Skin Complications of Orthopedic Procedures and Devices

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Abstract

Background:

Knowledge of skin complications and contributing factors in orthopedic patients is important for design and development of preventive approaches. Therefore, this study was designed to assess skin complications in orthopedic patients.

Methods:

In this case-series study, 126 orthopedic patients referred to Rasoul-e-Akram and Bahman hospitals from 2012 to 2016 with skin complications were analyzed. The adverse effects were assessed with respect to type and contributing factors. Fisher’s exact test, Chi-square, and independent sample t-test were performed to assess the associations between skin complications and other variables.

Results:

Skin complications in orthopedic patients included infections in 33 (26.1%) cases and hypersensitivity reactions in 88 (40%) cases. In total, 66 (55%) cases of fracture and 35 (29.2%) cases of cellulitis were detected, while the remaining cases involved complications such as disc herniation, nerve involvement, and osteoarthritis-related arthroplasty. Severe reactions presenting as toxic epidermal necrolysis were observed in 3 patients, 2 of whom died eventually. Age and gender were not related to the type of skin complications ( P>0.05).

Conclusion:

Complications due to orthopedic treatments were not common. However, since the disease may become fatal on certain occasions, patients should receive more attention from physicians and nurses.

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Most cited references 50

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The significance of infection related to orthopedic devices and issues of antibiotic resistance.

Davide Campoccia, Lucio Montanaro, Carla Renata Arciola (2006)

Over the last 15 years, with the advent of modern standards in the control of sterility within the operating room environment and adequate protocols of peri-operative antibiotic prophylaxis, the incidence of infections associated to orthopedic implants has become very low. Nevertheless, the event of infection still represents one of the most serious and devastating complications which may involve prosthetic devices. It leads to complex revision procedures and, often, to the failure of the implant and the need for its complete removal. In orthopedics, for the enormous number of surgical procedures involving invasive implant materials, even if nowadays rare, infections have a huge impact in terms of morbidity, mortality, and medical costs. The difficult battle to prevent and fight bacterial infections associated to prosthetic materials must be played on different grounds. A winning strategy requires a clear view of the pathogenesis and the epidemiology of implant-related infections, with a special attention on the alarming phenomenon of antibiotic resistance. In this regard staphylococci are the prevalent and most important causative pathogens involved in orthopedic implant-related infections, and, thus, the main enemy to defeat. In this paper, we offer an overview of the complexity of this battleground and of the current and new, in our opinion most promising, strategies in the field of biomaterials to reduce the risks and counteract the establishment of implant infections.

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Current Concepts in the Management of Necrotizing Fasciitis

Evangelos Misiakos, George Bagias, Paul Patapis … (2014)

Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure, and liver cirrhosis. NF is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling, and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the laboratory risk indicator for necrotizing fasciitis score or Fournier’s gangrene severity index score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites. Management of the infection begins with broad-spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.

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Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology.

Mike J. Crawford, Clifford H. Watson, Lara M. Greaves … (2008)

Unselected coagulation testing is widely practiced in the process of assessing bleeding risk prior to surgery. This may delay surgery inappropriately and cause unnecessary concern in patients who are found to have 'abnormal' tests. In addition it is associated with a significant cost. This systematic review was performed to determine whether patient bleeding history and unselected coagulation testing predict abnormal perioperative bleeding. A literature search of Medline between 1966 and 2005 was performed to identify appropriate studies. Studies that contained enough data to allow the calculation of the predictive value and likelihood ratios of tests for perioperative bleeding were included. Nine observational studies (three prospective) were identified. The positive predictive value (0.03-0.22) and likelihood ratio (0.94-5.1) for coagulation tests indicate that they are poor predictors of bleeding. Patients undergoing surgery should have a bleeding history taken. This should include detail of previous surgery and trauma, a family history, and detail of anti-thrombotic medication. Patients with a negative bleeding history do not require routine coagulation screening prior to surgery.

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Author and article information

Journal

Journal ID (nlm-ta): Iran J Public Health

Journal ID (iso-abbrev): Iran. J. Public Health

Journal ID (publisher-id): IJPH

Journal ID (pmc): IJPH

Title: Iranian Journal of Public Health

Publisher: Tehran University of Medical Sciences

ISSN (Print): 2251-6085

ISSN (Electronic): 2251-6093

Publication date (Print): December 2018

Volume: 47

Issue: 12

Pages: 1937-1944

Affiliations

[1. ] Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran

[2. ] Dept. of Orthopedic, Shahid Beheshti University of Medical Sciences, Tehran, Iran

[3. ] Dept. of Dermatology, Iran University of Medical Sciences, Tehran, Iran

[4. ] Kassir Dermatology, Dallas, Texas, USA

Author notes

[* ] Corresponding Author: Email: azizian_z@ 123456yahoo.com

Article

Publisher ID: ijph-47-1937

PMC ID: 6379618

PubMed ID: 30788310

SO-VID: 04f2cd38-284e-4372-b19a-2ac327995e12

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Skin Complications of Orthopedic Procedures and Devices

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Abstract

Background:

Methods:

Results:

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China Tropical Medicine

Most cited references 50

The significance of infection related to orthopedic devices and issues of antibiotic resistance.

Current Concepts in the Management of Necrotizing Fasciitis

Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology.

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