Wounds
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It is hypothesized that cumulative extended application of extracorporeal shockwave therapy (ESWT) can be beneficial to sustain the effect of ESWT and improve the long-term outcome in chronic diabetic foot ulcers (DFUs). ⋯ The effects of ESWT appear to maintain certain levels for an extended period of time at 1 year but start to show deterioration on tissue viability. Therefore, it is speculated that intermittent booster ESWT may maintain the effects of ESWT and sustain the tissue viability and repairing. The use of ESWT appeared to be effective for DFU treatment, and extended ESWT showed a tendency of sustaining ESWT effects when multiple booster treatments are utilized in patients with a DFU.
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Hospital-acquired pressure injuries (HAPIs) increase patient mortality and length of stay (LOS). Twenty-eight full-thickness HAPIs occurred in fiscal year 2015 (FY15), and that trend continued into FY16 with 14 injuries on multiple units throughout a tertiary acute care center with 400 beds. To address this trend, a multidisciplinary Pressure Injury Prevention (PIP) team was created. ⋯ The data demonstrate that the formation of a multidisciplinary PIP team of engaged clinicians can reduce the number of preventable full-thickness HAPIs.
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Fournier's gangrene (FG) remains a forbidding necrotizing soft tissue infection (NSTI) that necessitates early recognition, prompt surgical excision, and goal-directed antibiotic therapy. Traditionally, surgical management has included wide radical excision for sepsis control, but this management often leaves large, morbid wounds that require complex wound coverage, prolonged hospitalizations, and/or delayed healing. ⋯ To the best of the authors' knowledge, this is the largest case series reported in the literature using skin and soft tissue sparing surgery for wound closure of a FG NSTI.
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The problem of postburn itch has been underevaluated and undertreated in the past. However, recently published data have expanded the evidence base, which provides clinicians and their patients with new evaluation and treatment options that can help reduce and potentially eliminate the prolonged distress experienced by burn survivors faced with postburn itch. Although a gold standard evaluation method has not yet been agreed upon, there are a number of tools that have been published that clinicians can use for assessment. ⋯ A number of treatment protocols have been described that commonly call for concurrent administration of both pharmacological and nonpharmacological treatment approaches. These protocols provide clinicians with a structured, systematic approach to treatment decisions that are evidence-based. Although many questions require further investigation, the current state of the science creates an ethical imperative that all burn survivors' itch experience should be quantitatively evaluated and appropriate treatment options explored until satisfactory outcomes are obtained.
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Case Reports
Lemons in the Arizona Sunshine: The Effects of Furocoumarins Leading to Phytophotodermatitis and Burn-like Injuries.
Phytophototoxic dermatitis is a strong phototoxic reaction to ultraviolet A (UV-A) radiation exposure after cutaneous contact with citrus fruit containing furocoumarins, leading to skin injury. At the Arizona Burn Center (Phoenix, AZ), the majority of these injuries are managed in the outpatient setting. ⋯ Burn-like lesions caused by furocoumarins after cutaneous absorption and UV-A exposure are known clinical entities in Arizona. The sequential progression from erythema to blisters equivalent to second-degree burn-like lesions to cutaneous hyperpigmentation is a well-described clinical triad. Meticulous wound care and pain control for the treatment of these burn-like lesions are essential as is the need for the wound care specialist to be well versed on this topic to quickly identify the etiology of the injury, thereby avoiding misdiagnosing the patient with nonaccidental traumatic injuries.