The closed method has been known for nearly a century, and the principles upon which it is based were known to Hippocrates, who stated that rest and immobilisation are of capital importance in the treatment of wounds.
Closed plaster treatment of severe compound injuries – A report and revisitApollo Hospitals
A crushed injury of limb was treated with closed plaster method and elaborating the treatment protocol and follow-up. We should look behind the old treatment method again.
1. The document discusses negative pressure wound therapy (NPWT), including its history, mechanisms of action, clinical applications, and future perspectives.
2. NPWT uses subatmospheric pressure to promote wound healing through mechanisms like hemostasis, modulation of inflammation, angiogenesis, and granulation tissue formation.
3. Studies show NPWT can effectively treat wounds in complex areas like the head and neck region, and may help close submandibular fistulas. However, wounds with pockets or deep shapes are more prone to infection with NPWT.
This document discusses the use of cyanoacrylate adhesives in oral applications. It provides an overview of the mechanism of cyanoacrylate adhesives, their advantages over sutures for wound closure including faster hemostasis, less inflammation and pain, and ease of use. Several studies are cited showing cyanoacrylate adhesives resulted in less shrinkage of grafts, inflammation and patient discomfort compared to sutures for intraoral wound closure. The document concludes cyanoacrylate adhesives are useful alternatives to sutures for oral procedures due to their hemostatic, bacteriostatic and painless properties.
With increase in the number of laparoscopic procedures being performed, the incidence of port site complications has also increased proportionately. Infection and port site hernia are the commonest of the complications. Port site hernias are more prone to complications in view of the irregularity and narrowness of the defect. A case of an incarcerated umbilical port site hernia is presented to highlight the complexity of the problem and the surgical challenge that it poses.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
Buccal pad fat for cyst Indian Jr SCT volume 2, issue 1, April 16Avinash Gandi
A 14-year-old boy presented with a swelling on the right side of his face and upper jaw caused by a large dentigerous cyst. The cyst involved the area where his impacted right maxillary canine and other teeth were located. The patient's buccal pad of fat was harvested and processed to isolate the stromal vascular fraction (SVF) stem cells. After removing the cyst surgically, the SVF cells were administered to the bone defect area to aid bone regeneration and support orthodontic tooth movement. At 16 months post-operatively, good bone regeneration was observed and the patient was undergoing orthodontic treatment to align the impacted canine.
Crestal minimally invasive sinus lift on severely resorbedkarinazul13
This study evaluated a crestal minimally-invasive sinus lift technique for severely resorbed maxillary crests less than 5 mm in height. Seventeen patients received 20 implants and sinus floor elevation, with residual crestal heights ranging from 1.2-5.0 mm. No patients dropped out, all implants were successfully integrated, and the only complication was a minor perforation of the sinus membrane. At follow-up 24 months after loading, no implants failed and the mean regenerated bone height was maintained. The results suggest this crestal technique can successfully augment bone and allow implant placement in severely resorbed maxillae.
- Alveolar osteitis, commonly known as dry socket, is a painful inflammation of the jaw bone at the site of a recent tooth extraction characterized by pain and bad breath. It results from premature breakdown of the blood clot in the extraction socket.
- Risk factors include trauma during extraction, poor oral hygiene, smoking, use of oral contraceptives, and bacterial invasion of the socket.
- Treatment focuses on pain management through irrigation, placement of medicated dressings, analgesics, and occasionally antibiotics or laser therapy. Prevention emphasizes maintaining the blood clot through good oral hygiene and chlorhexidine use.
Closed plaster treatment of severe compound injuries – A report and revisitApollo Hospitals
A crushed injury of limb was treated with closed plaster method and elaborating the treatment protocol and follow-up. We should look behind the old treatment method again.
1. The document discusses negative pressure wound therapy (NPWT), including its history, mechanisms of action, clinical applications, and future perspectives.
2. NPWT uses subatmospheric pressure to promote wound healing through mechanisms like hemostasis, modulation of inflammation, angiogenesis, and granulation tissue formation.
3. Studies show NPWT can effectively treat wounds in complex areas like the head and neck region, and may help close submandibular fistulas. However, wounds with pockets or deep shapes are more prone to infection with NPWT.
This document discusses the use of cyanoacrylate adhesives in oral applications. It provides an overview of the mechanism of cyanoacrylate adhesives, their advantages over sutures for wound closure including faster hemostasis, less inflammation and pain, and ease of use. Several studies are cited showing cyanoacrylate adhesives resulted in less shrinkage of grafts, inflammation and patient discomfort compared to sutures for intraoral wound closure. The document concludes cyanoacrylate adhesives are useful alternatives to sutures for oral procedures due to their hemostatic, bacteriostatic and painless properties.
