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Olutoye OO, Eriksson E, Menchaca AD, Kirsner RS, Tanaka R, Schultz G, Weir D, Wagner T, Renata F, Naik-Mathuria B, Liu P, Ead KJ, Adedayo T, Armstrong DG, McMullin N, Balch Samora J, Akingba AG. Management of Acute Wounds - Expert Panel Consensus Statement. Adv Wound Care (New Rochelle) 2024. [PMID: 38618741 DOI: 10.1089/wound.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
SIGNIFICANCE The Wound Healing Foundation recognized the need for consensus-based unbiased recommendations for the treatment of wounds. As a first step, a consensus on the treatment of chronic wounds was developed and published in 2022.(1) The current publication on acute wounds represents the second step in this process. Acute wounds may result from any number of conditions, including burns, military and combat operations, and trauma to specific areas of the body. The management of acute wounds requires timely and evidence-driven intervention to achieve optimal clinical outcomes. This consensus statement provides the clinician with the necessary foundational approaches to the causes, diagnosis and therapeutic management of acute wounds. Presented in a structured format, this is a useful guide for clinicians and learners in all patient care settings. RECENT ADVANCES Recent advances in the management of acute wounds have centered on stabilization and treatment in the military and combat environment, Specifically advancements in hemostasis, resuscitation, and the mitigation of infection risk through timely initiation of antibiotics and avoidance of high pressure irrigation in contaminated soft tissue injury. . CRITICAL ISSUES Critical issues include infection control, pain management and the unique considerations for the management of acute wounds in pediatric patients. FUTURE DIRECTIONS Future directions include new approaches to preventing the progression and conversion of burns through the use of the microcapillary gel, a topical gel embedded with the anti-inflammatory drug infliximab.(38) Additionally, the use of three-dimensional bioprinting and photo-modulation for skin reconstruction following burns is a promising area for continued discovery.
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Affiliation(s)
- Oluyinka O Olutoye
- Nationwide Children's Hospital, 2650, Surgery, 700 Children's Drive, T6 Administration, Columbus, Columbus, Ohio, United States, 43205
- The Ohio State University, 2647, Surgery, 700 Children's Drive, T6 Administration, Columbus, Ohio, United States, 43210-1132;
| | - Elof Eriksson
- Harvard Medical School, 1811, Plastic & Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Alicia D Menchaca
- Nationwide Children's Hospital, 2650, Pediatric Surgery, 575 Children's Crossroad, Rm 4143, Columbus, Ohio, United States, 43205-2664;
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, United States;
| | - Rica Tanaka
- Juntendo University School of Medicine Graduate School of Medicine, 73362, Regenerative Therapy, Department of Plastic & Reconstructive Surgery, Bunkyo-ku, Tokyo, Japan;
| | - Gregory Schultz
- Institute for Wound Research, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, United States, 32610-0294;
| | - Dot Weir
- Saratoga Hospital for Wound Healing and Hyperbaric Medicine, Saratoga Springs, United States;
| | - Tracey Wagner
- Nationwide Children's Hospital, 2650, Emergency Medicine, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Fabia Renata
- Nationwide Children's Hospital, 2650, Pediatric Surgery , Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Bindi Naik-Mathuria
- The University of Texas Medical Branch at Galveston, 12338, Pediatric Surgery, Galveston, Texas, United States;
| | - Paul Liu
- Brown University/Rhode Island Hospital, Plastic Surgery, 225 Plain Street, Providence, Rhode Island, United States, 02905;
| | - Karim J Ead
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Temitope Adedayo
- Temple University School of Podiatric Medicine, 70068, Philadelphia, Pennsylvania, United States;
| | - David G Armstrong
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Neil McMullin
- Evans Army Community Hospital, 19909, Plastic Surgery, Fort Carson, Colorado, United States;
| | - Julie Balch Samora
- Nationwide Children's Hospital, 2650, Orthopedic Surgery, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Ajibola G Akingba
- VA, 8267, Vascular Surgery , Washington, District of Columbia, United States;
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Christodoulou N, Asimakopoulos D, Kapetanos K, Seah M, Khan W. Principles of management of hand fractures. J Perioper Pract 2023; 33:342-349. [PMID: 36408867 PMCID: PMC10623595 DOI: 10.1177/17504589221119739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.
