were compared by employing chi-
square test, and a p value of less than 0.05 was regarded
statistically significant.
Results
Out of a total of 120 patients, 73 (60.8%) were males
and 47 (39.2%) were females. Table I summarizes the age,
gender, and TBSA burned in the two groups of patients.
The initial tissue culture of the wounds sent at the time
of excision and grafting showed organism growth in one
E&G patient and in 35 D&G patients. The most commonly
found organisms were Pseudomonas aeruginosa (23 times),
Klebsiella (4), Staphylococcus aureus (3), methicillin-re-
sistant Staphylococcus aureus (MRSA) (3), Candida albi-
cans (3), E. coli (2), and Proteus (2). Double organisms
were cultured in four patients (Table II).
Series number Patients’ characteristics E&G group (n = 60) D&G group (n = 60)
1 Age (yr) 29.1 ± 14.3 28.8 ± 14.4
2 Male 36 37
Female 24 23
3 Percentage TBSA burned 30.6 ± 8.6 30.5 ± 8.6
Table I - Demographic and other characteristics of patients in the two groups (n = 120). E&G = early excision and grafting; D&G = delayed
excision and grafting
Series number Organisms cultured Number of patients (E&G group) Number of patients (D&G group) p (%)
1 Pseudomonas aeruginosa 1 (1.66%) 22 (36.66%) p < 0.05*
2 Klebsiella pneumoniae - 4 (6.66%) p >0.05**
3 Staphylococcus aureus - 3 (5%) p >0.05**
4 MRSA - 3 (5%) p >0.05**
5 Candida albicans - 3 (5%) p >0.05**
6 E. coli - 2 (3.33%) p >0.05**
7 Proteus - 2 (3.33%) p >0.05**
Table II - Pattern of wound cultures among burn patients in the two groups (n = 34). E&G = early excision and grafting; D&G = delayed ex-
cision and grafting
* p significant = <0.05, ** p not significant = p >0.05
3. Annals of Burns and Fire Disasters - vol. XXV - n. 3 - September 2012
145
Necrotic and inflamed tissues are removed, and resur-
facing with normal skin is performed. Eschar, being the
principal nidus for bacterial infection, is removed. The sub-
sequent skin grafting in turn reduces fluid loss and meta-
bolic demand, and protects the wound from exposure to
infectious organisms. Thus, early excision and grafting re-
duce inflammation and also avert the risk of infection,
wound sepsis, and multi-organ failure.
8-10
If surgery is not performed or is delayed in patients
with deep burns, this will have its consequences. In the
past, patients with burns used to be treated with dressings
and topical antimicrobial agents for weeks until the eschar
separated spontaneously. If the patient survived, the gran-
ulating wound would then be covered with split thickness
skin graft, a process that could take 3-5 weeks. Patients
with severe burns treated in this way, particularly those
with over 20% TBSA burns, were more likely to die of
sepsis due to the massive release of inflammatory media-
tors from the burn. This was further exacerbated by sub-
sequent infection of the wounds. With the traditional ap-
proach, patients’ hospital stay was prolonged, and patients
were more liable to develop problems like hypertrophic
scarring and contractures due to the problems associated
with delayed wound healing.
5,6,8
In our study, culture positive wounds were more fre-
quent in the delayed excision group. Subrahmanyam
11
al-
so reported fewer positive wound cultures and a statisti-
cally significant shorter duration of antibiotic treatment
among patients who had early excision and grafting. Bar-
rett et al.12
found that removing the burn eschar eliminat-
ed the source of wound infection. The devitalized tissue
not only increased its bacterial and fungal colonization but
also induced bacterial and fungal invasion into subcuta-
neous viable tissues.
In our study, graft take in our patients was signifi-
cantly better with early excision. We also had a signifi-
cant shortening of post-graft hospital stay in patients who
had undergone early excision and grafting. Our findings
are consistent with those of Xiao-Wu et al.,
10
who found
that delayed excision and grafting were associated with
longer hospitalization and increased rates of invasive
wound infection and sepsis in the group undergoing sur-
gery 7-14 days post-burn. Other published literature has
reported similar findings.