With increase in the number of laparoscopic procedures being performed, the incidence of port site complications has also increased proportionately. Infection and port site hernia are the commonest of the complications. Port site hernias are more prone to complications in view of the irregularity and narrowness of the defect. A case of an incarcerated umbilical port site hernia is presented to highlight the complexity of the problem and the surgical challenge that it poses.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
Buccal pad fat for cyst Indian Jr SCT volume 2, issue 1, April 16Avinash Gandi
A 14-year-old boy presented with a swelling on the right side of his face and upper jaw caused by a large dentigerous cyst. The cyst involved the area where his impacted right maxillary canine and other teeth were located. The patient's buccal pad of fat was harvested and processed to isolate the stromal vascular fraction (SVF) stem cells. After removing the cyst surgically, the SVF cells were administered to the bone defect area to aid bone regeneration and support orthodontic tooth movement. At 16 months post-operatively, good bone regeneration was observed and the patient was undergoing orthodontic treatment to align the impacted canine.
Crestal minimally invasive sinus lift on severely resorbedkarinazul13
This study evaluated a crestal minimally-invasive sinus lift technique for severely resorbed maxillary crests less than 5 mm in height. Seventeen patients received 20 implants and sinus floor elevation, with residual crestal heights ranging from 1.2-5.0 mm. No patients dropped out, all implants were successfully integrated, and the only complication was a minor perforation of the sinus membrane. At follow-up 24 months after loading, no implants failed and the mean regenerated bone height was maintained. The results suggest this crestal technique can successfully augment bone and allow implant placement in severely resorbed maxillae.
- Alveolar osteitis, commonly known as dry socket, is a painful inflammation of the jaw bone at the site of a recent tooth extraction characterized by pain and bad breath. It results from premature breakdown of the blood clot in the extraction socket.
- Risk factors include trauma during extraction, poor oral hygiene, smoking, use of oral contraceptives, and bacterial invasion of the socket.
- Treatment focuses on pain management through irrigation, placement of medicated dressings, analgesics, and occasionally antibiotics or laser therapy. Prevention emphasizes maintaining the blood clot through good oral hygiene and chlorhexidine use.
This study compared the frequency of post-operative adhesions in 62 patients undergoing endoscopic sinus surgery who received either an intranasal silastic splint plus anterior nasal packing (Group A) or anterior nasal packing alone (Group B). The frequency of post-operative adhesions was significantly lower in Group A (0%) compared to Group B (16.1%). Across age, gender, and symptom duration subgroups, adhesion rates remained significantly lower in patients receiving silastic splints. The study concludes that silastic splints are effective in reducing post-operative adhesions after endoscopic sinus surgery.
Journal Club on The clinical and radiographical characteristics of zygomatic ...Dr Bhavik Miyani
This document summarizes a study that compared the clinical outcomes of patients who underwent surgery to treat zygomatic complex fractures and were treated either surgically or non-surgically. The study found that extraoral steps, intraoral steps, and malar depression were significantly more common in surgically treated patients. While non-surgically treated patients also sometimes had displaced fractures, studying this group could provide insight into developing better methods for determining appropriate treatment. The study recommends further research on non-surgically treated patients with zygomatic complex fractures.
This study evaluated the use of vascularised fatty tissue flaps to replace excised parotid tissue and prevent Frey's syndrome in 37 patients who underwent parotidectomy between 2008-2017. The fatty flaps took an average of 17 minutes to dissect and were stable for up to 9 years of follow up. None of the patients reported symptoms of Frey's syndrome such as flushing or sweating when eating. The flaps were an easy technique that avoided donor site morbidity compared to other options and successfully prevented Frey's syndrome in all patients.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
This document describes the technique of a Z-plasty, which is used in scar revision and correction of free margin distortion. A Z-plasty involves making triangular flaps to lengthen or change the direction of a scar. The key steps are carefully planning and drawing the Z-plasty, making precise incisions, widely undermining the tissue, and transposing the flaps. The degree of scar lengthening and directional change depends on the angle of the flaps, with larger angles resulting in greater effects. Z-plasties must be carefully designed to align with skin tension lines for optimal results. Case examples demonstrate how Z-plasties can correct problems like scar contractures and alar retraction.
Intraoperative lacrimal intubation to prevent epiphora as aDr. SHEETAL KAPSE
1) The study assesses the effectiveness of intraoperative lacrimal intubation to prevent epiphora resulting from injury to the nasolacrimal system after fractures of the naso-orbitoethmoid complex.
2) 19 patients underwent open reduction and internal fixation for naso-orbitoethmoid fractures along with lacrimal intubation using silicone tubes, which were removed after 2-11 months.
3) The results showed that intraoperative lacrimal intubation successfully prevented permanent epiphora in all patients and offers greater benefits than omitting intubation.
Tissue expanders are valuable adjuncts in reconstructive maxillofacial surgery. They allow surgeons to replace lost or excised tissue with similar texture and thickness from neighboring tissue. Tissue expansion works by applying mechanical forces that induce controlled in situ skin growth. This stretches the skin beyond its limits, invoking biological pathways that increase cell growth and collagen synthesis, resulting in a net gain in skin surface area. Tissue expanders are silicone implants placed subcutaneously that are inflated over time to generate new tissue. They improve surgical outcomes by reducing the need for skin grafts and flaps.
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
This document summarizes recent advances in the management of oral and maxillofacial injuries. Key points include:
1) Minimally invasive endoscopic techniques are being used more for fractures of the mandibular condyle, zygomatic complex, orbit, and frontal sinus to limit incisions and improve visualization.
