bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wound coverage considerations for defects of the lower third of the leg
Authors: Bajantri Babu , Bharathi R. Ravindra , Sabapathy S. Raja 
Published: September 2012

ABSTRACTAnatomical features of the lower third of the leg like subcutaneous bone surrounded by tendons with no muscles, vessels in isolated compartments with little intercommunication between them make the coverage of the wounds in the region a challenging problem. Free flaps continue to be the gold standard for the coverage of lower third leg wounds because of their ability to cover large defects with high success rates and feasibility of using it in acute situations by choosing distant recipient vessels. Reverse flow flaps are more useful for the coverage of the ankle and foot defects than lower third leg defects. The perforators in the lower third leg on which these flaps are based are often damaged during the injury. In medium-sized defects of less than 50 cm2 size, local transposition flaps, perforator flaps, or propeller flaps can be used. Preoperative identification by the Doppler is essential before embarking on these flaps. Of the muscle flaps, the peroneus brevis flap can be used in selected cases with small defects. In spite of all recent developments, cross-leg flaps continue to remain as a useful technique. In rare occasions when other flaps are not possible or when other options fail it can be a life boat. In the author′s practice free flaps continue to be the first choice for coverage of wounds in the lower third leg with gracilis muscle flap for small and medium defects, latissimus dorsi muscle flap for large defects and anterolateral thigh flap when a skin flap is preferred.
Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment
Authors: Topaz Moris 
Published: September 2012

ABSTRACTRegulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound′s environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review.
Exploiting potency of negative pressure in wound dressing using limited access dressing and suction-assisted dressing
Authors: Kumar Pramod 
Published: September 2012

ABSTRACTRole of negative pressure dressing and moist wound healing are well established in the treatment of both acute and chronic wounds with certain advantages and disadvantages in both the techniques. Both these techniques prevents wound colonization, but the negative pressure dressing method has proved to have a greater potency to remove secretions, prevent wound invasion and eradication established infection. In both these techniques there is no accessibility to wound environment. Limited access dressing (LAD) is a moist wound dressing with negative pressure. It provides limited access to the wound through two small ports for both dressers and pathogens. The LAD design has notable advantages like wound isolation that reduces chance of wound colonization and safe disposal of infected materials (important factor to reduce hospital-acquired infections), while avoiding some major disadvantages such as opacity of dressing materials, inaccessible offensive smelling wound environment, and relatively high treatment costs. In LAD a definite intermittent negative pressure regimen is followed. The intermittent negative pressure (cycle of 30 minutes suction and 3 1 / 2 hours rest) is effective. Overall, the LAD is a safe and effective alternative to conventional dressing methods. LAD is an excellent research tool for wound healing as frequent/continuous record of wound healing is possible without disturbing the wound healing process. LAD is an effective dressing for limb salvage in cases of acute and chronic complex wounds. Leech effect prevents wound related systematic response syndrome and sepsis. Suction-assisted dressing (SAD) is a combination of semiocclusive dressing with negative pressure. It works by removal of fluids by intermittent (like LAD) negative pressure and preventing bacterial invasion. SAD is especially advantageous where soakage is less, there is no dead tissue covering the wound (e.g., following skin grafting), superficial skin wounds (e.g., donor area) and also where LAD is technically difficult to apply over circumferential trunk and neck dressings under anesthesia.
Trophic ulcers-Practical management guidelines
Authors: Puri Vinita , Venkateshwaran N , Khare Nishant 
Published: September 2012

ABSTRACTThe management of patients with trophic ulcers and their consequences is difficult not only because it is a recurrent and recalcitrant problem but also because the pathogenesis of the ulcer maybe different in each case. Methodically and systematically evaluating and ruling out concomitant pathologies helps to address each patient′s specific needs and hence bring down devastating complications like amputation. With incidence of diabetes being high in our country, and leprosy being endemic too the consequences of neuropathy and angiopathy are faced by most wound care specialists. This article presents a review of current English literature available on this subject. The search words were entered in PubMed central and appropriate abstracts reviewed. Relevant full text articles were retrieved and perused. Cross references from these articles were also reviewed. Based on these articles and the authors′ experiences algorithms for management have been presented to facilitate easier understanding. It is hoped that the information presented in this article will help in management of this recalcitrant problem.
The management of perineal wounds
Authors: Parashar Atul , Sharma Ramesh K. 
Published: September 2012

ABSTRACTManagement of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum.
Recent advances in topical wound care
Authors: Sarabahi Sujata 
Published: September 2012

ABSTRACTThere are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ′magical dressings′. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.
Skin substitutes: An Indian perspective
Authors: Singh A. K. , Shenoy Y. R. 
Published: September 2012

ABSTRACTThere have been numerous alternatives developed to replace skin. These can either be permanent substitutes or temporary substitutes, which need to be replaced later by autologous grafts. These have been tried in recent times as an attempt to reduce the need or in the case of permanent substitutes ,altogether replace autologous skin grafts. However till date no ideal skin substitute has been developed. Various factors have to be considered while choosing one of these substitutes. In a developing country like India awareness and availability of these skin substitutes is not adequate considering the volume of cases that require this modality of treatment. Also there are skin substitutes developed in our country that need to be highlighted. This article is an attempt to review the vast array of skin substitutes that have been developed and consider their utility and feasibility for developing countries.
Abnormal pigmentation within cutaneous scars: A complication of wound healing
Authors: Chadwick Sarah , Heath Rebecca , Shah Mamta 
Published: September 2012