12-14
In our study early excisions were performed on days
4-7. The optimum time for early excisions continues to be
debated. Many studies have reported that burn excision can
be started after initial assessment and once stabilization
has been achieved (which takes 48-72 h) and also that ex-
cision can be performed while the patient’s general man-
Series number Graft take (%) Number of patients (E&G group) Number of patients (D&G group) p (%)
1 Good (≥ 95%) 54 (90%) 13 (21.66%) p < 0.05*
2 Fair (80-94%) 5 (8.33%) 34 (56.66%) p < 0.05*
3 Poor (< 80%) 1 (1.66%) 13 (21.66%) p < 0.05*
Table III - Take pattern of split thickness skin graft among burn patients in the two groups (n = 60 each group). E&G = early excision and
grafting; D&G = delayed excision and grafting
* p significant = <0.05
Series number Post-graft duration of hospital stay (%) Number of patients (E&G group) Number of patients (D&G group) p (%)
1 Up to 7 days 54 (90%) 13 (21.66% ) p < 0.05*
2 8-14 days 6 (10%) 37 (61.66% ) p < 0.05*
3 > 14 days – 10 (16.66% ) P >0.05**
Table IV - Post-graft duration of hospital stay among burn patients in the two groups (n = 60 each group)
*p significant = <0.05; ** = not significant
Series Patients’ characteristics
number Age (yr) Gender TBSA burned Day after sustaining injury Graft take Day of death after Remark/
(%) excision/ STSG performed pattern excision/STSG Reason of death
1 11 Male 27 Day 14 Fair Post-op day 11 Sepsis
2 34 Male 40 Day 24 Poor Post-op day 20 Sepsis
3 25 Female 30 Day 28 Poor Post-op day 14 Sepsis
4 48 Male 35 Day 23 Poor Post-op day 28 Sepsis
Table V - Mortality (n = 4)
4. Annals of Burns and Fire Disasters - vol. XXV - n. 3 - September 2012
146
agement proceeds.
5
Despite these findings, the literature
does not give a conclusive answer as to which treatment
protocol is optimal. Barrett et al.
12
demonstrated that all
severe burns should be excised within 48 h for fully ben-
eficial effects. Herndon et al.,
16
in a prospective series, ex-
amined burns of greater than 30% TBSA, and found sig-
nificantly reduced mortality with early excision (within 72
h) in patients aged 17-30 yr with no inhalation injury.
However, they did not find any difference in mortality in
patients over 30 years of age.
Ong et al.,
8
in a meta-analysis of six randomized, con-
trolled trials, published from 1966 through 2004, compar-
ing early excision of burns versus conservative approach-
es, found a trend towards reduced mortality thanks to ear-
ly excision. Pavoni et al.
9
found that, in addition to sev-
eral other factors, any delay in the timing of the first es-
charectomy was a significant contributor to patients’ mor-
tality. Khadjibayev et al.
7
found that improved results in
the surgical treatment of deep burns were linked to the
wide application of active surgical tactics.
In our study, the blood transfusion requirements in the
two groups of patients were comparable. Khadjibayev et
al.
7
reported increased blood after 16 days, since that was
a blunt debridement of a granulating bed rather than a
sharp removal of adherent eschar as it is the case in ear-
ly excision.
Hopefully our study will prompt other similar local
studies and thus permit a more meaningful comparison of
the results in our own population and we therefore rec-
ommend carrying out a multicentre local study to confirm
and improve upon our results. A local study would also
be useful to compare the overall cost of management with
E&G versus the cost with D&G, thereby producing con-
crete evidence confirming that E&G is an economical al-
ternative to D&G, particularly in the context of a devel-
oping country like ours.
Limitations of the Study
Our study presents some limitations. It is a single cen-
tre study. Randomization and blinding of the patients or
of treating doctors was not possible, so observer bias could
not be eliminated completely. Ideally, a well-designed ran-
domized controlled trial should have been conducted but
it would have been non-ethical to deprive patients of the
known benefits of early excision. In our study, exact match-
ing of the two groups with respect to initial topical wound
care or initial fluid resuscitation could not be done as these
confounders were beyond our control in late admissions.
Inadequate initial management of these patients probably
resulted in higher infection rates. We estimated the graft
take pattern by gross inspection without employing a blind-
ed investigator, and there may therefore have been an el-
ement of observer bias. Likewise, we could not evaluate
cosmetic or long term functional results from the two man-
agement approaches.
Recommendations
On the basis of this evidence, we recommend launch-
ing educational programmes to raise doctors’ awareness of
the importance of early surgical excision of deep burns in
order to avert the subsequent morbidity resulting from pit-
falls in the early management of burns. As burn surgery
continues to be a largely neglected area of plastic surgery
in both the public and the private sector hospitals in our
country, we strongly recommend establishing improved fa-
cilities for acute burn management and for rehabilitation
throughout the country. Dedicated and well trained pro-
fessionals are needed to ensure proper surgical manage-
ment of burns in our country. We also need to develop
national guidelines that are consistent with our local cir-
cumstances.
