Using Absorbable Suture For Traumatic Wound Closure To Avoid Additional Hospital Visit For Suture Removal During The Covid 19 Pandemic: A Randomized Controlled Trial

Introduction: The COVID-19 pandemic worldwide forced governments to undertake intervention measures to encourage social distancing. Meanwhile, traumatic skin lacerations require multiple hospital visits for dressing, changings, and suture removal since they are usually repaired with non-absorbable sutures. In a matter of fact, these visits can be avoided by using absorbable sutures instead. However, absorbable sutures carry the theoretical risk of wound infection. In this study, our aim was to determine whether absorbable sutures are better than non-absorbable sutures in repairing lacerations during the COVID-19 pandemic. The first and second objectives were to assess the rate of infection and the number of postoperative hospital visits. Method(s): A sample of 469 patients with traumatic skin lacerations were analysed during the COVID-19 pandemic in April-July 2020. In the control group, wounds were repaired using non-absorbable sutures, while rapid-onset absorbable sutures were used in the treatment group. By conducting a phone call follow-up after 21 days, several parameters regarding infection signs and hospital visits were compared between both groups. Result(s): No statistically significant difference was observed between both groups regarding wound infection (p-value= 0.623). Using absorbable sutures resulted in fewer postoperative hospital visits than non-absorbable sutures (p-value= 0.001). This study is limited because the assessment of wound infection was subjective to the patient by a phone call follow-up. Conclusion(s): Using absorbable sutures to close traumatic skin lacerations is safe. They should be considered during a pandemic to reduce hospital visits for suture removal, which will subsequently enhance social distancing and relieve hospital load.

Work for Idle Hands: A Simulation Model for Nail Bed Injury and Avulsion Repair

Learning Objectives: Wounds of the fingernail bed are a frequent injury encountered in the emergency department however residents often learn techniques for repair at the bedside. We aimed to develop and evaluate an economical and accessible simulation model of nail bed repair that could be used during online lecturing. Introduction: Hand and fingertip trauma account for millions of visits to the emergency department annually. Nail bed injuries, including avulsions or unstable nails, are particularly common, however, there are limited opportunities for supervised practice and mastery of nail bed avulsion repair. We developed an economical and accessible simulation model to allow for practice of nail bed avulsion Covid-19 pandemic. Curricular Design: The model consists of a halved hotdog with an acrylic nail embedded into and glued using nail glue at the terminal rounded end. Pressure was applied to the distal acrylic nail, tearing the hotdog at the insertion site of the nail, creating a horizontal nail bed laceration consistent with a nail bed avulsion injury. Red food coloring was used to mimic bleeding from a nail avulsion. The cost was approximately $0.20 per model. Models and suture material were available for residents to pick up at the hospital prior to the online conference. Impact/Effectiveness: The model was tested with thirty-four emergency medicine residents during an online conference and simulation session performed over Zoom;the ultimate goal was to reapproximate the nail in good anatomical position with appropriately placed absorbable sutures. A voluntary survey was available for residents which yielded highly positive feedback with survey results confirming that the model provided valuable education.

Management of Maxillofacial Trauma Emergency Department Presentations in an Evolving Pandemic. Did COVID-19 Change Our Practice?

Aim: Trauma encompasses a significant proportion of referrals to Oral Maxillofacial Surgery (OMFS). COVID-19 called for clinicians globally to tailor practice and follow-up patterns. Multiple government-imposed lock downs saw changes in patterns of emergency department (ED) attendances nationally. The aim of this audit was to examine the impact of COVID-19 on Maxillofacial trauma presentations, admissions, and existing practice in University Hospital of Wales (UHW). Method: Data was collected using an electronic patient database Team Talk. Patients filtered by pathology (Soft tissue trauma, fractures) and location (ED). Annual data collected for 2019, 2020 and 2021, to compare pre-pandemic (2019), evolving pandemic (2020) and established pandemic (2021) figures. Results: Trauma made up 74%, 73% and 78% of total OMFS referrals (2019, 2020, 2021). There was an 83% decrease in the number of trauma referrals between 2019 and 2020, despite UHW becoming a major trauma centre. No correlation identified between trauma presentations and lockdown events (2020) but lifting of restrictions (September 2021) showed an increase in presentations. 16.8%, 16.4% and 16.2% (2019, 2020 and 2021, respectively) of ED referrals were offered follow up follow up. Percentage of follow up appointments used for removal of sutures (ROS) decreased by 30% (2019-2020). Conclusions: 1) Overall decrease of trauma presentations during the COVID-19 pandemic, but trauma still comprised >70% of all OMFS referrals from ED. 2) Pandemic pressures did not change follow-up, discharge, or admission decisions for ED referrals. 3) Change to absorbable sutures can be taken forward to reduce percentage of follow up clinic appointments required for ROS.