2) Computer-assisted surgery is being used to assist with preoperative planning, intraoperative guidance, and postoperative evaluation for oral and maxillofacial procedures.
3) Advances have been made in the treatment of many specific facial fractures including mandibular, midfacial, orbital, nasal, frontal, and temporomandibular joint fractures through the use of new techniques,
This document describes the endodontic treatment of a mandibular second molar (tooth 37) with acute irreversible pulpitis and cracked tooth syndrome, and the retreatment of an adjacent mandibular second molar (tooth 36) with chronic apical periodontitis. Tooth 37 exhibited signs and symptoms of cracked tooth syndrome including lingering pain upon testing and biting. Access was gained and the canals were instrumented and filled. Tooth 36 showed signs of previous insufficient root canal treatment and was retreated. At 12-month follow up, tooth 37 still occasionally caused discomfort but no pain on biting or chewing. The document discusses cracked tooth syndrome and different classifications of tooth fractures.
The antralpseudocyst originates from the accumulation of serous inflammatory exudate in the sinus membrane without a specific etiology, this cyst has not of age group or gender preference. Radiographically, it is associated with a soft dome-shaped radiopaque pattern. This case is about a male patient of 58 years of age, with increased volume in the malar and left genic region of smooth, fluctuating consistency, which crackles at the pressure. Intraorally with the corresponding increase in volume in the sac, without changes in the oral mucosa. The tomography showed a radiolucent lesion that occupies and destroys left jaw and orbital fl oor. Thus, complete enucleation of the lesion and reconstruction of adjacent structures were performed. Clinical and imaging follow-up was carried out without postoperative complications and 8 years free of injury. It is of vital importance a correct diagnosis to guide the treatment adequately, however it is not necessary to underestimate the behavior of benign lesions and described as non-invasive.
Management of posttraumatic malocclusion caused by condylar process fractureDr. SHEETAL KAPSE
This study evaluated the treatment of 21 patients with post-traumatic malocclusions caused by condylar process fractures. For asymmetric malocclusions from unilateral fractures (n=15), patients underwent unilateral or bilateral mandibular ramus osteotomies. For anterior open bites from bilateral fractures (n=6), patients underwent either Le Fort I osteotomies (n=5) or bilateral ramus osteotomies (n=1). All patients had stable dental and skeletal results after 1+ years except one treated with bilateral ramus osteotomies. The authors conclude that osteotomies of the affected jaw are effective for treating post-traumatic malocclusions from condylar fractures.
Use of grafts & alloplastic material in maxillofacial traumaDr. SHEETAL KAPSE
The document discusses various graft materials that can be used for head and neck reconstruction. It covers bone grafts, cartilage grafts, muscle grafts, skin grafts, nerve grafts, vessel grafts, fat grafts, and alloplastic graft materials. For each type of graft, it discusses principles of harvesting and placement, as well as outcomes. Regional sites are described for harvesting bone grafts. Principles of skin graft healing and nerve repair techniques are also summarized. Common alloplastic graft materials discussed include silicone, expanded polytetrafluoroethylene, and high-density polyethylene.
Effectiveness of primary correction of traumatic telecanthusDr. SHEETAL KAPSE
This study evaluated 36 cases of traumatic telecanthus (abnormal widening of the distance between the eyes) resulting from naso-orbito-ethmoid fractures that were treated primarily with either direct or indirect canthopexy. Direct canthopexy resulted in a smaller intercanthal distance and less relapse compared to indirect canthopexy. Early primary treatment within 2 weeks led to fewer cases of epiphora (watery eyes) or dacryocystitis (blocked tear duct) compared to later treatment. The study concludes that traumatic telecanthus should receive early primary treatment to achieve the best aesthetic and functional results.
Distraction osteogenesis was performed on 15 patients with retrognathia and obstructive sleep apnea secondary to temporomandibular joint ankylosis. This study evaluated the effects of mandibular advancement using distraction osteogenesis to increase the posterior airway space. Results found significant improvements in sleep apnea symptoms and polysomnography outcomes after distraction, including reduced apnea-hypopnea index and increased lowest blood oxygen saturation. The authors concluded that distraction osteogenesis is an effective treatment for obstructive sleep apnea in patients with severe acquired retrognathia.
This document discusses techniques for closing midline laparotomy incisions. It recommends mass closure using continuous slowly absorbable monofilament sutures placed 5-8mm from the wound edge and 4-5mm apart. A suture length to wound length ratio of 4:1 or greater should be used to minimize complications like wound dehiscence and incisional hernia. Proper technique and suture material can reduce surgical site infections, wound failures, and hernia rates.
This document summarizes a clinical study on using the zygomaticomaxillary buttress as a donor site for bone grafting to augment maxillary alveolar defects for dental implant placement. It describes the anatomy of the zygomaticomaxillary buttress and reviews its advantages as a donor site, including good bone quality and quantity while avoiding complications from other sites. It then presents a case study where bone was harvested from the buttress to graft a maxillary defect and allow successful implant placement, with follow-up showing osseointegration and no complications. The conclusion is that the zygomaticomaxillary buttress is a viable donor site for limited bone grafting for dental implants.