ABSTRACTAbnormally pigmented scars are an undesirable consequence of cutaneous wound healing and are a complication every single individual worldwide is at risk of. They present a challenge for clinicians, as there are currently no definitive treatment options available, and render scars much more noticeable making them highly distressing for patients. Despite extensive research into both wound healing and the pigment cell, there remains a scarcity of knowledge surrounding the repigmentation of cutaneous scars. Pigment production is complex and under the control of many extrinsic and intrinsic factors and patterns of scar repigmentation are unpredictable. This article gives an overview of human skin pigmentation, repigmentation following wounding and current treatment options.
Telemedicine for wound management
Authors: Chittoria Ravi K. 
Published: September 2012

ABSTRACTThe escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.
A novel and accurate technique of photographic wound measurement
Authors: Shetty Rahul , Sreekar H. , Lamba Shashank , Gupta Ashish Kumar 
Published: September 2012

ABSTRACT
Context: Wound measurement is an important aspect of wound management. Though there are many techniques to measure wounds, most of them are either cumbersome or too expensive. Aims: To introduce a simple and accurate technique by which wounds can be accurately measured. Settings and Design: This is a comparative study of 10 patients whose wounds were measured by three techniques, i.e. ruler, graph and our technique. Materials and Methods: The graph method was taken as the control measurement. The extent of deviation in wound measurements with our method was compared with the standard technique. The statistical analysis used was ANOVA. Results: The ruler method was highly inaccurate and overestimated the wound size by nearly 50%. Our technique remained consistent and accurate with the percentage of over or underestimation being 2-4% in comparison with the graph method. Conclusions: This technique is simple and accurate and is an inexpensive and non-invasive method to accurately measure wounds.
Bladder Neck Rupture following Perineal Bull Horn Injury: A Surgical Challenge
Authors: Padilla Fernandez B. , Diaz Alferez F.J. , Garcia Garcia M.A. , Herrero Polo M. , Velasquez Saldarriaga J.F. , Lorenzo Gomez M.F. 
Published: September 2012

Pelvic-abdominal injuries caused by goring are serious lesions which require rapid diagnosis and urgent treatment in the context of a polytraumatized patient. The simultaneous rupture of both the bladder and the prostatic-membranous urethra occurs in 10%-29% of males with pelvic fractures but bladder neck injuries in adults are rarer. Unstable pelvic fractures, bilateral fractures of the ischiopubic branches (also referred to as fractures from falling astride) and the diastasis of the pubic symphysis are those that have the greatest likelihood of injuring both the posterior urethra and the bladder. We present a case of perineal bull horn injury with muscle laceration, bone fractures, scrotal avulsion and rupture of the bladder neck involving the right ureter which required two operations to be repaired.
Community Participation and Recovery for Mental Health Service Users: An Action Research Inquiry
Authors: Fieldhouse Jon 
Published: September 2012

Introduction: The social inclusion of individuals with mental health problems is an issue for mental health services, for the individuals who experience stigma, discrimination and exclusion, and for society at large. To develop community-orientated services that are capable of promoting inclusion it will, therefore, be advantageous to all parties to understand what service users find most helpful. Method: A 2-year action research project explored the recovery journeys of a group of assertive outreach service users who had progressed from being socially excluded and occupationally deprived to being participants in their local communities. The research aimed to understand how these outcomes were produced and to use this knowledge to inform local service development. Findings: This paper focuses on eight qualitative interviews, where service users recounted their stories of community participation and inclusion. The findings show how assertive outreach practitioners harnessed occupation as a basis for building relationships between practitioners and service users, and how this became a conduit towards participation in the mainstream community. Conclusion: Facilitating engagement in community-based occupations through creative collaboration helped participants reconnect with cherished roles, achieve long-standing goals and develop feelings of self-efficacy, belonging and wellbeing.
Glaucoma Progression Detection: Agreement, Sensitivity, and Specificity of Expert Visual Field Evaluation, Event Analysis, and Trend Analysis
Authors: Antón Alfonso , Pazos Marta , Martín Belén , Navero José Manuel , Ayala Miriam Eleonora , Castany Marta , Martínez Patricia , Bardavío Javier 
Published: September 2012

