Subject(s)
Leprosy/epidemiology , Tuberculosis, Pulmonary/epidemiology , Adult , Antibiotics, Antitubercular/administration & dosage , Comorbidity , Dapsone/administration & dosage , Drug Therapy, Combination , Humans , Leprosy/pathology , Male , Rifampin/administration & dosage , Tuberculosis, Pulmonary/drug therapyABSTRACT
BACKGROUND/OBJECTIVE: Wheelchair-related injuries are common, and with proper reporting of injuries, advanced technologic support may offer new ways to prevent those injuries. METHOD: Case REPORT AND FINDINGS: A man with tetraplegia who retains only minimal use of his right hand experienced a right-sided armrest malfunction of his wheelchair resulting in his wheelchair controls being out of reach. This left him stranded in the sun for almost 2 hours in 86 degrees F weather. During that time, he developed full thickness sunburns of his left forearm and deep partial thickness burns of the left fingertips where they were in contact with the left armrest. CONCLUSION: This patient's full thickness burns could have been prevented if his motorized wheelchair had back-up communication in the event of a malfunction. Technology developers must realize the need for such systems. Health care professionals must advocate for a higher standard of safety and report injuries related to wheelchair malfunction.
Subject(s)
Equipment Failure Analysis , Forearm Injuries/etiology , Forearm Injuries/prevention & control , Quadriplegia/rehabilitation , Sunburn/etiology , Sunburn/prevention & control , Wheelchairs/adverse effects , Adult , Communication Aids for Disabled , Debridement , Equipment Design , Equipment Safety , Forearm Injuries/surgery , Humans , Male , Skin Transplantation , Sunburn/surgeryABSTRACT
BACKGROUND: Full-thickness skin grafting following Mohs micrographic surgery (MMS) of the nasal tip and ala provides easy postoperative wound care and avoids functional impairment caused by wound contraction of the nasal ala free margins. Direct comparison of immediate and delayed skin grafting determined which offers greater success and defined factors contributing to success. OBJECTIVE: To determine if delayed or immediate full-thickness skin grafting results in better graft survival with improved function and appearance, and to identify the recipient bed characteristics, including the size of the wound, the proportion of the wound base having perichondrium, denuded cartilage, and granulation tissue, and graft survival for each technique. METHODS: We used a prospective study comparing 200 patients with wounds having a 3-5 cm2 surface area repaired immediately with a full-thickness skin graft (FTSG) to 200 patients with a delayed FTSG. The depth and diameter of the wound of the nasal ala and tip, and characteristics of recipient bed including size (cm2), location, proportion of wound base with perichondrium present, denuded cartilage, granulation tissue, and proportion of graft loss were the main outcomes measured. RESULTS: Partial graft loss occurred in 11% of those having delayed skin grafts and 30% of those with immediate repair. Delayed grafting was associated with a larger wound surface area (P <.0001), more denuded cartilage (P =.017), greater exposed perichondrium (P <.0001), and less partial graft loss (P <.001). When partial graft loss occurred, the area of loss was smaller with delayed FTSG (P =.036). Contraction of the wound and subsequent nasal valve impairment occurred less often with delayed FTSG (P <.0001). Graft depression was significantly less with delayed FTSG of the ala (P <.0001) and also improved on the nasal tip (P =.47). CONCLUSION: This prospective clinical trial of immediate and delayed FTSGs of the nasal tip and ala with denuded cartilage showed improved graft survival in cases where grafting was delayed for 12-14 days. During this period, substantial granulation tissue formed in the wound base. Assessment of the wound base and the presence of granulation tissue are key factors in the success of full-thickness skin grafting.