Conclusion
Early excision and grafting should be employed in
the management of deep burns given their significant ad-
vantages compared with traditional conservative man-
agement.
RÉSUMÉ. Il s’agit d’une étude portant sur 120 patients des deux sexes et de tous les âges qui avaient subi des brûlures profondes
allant jusqu’à 40% de la surface totale du corps. La moitié des patients ont subi l’excision précoce suivie de l’autogreffe cutanée
(dans les 4-7 premiers jours après la brûlure) et les autres l’excision et l’autogreffe cutanée retardée (à moins d’une à 4 semaines
post-brûlure). Les Auteurs ont observé des différences significatives en faveur des patients du groupe excision/greffe précoce pour
ce qui concerne les divers paramètres pris en considération des résultats de la gestion des brûlures, c’est-à-dire la positivité de la
culture des lésions, la prise de la greffe, la durée de l’hospitalisation post-greffe et la mortalité.
Mots-clés: brûlures thermiques profondes, excision et greffe précoce et retardée
BIBLIOGRAPHY
1. Jackson DM: The diagnosis of the depth of burning. Br J Surg,
40: 588-96, 1953.
2. Despa F, Orgill DP, Neuwalder J et al.: The relative thermal sta-
bility of tissue macromolecules and cellular structure in burn in-
jury. Burns, 31: 568-77, 2005.
3. Fritz DA: Burns and smoke inhalation. In: Stone CK, Humphries
5. Annals of Burns and Fire Disasters - vol. XXV - n. 3 - September 2012
147
RL (eds): “Current Diagnosis and Treatment: Emergency Medi-
cine” (6th ed.), 836-48, McGraw-Hill, New York, 2008.
4. Cope O, Langohr JL, Moore FD et al.: Expeditious care of full-
thickness burn wounds by surgical excision and grafting. Ann Surg,
125: 1-22, 1947.
5. Janzekovic Z: A new concept in the early excision and immedi-
ate grafting of burns. J Trauma, 10: 1103-8, 1970.
6. Orgill DP: Excision and skin grafting of thermal burns. N Engl J
Med, 360: 893-901, 2009.
7. Khadjibayev AM, Fayazov AD, Djabriyev DA et al.: Surgical treat-
ment of deep burns. Ann Burns Fire Disasters, 21: 150-2, 2008.
8. Ong YS, Samuel M, Song C: Meta-analysis of early excision of
burns. Burns, 32: 145-50, 2006.
9. Pavoni V, Gianesello L, Paparella L et al.: Outcome predictors
and quality of life of severe burn patients admitted to intensive
care unit. Scand J Trauma Resusc Emerg Med, 18: 24, 2010. (Pub-
lished online 2010 April 27. DOI: 10.1186/1757-7241-18-24)
10. Xiao-Wu W, Herndon DN, Spies M et al.: Effects of delayed
wound excision and grafting in severely burned children. Arch
Surg, 137: 1049-54, 2002.
11. Subrahmanyam M: Early tangential excision and skin grafting of
moderate burns is superior to honey dressing: A prospective ran-
domized trial. Burns, 25: 729–31, 1999.
12. Barret JP, Herndon DN: Effects of burn wound excision on bac-
terial colonization and invasion. Plast Reconstruct Surg, 111: 744-
50, 2003.
13. McManus WF, Mason AD, jr, Pruitt BA, jr: Excision of the burn
wound in patients with large burn. Arch Surg, 124: 718-20, 1989.
14. Thompson P, Herndon DN, Abston S et al.: Effect of early exci-
sion on patients with major thermal injury. J Trauma, 27: 205-7,
1987.
15. Wang YU, Tang HT, Xia ZF et al.: Factors affecting survival in
adult patients with massive burns. Burns, 36: 57-64, 2010.
16. Herndon DN, Barrow RE, Rutan R et al.: A comparison of con-
servative versus early excision therapies in severely burned pa-
tients. Ann Surg, 209: 547-53, 1989.
17. Desai MH, Herndon DN, Broemeling L et al.: Early burn wound
excision significantly reduces blood loss. Ann Surg, 221: 753-62,
1990.
Conflict of interest statement. The authors of this paper
declare that they have no conflict of interest and there
is no financial or personal relationship with any other
person or organization that could bias their work. No
funding has been involved.
This paper was accepted on 6 June 2012.