dijous, 28 d’agost de 2014

Ferides tractades amb cura de pressio negativa

Negative-Pressure Wound Therapy After Fasciotomy Reduces Muscle-Fiber Regeneration in a Pig Model
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Clinical Relevance: NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.
Acute compartment syndrome is a limb-threatening condition. As pressure rises inside a muscle fascial compartment, capillary perfusion pressure falls and causes cellular hypoxia. Untreated, the cascade of hypoxia, microvascular dysfunction, and increased capillary permeability results in irreversible ischemic injury. Prompt fasciotomy is the ideal treatment. Many patients who undergo fasciotomy require delayed skin-grafting and have long-term functional impairment1.
Recently, negative-pressure wound therapy (NPWT) has been used on fasciotomy wounds. The results of this practice are variable. Some authors have reported decreased wound size2 and a shorter time to wound closure3, but a recent randomized controlled trial showed a longer time to wound closure and an increased need for skin grafts with NPWT4.
To our knowledge, no one has examined NPWT effects on the underlying skeletal muscle. NPWT increases microvascular circulation around the wound5-8, and this may be beneficial after ischemia. We assessed NPWT effects on skeletal muscle cellular morphology at different time points after compartment syndrome in an animal model and attempted to determine whether regional differences in fiber recovery occurred. The primary outcome that we investigated was the cross-sectional area occupied by normal-appearing muscle fibers and other cellular morphologies. A secondary outcome was the change in muscle weight as a marker of intramuscular fluid accumulation. We hypothesized that NPWT would improve muscle fiber regeneration after an acute compartment syndrome and would decrease muscle weight by enhancing edema clearance.

La bibliografia pot ser  interessant x si heu de presentar algun cas tractat amb aquest tipus de cura oclusiva-aspirativa

Inmobilitzacio en rotacio externa de la luxacio espatlla reduïda

Bueno sembla Dra Boo que no es posen d'acord en la inmob en RExt de l'espatlla...............
Immobilization with an External Rotation Brace Was Similar to an Internal Rotation Sling for Shoulder Dislocation......Conclusion: In patients with a shoulder dislocation, immobilization with use of an external rotation brace did not reduce the rate of recurrent instability or improve quality of life more than use of an internal rotation sling.

Artrosi post meniscectomia

Tots els llibres diuen que la meniscectomia va seguida de una artropatia degenerativa. Aqui un exemple:

Total meniscectomy in adolescents: A 40-YEAR FOLLOW-UP.
pág. 1649-1654
DOI: 10.1302/0301-620X.94B12.30562
Pengas, I. P.; Assiotis, A.; Nash, W.; Hatcher, J.; Banks, J.; McNicholas, M. J.

AB : We continued a prospective longitudinal follow-up study of 53 remaining patients who underwent open total meniscectomy as adolescents and who at that time had no other intra-articular pathology of the knee. Their clinical, radiological and patient-reported outcomes are described at a mean follow-up of 40 years (33 to 50). The cohort of patients who had undergone radiological evaluation previously after 30 years were invited for clinical examination, radiological evaluation and review using two patient-reported outcome measures. A total of seven patients (13.2%) had already undergone total knee replacement at the time of follow-up. A significant difference was observed between the operated and nonoperated knee in terms of range of movement and osteoarthritis of the tibiofemoral joint, indicating a greater than fourfold relative risk of osteoarthritis at 40 years postoperatively. All patients were symptomatic as defined by the Knee Injury and Osteoarthritis Outcome Score. This study represents the longest follow-up to date and it can be concluded that meniscectomy leads to symptomatic osteoarthritis of the knee later in life, with a resultant 132-fold increase in the rate of total knee replacement in comparison to their geographical and age-matched peers. 
(C) 2012 British Editorial Society of Bone and Joint Surgery