T2India offers family tour packages in India that include activities and luxury resort accommodations. They are a travel agency based in New Delhi that can help plan tours to various destinations around India. Their contact information is provided should anyone want to inquire further about tour options or book a trip.
This document discusses diabetes and kidney disease. It notes that diabetes is a worldwide epidemic that is increasing prevalence, especially in India. Diabetes is now the leading cause of end-stage kidney disease globally. Up to 40% of patients with diabetes will develop some form of kidney damage. The natural history of diabetic nephropathy is described, from early microalbuminuria to later macroalbuminuria and declining kidney function. Treatment focuses on glycemic control, blood pressure control, and blocking the renin-angiotensin system to slow disease progression. However, reductions in progression have been modest with current therapies.
This study compared the frequency of post-operative adhesions in 62 patients undergoing endoscopic sinus surgery who received either an intranasal silastic splint plus anterior nasal packing (Group A) or anterior nasal packing alone (Group B). The frequency of post-operative adhesions was significantly lower in Group A (0%) compared to Group B (16.1%). Across age, gender, and symptom duration subgroups, adhesion rates remained significantly lower in patients receiving silastic splints. The study concludes that silastic splints are effective in reducing post-operative adhesions after endoscopic sinus surgery.
Journal Club on The clinical and radiographical characteristics of zygomatic ...Dr Bhavik Miyani
This document summarizes a study that compared the clinical outcomes of patients who underwent surgery to treat zygomatic complex fractures and were treated either surgically or non-surgically. The study found that extraoral steps, intraoral steps, and malar depression were significantly more common in surgically treated patients. While non-surgically treated patients also sometimes had displaced fractures, studying this group could provide insight into developing better methods for determining appropriate treatment. The study recommends further research on non-surgically treated patients with zygomatic complex fractures.
This study evaluated the use of vascularised fatty tissue flaps to replace excised parotid tissue and prevent Frey's syndrome in 37 patients who underwent parotidectomy between 2008-2017. The fatty flaps took an average of 17 minutes to dissect and were stable for up to 9 years of follow up. None of the patients reported symptoms of Frey's syndrome such as flushing or sweating when eating. The flaps were an easy technique that avoided donor site morbidity compared to other options and successfully prevented Frey's syndrome in all patients.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
This document describes the technique of a Z-plasty, which is used in scar revision and correction of free margin distortion. A Z-plasty involves making triangular flaps to lengthen or change the direction of a scar. The key steps are carefully planning and drawing the Z-plasty, making precise incisions, widely undermining the tissue, and transposing the flaps. The degree of scar lengthening and directional change depends on the angle of the flaps, with larger angles resulting in greater effects. Z-plasties must be carefully designed to align with skin tension lines for optimal results. Case examples demonstrate how Z-plasties can correct problems like scar contractures and alar retraction.
Intraoperative lacrimal intubation to prevent epiphora as aDr. SHEETAL KAPSE
1) The study assesses the effectiveness of intraoperative lacrimal intubation to prevent epiphora resulting from injury to the nasolacrimal system after fractures of the naso-orbitoethmoid complex.
2) 19 patients underwent open reduction and internal fixation for naso-orbitoethmoid fractures along with lacrimal intubation using silicone tubes, which were removed after 2-11 months.
3) The results showed that intraoperative lacrimal intubation successfully prevented permanent epiphora in all patients and offers greater benefits than omitting intubation.
Tissue expanders are valuable adjuncts in reconstructive maxillofacial surgery. They allow surgeons to replace lost or excised tissue with similar texture and thickness from neighboring tissue. Tissue expansion works by applying mechanical forces that induce controlled in situ skin growth. This stretches the skin beyond its limits, invoking biological pathways that increase cell growth and collagen synthesis, resulting in a net gain in skin surface area. Tissue expanders are silicone implants placed subcutaneously that are inflated over time to generate new tissue. They improve surgical outcomes by reducing the need for skin grafts and flaps.
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
This document summarizes recent advances in the management of oral and maxillofacial injuries. Key points include:
1) Minimally invasive endoscopic techniques are being used more for fractures of the mandibular condyle, zygomatic complex, orbit, and frontal sinus to limit incisions and improve visualization.
2) Computer-assisted surgery is being used to assist with preoperative planning, intraoperative guidance, and postoperative evaluation for oral and maxillofacial procedures.
3) Advances have been made in the treatment of many specific facial fractures including mandibular, midfacial, orbital, nasal, frontal, and temporomandibular joint fractures through the use of new techniques,
This document describes the endodontic treatment of a mandibular second molar (tooth 37) with acute irreversible pulpitis and cracked tooth syndrome, and the retreatment of an adjacent mandibular second molar (tooth 36) with chronic apical periodontitis. Tooth 37 exhibited signs and symptoms of cracked tooth syndrome including lingering pain upon testing and biting. Access was gained and the canals were instrumented and filled. Tooth 36 showed signs of previous insufficient root canal treatment and was retreated. At 12-month follow up, tooth 37 still occasionally caused discomfort but no pain on biting or chewing. The document discusses cracked tooth syndrome and different classifications of tooth fractures.