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Affiliation(s)
| | | | | | - Matthew Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
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3
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J Jordan D, Leow JM, Stirling PHC, Lam WL. Revisiting the dogma of the Edinburgh position for safe immobilization. J Hand Surg Eur Vol 2021; 46:37-44. [PMID: 33135526 DOI: 10.1177/1753193420966233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Since the concept was first described 50 years ago in Edinburgh by J. I. P. James, the term 'Edinburgh position' has been synonymous with the position of safe immobilization for the hand. Widely employed for the management of injured hands, the position is associated with splinting the metacarpophalangeal joints at 90° and the proximal interphalangeal joints completely straight, namely, 'the intrinsic-plus position', to help reduce the long-term consequences of a stiff hand. Over the decades, the strict joint angles of the Edinburgh position have been debated due to changes in patterns of injury, treatment and rehabilitation. This article challenges the dogma that surrounds the use of the Edinburgh position in clinical practice. The history of the position was explored, and the results of a survey about current practice of hand immobilization from two study centres in Edinburgh is presented.Level of evidence: IV.
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Affiliation(s)
- Daniel J Jordan
- Department of Plastic, Reconstructive and Hand Surgery, St John's Hospital, Livingston, UK
| | - Jun M Leow
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul H C Stirling
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Wee L Lam
- Department of Plastic, Reconstructive and Hand Surgery, St John's Hospital, Livingston, UK
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4
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Pillai S, Campbell E, Mifsud A, Vamadeva SV, Pahal GS. Hand infections. Br J Hosp Med (Lond) 2020; 81:1-14. [PMID: 33263466 DOI: 10.12968/hmed.2020.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hand is an extremely versatile organ adapted for fine tasks with various clinicoanatomical compartments. This article reviews the types of common hand infections that present to the emergency department and/or hand surgeon, with relevant investigations and strategies for diagnosis and treatment, with the emphasis on distinguishing between superficial and more serious infections.
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Affiliation(s)
- S Pillai
- Department of Plastic Surgery, Royal London Hospital, London, UK
| | - E Campbell
- Department of Plastic Surgery, Royal London Hospital, London, UK
| | - A Mifsud
- Department of Microbiology, Whipps Cross Hospital, London, UK
| | - S V Vamadeva
- Department of Plastic Surgery, Royal London Hospital, London, UK
| | - G S Pahal
- Department of Plastic Surgery, Royal London Hospital, London, UK
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of closed hand and wrist injuries in the emergency department (part 5 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2018; 30:610-640. [DOI: 10.1111/1742-6723.12969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/16/2018] [Accepted: 02/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kirsten Strudwick
- Emergency Department; Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service; Brisbane Queensland Australia
- Physiotherapy Department; Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service; Brisbane Queensland Australia
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
| | - Megan McPhee
- Physiotherapy Department; Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service; Brisbane Queensland Australia
| | - Anthony Bell
- Emergency and Trauma Centre; Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service; Brisbane Queensland Australia
- Faculty of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research; Faculty of Medicine, The University of Queensland; Brisbane Queensland Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
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Richards T, Clement R, Russell I, Newington D. Acute hand injury splinting - the good, the bad and the ugly. Ann R Coll Surg Engl 2018; 100:92-96. [PMID: 29182002 PMCID: PMC5838697 DOI: 10.1308/rcsann.2017.0195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 11/22/2022] Open
Abstract
Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting. This article aims to provide guidance for frontline staff on the management of hand fractures, with particular emphasis on the appropriate nonoperative care to avoid any unnecessary morbidity.
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Affiliation(s)
- T Richards
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
| | - R Clement
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
| | - I Russell
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
| | - D Newington
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
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