Purpose. To assess sensitivity, specificity, and agreement among automated event analysis, automated trend analysis, and expert evaluation to detect glaucoma progression. Methods. This was a prospective study that included 37 eyes with a follow-up of 36 months. All had glaucomatous disks and fields and performed reliable visual fields every 6 months. Each series of fields was assessed with 3 different methods: subjective assessment by 2 independent teams of glaucoma experts, glaucoma/guided progression analysis (GPA) event analysis, and GPA (visual field index-based) trend analysis. Kappa agreement coefficient between methods and sensitivity and specificity for each method using expert opinion as gold standard were calculated. Results. The incidence of glaucoma progression was 16% to 18% in 3 years but only 3 cases showed progression with all 3 methods. Kappa agreement coefficient was high (k=0.82) between subjective expert assessment and GPA event analysis, and only moderate between these two and GPA trend analysis (k=0.57). Sensitivity and specificity for GPA event and GPA trend analysis were 71% and 96%, and 57% and 93%, respectively. Conclusions. The 3 methods detected similar numbers of progressing cases. The GPA event analysis and expert subjective assessment showed high agreement between them and moderate agreement with GPA trend analysis. In a period of 3 years, both methods of GPA analysis offered high specificity, event analysis showed 83% sensitivity, and trend analysis had a 66% sensitivity.
Mules and Men and Messiahs: Continuity in Yoruba Divination Verses and African American Folktales
Authors: Washington Teresa N. 
Published: September 2012

Abstract
Zora Neale Hurston’s Mules and Men reveals that African Americans were able to revise, restructure, and reformulate African orature to fit their social, political, and spiritual needs. This study examines the transformation of Yoruba ese Ifá (Ifá divination verses) into folktales and analyzes the similarities and divergences in the content and characters of the orature. This essay highlights the subtle ways that African Americans politicized and revolutionized the ese Ifá to protect the verses’ wisdom and facilitate their proliferation. The revised ese Ifá, disguised as innocuous folktales, were central to the formation of the African American worldview because they reminded dislocated Africans that divinity was not restricted to an invisible entity or controlled by a select few but was both an inheritance and an imperative essential for liberation and self-actualization.
Establishing Igbo Community Tradition in the United States: Lessons from Folkloristics
Authors: Njoku J. Akuma-Kalu 
Published: September 2012

Abstract
Since 2000, the goal of my teaching of Igbo cultural heritage in the United States has been to resuscitate suppressed Igbo community traditions and neglected traditional knowledge among educated parents so that they can pass their Igbo culture on to their American-born children. It is for this reason that I have chosen to be called, and have come to be known in Igbo American communities as TICHA, which stands for the Teaching of Igbo Cultural Heritage in America. This article shows how I have been using lessons from my over thirty years’ study of Igbo folklore to reacquaint Igbo people in America with Igbo cultural heritage, thereby shaping their preparedness to resuscitate and establish their ethnic community tradition in the United States.
Extraocular sebaceous carcinoma: a series of three cases with varied presentation
Authors: Panjwani Poonam K. , Tirumalae Rajalakshmi , Castra Julian , Manjunath Suraj , Rout Pritilata 
Published: September 2012

Background: Extraocular sebaceous carcinomas are rare cutaneous malignancies that account for only about 25% of all sebaceous carcinomas. The most common site of occurrence is the head/neck region. They are aggressive neoplasms that possess metastatic potential to regional or distant sites. Wide local excision of the lesion with removal of regional lymph nodes is the usual mode of therapy.
Methods: We present a series of three cases of sebaceous carcinomas occurring in extraocular sites outside the head and neck areas, like the axilla, chest wall, arm and thigh. One of these cases had an associated colonic carcinoma and constituted Muir-Torre syndrome (MTS). Another case presented with a skin nodule and regional nodal metastasis. The third case had a history of recurrent similar lesions at the same site.
Conclusion: Although rare, extraocular sebaceous carcinomas are seen at varied sites and frequently pose problems in diagnosis. A longterm follow-up of these cases is warranted due to their aggressive behaviour, risks of recurrence, metastasis and the possibility of development of visceral malignancies.
Extensive regression in pigmented skin lesions: a dangerous confounding feature
Authors: Lallas Aimilios , Apalla Zoe , Moscarella Elvira , Zalaudek Iris , Tzellos Thrasivoulos , Lefaki Ioanna , Cota Carlo , Argenziano Giuseppe 
Published: September 2012

Spontaneous regression in melanomas is not an uncommon phenomenon, as it has been described in 10-35% of primary cutaneous lesions [1]. Regression does not appear to predict a more favorable course, since even fully regressed melanomas may progress into metastatic disease [2]. Several dermoscopic features have been correlated with the regression process, including white scar-like depigmented areas and gray-blue, pepper-like granules, which correspond to dermal scarring, pigment incontinence and presence of melanophages [3,4]. Regression may occur not only in melanomas, but also in melanocytic nevi, which similarly may exhibit white areas and gray-blue granules or areas under dermoscopy [5]. Overall, white areas have been proposed to be associated with the fibrosis type of regression and gray-blue areas to the melanosis type of regression of melanocytic tumors [3]. Lichen planus like keratosis (LPLK) is considered to represent a regressed solar lentigo or seborrheic keratosis. Dermoscopy of LPLK at the late stage of the regression process reveals a diffuse gray-blue granular pattern, similar to that observed in regressed melanocytic lesions [6].
In this context, when evaluating skin lesions that exhibit high degree of regression, interpretation of dermoscopic findings may be problematic, especially when no other dermoscopic clues can be recognized.