The antralpseudocyst originates from the accumulation of serous inflammatory exudate in the sinus membrane without a specific etiology, this cyst has not of age group or gender preference. Radiographically, it is associated with a soft dome-shaped radiopaque pattern. This case is about a male patient of 58 years of age, with increased volume in the malar and left genic region of smooth, fluctuating consistency, which crackles at the pressure. Intraorally with the corresponding increase in volume in the sac, without changes in the oral mucosa. The tomography showed a radiolucent lesion that occupies and destroys left jaw and orbital fl oor. Thus, complete enucleation of the lesion and reconstruction of adjacent structures were performed. Clinical and imaging follow-up was carried out without postoperative complications and 8 years free of injury. It is of vital importance a correct diagnosis to guide the treatment adequately, however it is not necessary to underestimate the behavior of benign lesions and described as non-invasive.
Management of posttraumatic malocclusion caused by condylar process fractureDr. SHEETAL KAPSE
This study evaluated the treatment of 21 patients with post-traumatic malocclusions caused by condylar process fractures. For asymmetric malocclusions from unilateral fractures (n=15), patients underwent unilateral or bilateral mandibular ramus osteotomies. For anterior open bites from bilateral fractures (n=6), patients underwent either Le Fort I osteotomies (n=5) or bilateral ramus osteotomies (n=1). All patients had stable dental and skeletal results after 1+ years except one treated with bilateral ramus osteotomies. The authors conclude that osteotomies of the affected jaw are effective for treating post-traumatic malocclusions from condylar fractures.
Use of grafts & alloplastic material in maxillofacial traumaDr. SHEETAL KAPSE
The document discusses various graft materials that can be used for head and neck reconstruction. It covers bone grafts, cartilage grafts, muscle grafts, skin grafts, nerve grafts, vessel grafts, fat grafts, and alloplastic graft materials. For each type of graft, it discusses principles of harvesting and placement, as well as outcomes. Regional sites are described for harvesting bone grafts. Principles of skin graft healing and nerve repair techniques are also summarized. Common alloplastic graft materials discussed include silicone, expanded polytetrafluoroethylene, and high-density polyethylene.
Effectiveness of primary correction of traumatic telecanthusDr. SHEETAL KAPSE
This study evaluated 36 cases of traumatic telecanthus (abnormal widening of the distance between the eyes) resulting from naso-orbito-ethmoid fractures that were treated primarily with either direct or indirect canthopexy. Direct canthopexy resulted in a smaller intercanthal distance and less relapse compared to indirect canthopexy. Early primary treatment within 2 weeks led to fewer cases of epiphora (watery eyes) or dacryocystitis (blocked tear duct) compared to later treatment. The study concludes that traumatic telecanthus should receive early primary treatment to achieve the best aesthetic and functional results.
Distraction osteogenesis was performed on 15 patients with retrognathia and obstructive sleep apnea secondary to temporomandibular joint ankylosis. This study evaluated the effects of mandibular advancement using distraction osteogenesis to increase the posterior airway space. Results found significant improvements in sleep apnea symptoms and polysomnography outcomes after distraction, including reduced apnea-hypopnea index and increased lowest blood oxygen saturation. The authors concluded that distraction osteogenesis is an effective treatment for obstructive sleep apnea in patients with severe acquired retrognathia.
This document discusses techniques for closing midline laparotomy incisions. It recommends mass closure using continuous slowly absorbable monofilament sutures placed 5-8mm from the wound edge and 4-5mm apart. A suture length to wound length ratio of 4:1 or greater should be used to minimize complications like wound dehiscence and incisional hernia. Proper technique and suture material can reduce surgical site infections, wound failures, and hernia rates.
This document summarizes a clinical study on using the zygomaticomaxillary buttress as a donor site for bone grafting to augment maxillary alveolar defects for dental implant placement. It describes the anatomy of the zygomaticomaxillary buttress and reviews its advantages as a donor site, including good bone quality and quantity while avoiding complications from other sites. It then presents a case study where bone was harvested from the buttress to graft a maxillary defect and allow successful implant placement, with follow-up showing osseointegration and no complications. The conclusion is that the zygomaticomaxillary buttress is a viable donor site for limited bone grafting for dental implants.
T2India offers family tour packages in India that include activities and luxury resort accommodations. They are a travel agency based in New Delhi that can help plan tours to various destinations around India. Their contact information is provided should anyone want to inquire further about tour options or book a trip.
This document discusses diabetes and kidney disease. It notes that diabetes is a worldwide epidemic that is increasing prevalence, especially in India. Diabetes is now the leading cause of end-stage kidney disease globally. Up to 40% of patients with diabetes will develop some form of kidney damage. The natural history of diabetic nephropathy is described, from early microalbuminuria to later macroalbuminuria and declining kidney function. Treatment focuses on glycemic control, blood pressure control, and blocking the renin-angiotensin system to slow disease progression. However, reductions in progression have been modest with current therapies.
