Wound healing in total joint arthroplasty.
Identifieur interne : 002921 ( PubMed/Corpus ); précédent : 002920; suivant : 002922Wound healing in total joint arthroplasty.
Auteurs : Richard E. JonesSource :
- Orthopedics [ 1938-2367 ] ; 2010.
English descriptors
- KwdEn :
- MESH :
- diagnosis : Postoperative Complications, Prosthesis-Related Infections.
- prevention & control : Prosthesis-Related Infections.
- therapy : Postoperative Complications.
- Arthroplasty, Replacement, Knee, Bandages, Drainage, Humans, Wound Healing.
Abstract
Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.
DOI: 10.3928/01477447-20100722-35
PubMed: 20839686
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Jones</name><affiliation><nlm:affiliation>Department Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA. dickeyjones@gmail.com</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2010">2010</date><idno type="RBID">pubmed:20839686</idno><idno type="pmid">20839686</idno><idno type="doi">10.3928/01477447-20100722-35</idno><idno type="wicri:Area/PubMed/Corpus">002921</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">002921</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Wound healing in total joint arthroplasty.</title><author><name sortKey="Jones, Richard E" sort="Jones, Richard E" uniqKey="Jones R" first="Richard E" last="Jones">Richard E. Jones</name><affiliation><nlm:affiliation>Department Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA. dickeyjones@gmail.com</nlm:affiliation></affiliation></author></analytic><series><title level="j">Orthopedics</title><idno type="eISSN">1938-2367</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term><term>Bandages</term><term>Drainage</term><term>Humans</term><term>Postoperative Complications (diagnosis)</term><term>Postoperative Complications (therapy)</term><term>Prosthesis-Related Infections (diagnosis)</term><term>Prosthesis-Related Infections (prevention & control)</term><term>Wound Healing</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Postoperative Complications</term><term>Prosthesis-Related Infections</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Prosthesis-Related Infections</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Postoperative Complications</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term><term>Bandages</term><term>Drainage</term><term>Humans</term><term>Wound Healing</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">20839686</PMID><DateCreated><Year>2010</Year><Month>09</Month><Day>15</Day></DateCreated><DateCompleted><Year>2011</Year><Month>02</Month><Day>04</Day></DateCompleted><DateRevised><Year>2010</Year><Month>09</Month><Day>15</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1938-2367</ISSN><JournalIssue CitedMedium="Internet"><Volume>33</Volume><Issue>9</Issue><PubDate><Year>2010</Year><Month>Sep</Month><Day>07</Day></PubDate></JournalIssue><Title>Orthopedics</Title><ISOAbbreviation>Orthopedics</ISOAbbreviation></Journal><ArticleTitle>Wound healing in total joint arthroplasty.</ArticleTitle><Pagination><MedlinePgn>660</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3928/01477447-20100722-35</ELocationID><Abstract><AbstractText>Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.</AbstractText><CopyrightInformation>Copyright 2010, SLACK Incorporated.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Jones</LastName><ForeName>Richard E</ForeName><Initials>RE</Initials><AffiliationInfo><Affiliation>Department Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA. dickeyjones@gmail.com</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2010</Year><Month>09</Month><Day>07</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Orthopedics</MedlineTA><NlmUniqueID>7806107</NlmUniqueID><ISSNLinking>0147-7447</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D019645" MajorTopicYN="Y">Arthroplasty, Replacement, Knee</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001458" MajorTopicYN="N">Bandages</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004322" MajorTopicYN="N">Drainage</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011183" MajorTopicYN="N">Postoperative Complications</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016459" MajorTopicYN="N">Prosthesis-Related Infections</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014945" MajorTopicYN="Y">Wound Healing</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2010</Year><Month>9</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2010</Year><Month>9</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2011</Year><Month>2</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">20839686</ArticleId><ArticleId IdType="doi">10.3928/01477447-20100722-35</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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