Progression of Chronic Kidney Disease: Mechanisms and Interventions in Retard...Apollo Hospitals
The incidence ofchronickidneydisease (CKD) is increasingworldwideandisbecoming a major concern for the healthcare. Approximately 1.8 million people, worldwide, are currently treated with renal replacement therapy (RRT), which consists primarily of kidney transplantation,
hemodialysis, and peritoneal dialysis.
Patient safety is now recognized as a serious global public health issue. There is a 1 in 300 chance of a patient's safety being compromised in a hospital setting.
Liposarcoma of the spermatic cord is a rare entity with only two series and less than 100 cases reported in literature. We report a case of a giant liposarcoma of the spermatic cord.
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Management of compound fracture tibia in children with titanium elastic nailsApollo Hospitals
Tibia fractures in the skeletally immature patient can usually be treated without surgery. The purpose of this study was to assess the use of flexible titanium nails in the open fracture tibia that requires operative stabilization.
This document discusses autogenous temporomandibular joint replacement. It begins with a definition and brief history of autogenous TMJ replacement. It then discusses indications for total TMJ reconstruction and goals of autogenous replacement, which include restoring ramus length and morphology, normal range of motion, and jaw relations/occlusion. Potential donor sites are also reviewed, including the costochondral rib graft which is often used due its ability to grow similarly to the mandible in pediatric patients. Techniques and complications of autogenous TMJ replacement are summarized.
This document describes a two-stage technique for treating chronic osteomyelitis of long bones. In stage one, all infected and compromised bone and soft tissue is radically debrided. Healthy soft tissue coverage is then provided, either directly or with a muscle flap. Stage two occurs 3-6 weeks later, where any remaining bone defects are grafted with cancellous bone grafts. This technique was used to treat 37 patients with chronic osteomyelitis of the tibia, femur, radius or humerus. Infection was eradicated in 34 patients, with no patients requiring amputation.
This document provides information on the assessment and treatment of compound fractures where the bone is exposed to the external environment. It defines compound fractures and discusses their pathophysiology, risk factors, initial assessment including examination of the wound and injured limb, antibiotic treatment, classification systems, treatment options including debridement, stabilization, and wound management. Treatment is aimed at achieving a stable skeletal fixation and environment conducive to fracture and soft tissue healing.
1. Open fractures occur when a broken bone pierces the overlying soft tissue, exposing the bone. The most common causes are motor vehicle accidents, motorcycle accidents, falls, and pedestrian injuries.
2. Treatment goals are to preserve life, limb, and function. This involves assessing for other injuries, stabilizing the patient, cleaning and debriding the wound, administering antibiotics and tetanus prophylaxis, and stabilizing the fracture—often initially with external fixation.
3. Further debridement and irrigation is done in the operating room, followed by temporary stabilization. Definitive reconstruction and internal or intramedullary fixation is done later, once the risk of infection decreases. Close monitoring is
Incisions in the neck, thyroidectomy, parathyroidectomyMahimaShrivastava6
Contoso Pharmaceuticals provides information on various neck surgeries and procedures:
- Thyroidectomy is the removal of the thyroid gland, often due to cancer or hyperthyroidism. Parathyroidectomy removes one or more parathyroid glands located behind the thyroid.
- Incisions in the neck must consider skin tension lines to reduce scarring. Vertical incisions better expose arteries while transverse incisions are cosmetically superior.
- Cricothyroidotomy establishes an airway during life-threatening airway obstruction. It can be performed with a needle or surgically by incising the cricothyroid membrane to insert a tube into the trachea.
-
The document discusses open fractures, providing details on epidemiology, classification, management principles, antibiotic treatment, wound irrigation and debridement. Open fractures commonly involve the fingers, tibia and distal radius, and result from high-energy trauma like vehicle accidents or falls. Immediate evaluation and treatment is needed, including antibiotics, wound cleaning, and splinting or stabilization to prevent infection while facilitating healing.
This document describes a study evaluating the use of dynamic dermal approximation sutures for closing wounds following fasciotomy to treat compartment syndrome. The technique was applied to 12 patients and achieved wound closure in 75% of cases without need for skin grafting. Specifically, it closed all wounds in 6 patients who developed compartment syndrome due to contrast extravasation. The technique aims to provide early wound closure following fasciotomy in order to reduce complications compared to delayed closure or skin grafting. The results suggest this technique can successfully close uncomplicated fasciotomy wounds with minimal risk and good cosmetic outcomes.
This document summarizes a journal article discussing the use of noncontact locking plates as an internal fixator for open fractures. Some key points:
- Open fractures involve communication between the external environment and fracture site, complicating treatment. Traditional fixation methods like plates and screws risk high infection rates.
- The study evaluated outcomes of using noncontact locking plates in 42 patients with open tibia or femur fractures. All fractures united within 19.7 weeks on average with minimal complications.
- Advantages of this technique include minimizing contact between implant and bone to reduce risks of infection, while still providing stable fixation comparable to traditional plating. The results were satisfactory compared to other studies.
Reconstructive periodontal therapy
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
This case report describes an unusual case of pseudo-ankylosis in an 8-year-old child with a history of trauma. Imaging revealed an old fractured right condyle that had been anteriorly displaced and dislocated into the sigmoid notch, where it had fused to the zygomatic arch. Computed tomography with 3D reconstruction clearly showed the displaced condylar fragment. The child underwent surgery to release the ankylotic mass and perform a coronoidectomy to improve mouth opening. Post-operatively, aggressive physiotherapy helped increase the child's maximum interincisal opening. This unique case highlights the importance of accurate imaging and diagnosis for successful treatment of complex facial injuries.
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Surgical management of the failed airway a guide to percutaneous cricothyrotomyEmergency Live
Surgical Management Of the Failed Airway: A guide to precutaneous cricothyrotomy
Guidelines from Hoan E. Spiegel, MD
Assistant Professor
Beth Israel Ddeaconess Medical Center
Harvard medical School Boston, MS
Vipul Shah, MD
Western Washington Medical Group
Everett, Washington
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Closed plaster treatment of severe compound injuries - A report and revisit
1. Brief Report
Closed plaster treatment of severe compound
injuries e A report and revisit
Pankaj Kumar*
Consultant Orthopaedic and Spine Surgeon, Apollo Reach Hospital, Karimnagar, Andhra Pradesh 505001, India
a r t i c l e i n f o
Article history:
Received 26 October 2012
Accepted 17 May 2013
Available online xxx
Keywords:
Crush injuries
Treatment
POP
a b s t r a c t
A crushed injury of limb was treated with closed plaster method and elaborating the
treatment protocol and follow-up. We should look behind the old treatment method again.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
The closed method has been known for nearly a century, and
the principles upon which it is based were known to Hippo-
crates, who stated that rest and immobilisation are of capital
importance in the treatment of wounds.
Billroth1
used plaster of Paris fixation with a window over
the wound and a no dressing. Ollier2
was the first to enclose
the wound completely in plaster. He treated 60 cases by his
occlusive method in the FrancoePrussian War, and described
his results in 1872. In 1881, Morisons3
of Newcastle-on-Tyne
strongly advocated large, firm dressings for wounds, to be
undisturbed for three to four weeks.
The closed treatment of wounds is based on sound prin-
ciples. The technique is exact and attention must be paid to
every detail if success is to be assured.
2. Principles upon which the method is based
A. Excision and surgical toilet: Primarily the object of early
excision of dead and devitalised skin, muscle, fascia etc, is
to get beyond the depth of penetration of bacteria and in
addition to remove dead tissue which would form an ideal
nidus for organisal growth. Dead muscle especially is an
ideal culture medium for the gas gangrene organisms. The
excision, thus, must be thorough and wide. The necessity
for removal of accessible foreign bodies, bits of cloth, etc.,
is obvious. Generally speaking, wounds seen up to 8 h of
infliction may be excised. When obvious infection is
already present, provision for drainage only should be
made, and no formal excision should be carried out.
B. Drainage: All parts of the wound must be left with free
access to the surface for the evacuation of discharges, and
* Tel.: þ91 (0) 9618123678 (mobile).
E-mail addresses: drpankaj06@yahoo.co.in, drpankaj06@gmail.com.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/apme
a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1 e3
Please cite this article in press as: Kumar P, Closed plaster treatment of severe compound injuries e A report and revisit, Apollo
Medicine (2013), http://dx.doi.org/10.1016/j.apme.2013.05.014
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.05.014
2. there must be complete freedom from tension in the
wound. Wide openings, with “saucerisation”, and efficient
packing with Vaseline gauze, so as to form a conical pack,
fill these requirements. Tubes and sutures should not be
used.
C. Immobilisation: This is essential for healing of fractures,
for repair of injured soft tissues, and for prevention of
pain. Plaster of Paris, applied, including the joint above and
below the wound is the best form of fixation.
No window is cut over the wound, as “window oede-
ma”occurs, and healing is delayed. Trueta and Barnes4
have
proved experimentally that bacteria and certain toxins
(including tetanus toxin) are absorbed from wounds into the
blood-stream via the lymphatics only. They are not absorbed
when the lymphatics are obstructed or when the limb is
completely immobilised in plaster. They have also shown that
flow of lymph from a limb is increased by movement, heat,
massage and oedema. All efforts in wound treatment, there-
fore, must be directed to the reduction of lymph flow from the
limb. Complete immobilisation by means of a well fitting
plaster and prevention of oedema by a vaseline pack. No
window in the plaster, adequate local drainage, and elevation
of the limb, effectively.
3. Contraindication
The method is not to be used:
A. When a vascular lesion is present or when the circulation
of the limb is in doubt. Gas gangrene organisms flourish in
dead or poorly nourished muscles. These cases must he
observed or a few days before applying plaster.
B. When there is any suspicion of true gas gangrene. If there
is the slightest doubt about the significance of gas bubbles
or any anxiety about the state of nutrition of the limb, it is
better not to use the closed plaster.
C. When there is so much contusion and crushing of the limb
that all devitalised tissue cannot possibly be excised and
there is risk of extensive necrosis subsequently,
D. In cases of severe multiple injuries, e.g. wounds of hu-
merus and chest, or of femur and abdomen, where a
plaster would interfere with the wounds on the trunk.
E. When extensive spreading cellulitis, e.g. Streptococcal or
anaerobic (B.welchii), cellulitis is present, plaster applica-
tion should be deferred until this has settled down.
4. Case report
A 7 years boy reported to the emergency department with his-
tory of playing near parking, when driver started the car his one
leg trapped inside the wheel of car and in hurry somebody tried
to pull his leg from the wheel of car. While pulling he got this
severe injuries. His leg and foot were crushed. He reported to
emergency department within 3 h of injuries with active
bleeding from wound and with hypovolemic shock. When we
examined the limb there was almost complete degloved lower
two third right leg with visible anterior two third of tibia and
fibula and anterior part of all bone of foot, visible all tendon
including all around the ankle joints and tendon anterior to foot
waslost,with novisiblepulsationbut sole offootwasintact and
there was active bleeding from muscles. We corrected the
shock, and X-ray showed there were multiple fractures of
metatarsal bone and without fracture of tibia and fibula. We
planned for wound debridement and K-wire fixation of bone
and coverage of bone by the help of plastic surgeon. According
toplastic surgeon itisnotpossibletocovertheopenvisiblebone
of leg and foot in one sitting. So he said, you try some other
means of modalities. Then we opt for closed plaster treatment
because we don’t have any other choice. We did wound
debridement and K-wire fixation of metatarsal of foot and
above knee POP cast application. K-wire removed at 6 weeks
interval. Initial first month we had removed the old cast and
reapplication POP cast at one week interval and from second
month fifteen day interval or when POP is soaked whichever are
early. After three month bone was completely covered with
granulation tissue. We did skin grafting. In follow-up, wound
was completely healed and child was completely walking with
near normal gait at the end of two years of follow-up (Fig. 1).
5. Discussion
Crush injuries of the limb are serious and can be difficult to
manage. These complex injuries often involve soft tissue and
osseous structures. Potentially devastating complications and
long-term sequelae can occur if these injuries are under-
estimated or mismanaged. Due to the high morbidity associ-
ated with crush injuries, prompt and meticulous care is
essential. Orr5
strongly condemns the closure of a wound
communicating’ with a compound fracture on the grounds that
in compound fractures generally it is virtually impossible to be
sure that a wound is clean and to close it up (by suture) after no
matter how thorough a mechanical cleansing and an antiseptic
sterilization is usually to close up no little potential infection.
Trueta6
advocates the closed method of treating war frac-
tures. This was carried out by him as follows: (a) Excision of the
all dead muscle and haematomata, (b) Reduction of the frac-
ture, (c) Drainage of the wound with absorbent gauze, (d)
Immobilization of the limb in plaster of Paris. By this means
every possible attempt is made to prevent the growth of or-
ganisms from the moment of wounding. The surgeon then has
much better opportunity to eliminate infection by excision and
debridement, even if undertaken well over the 8-h period.
It is realised that a better line of treatment would have
been immediate reduction of the fracture with a K-wire and
coverage of wound with appropriate soft tissue. Unfortunately
no such apparatus was available. Closed plaster method
depended for its efficiency on physical and physiological ef-
fects rather than its influence on the flora.
This article reviews the characteristics of plaster of Paris
and re-introduces the concept of tissue adaptation in
response to the application of plaster of Paris splints and
casts. Clinical examples of the use of plaster of Paris are dis-
cussed. Such question should lead the reader to use plaster of
Paris splinting or casting more often to solve clinical problem.
It is recommended that a consultation with colleagues should
a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1 e32
Please cite this article in press as: Kumar P, Closed plaster treatment of severe compound injuries e A report and revisit, Apollo
Medicine (2013), http://dx.doi.org/10.1016/j.apme.2013.05.014
3. always be held if it is decided to amputate a limb. One may
conclude by stressing again the basic principle of adequate
drainage and complete immobilisation in using the closed
method; the importance of selecting cases and bearing mind
the few contraindications to the closed plaster meticulous
attention to detail in technique and after e care.
Conflicts of interest
The author has none to declare.
r e f e r e n c e s
1. Billroth. Clinical Surgery. London: The New Sydenham Society;
1881.
2. Ollier L. Congress medical de France; 1872:192.
3. Morison Rutherford. Surgical Contraindication. vol. 1, pp 2
and 11.
4. Trueta J, Barnes. British Med J. 1940 July 13:46.
5. Orr Vinnett. J Bone Joint Surg. 1928;10:605.
6. Trueta j. Treatment of War Wound and Fractures. Hamish
Hamilton; 1940.
Fig. 1 e a and b: Preoperative photograph. c and d: during POP application period. e :photograph during skin grafting. f and g:
after 3 months of skin grafting. h and i: photograph at the end of 2 years.
a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1 e3 3
Please cite this article in press as: Kumar P, Closed plaster treatment of severe compound injuries e A report and revisit, Apollo
Medicine (2013), http://dx.doi.org/10.1016/j.apme.2013.05.014