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Dermatological problems and treatment in long-term/nursing-home care
Published in Robert A. Norman, Geriatric Dermatology, 2020
A pressure ulcer is a localized area of trauma or tissue necrosis resulting from lack of blood supply to the tissues involved (Figure 1). Although many factors contribute to the development of pressure ulcers, the four most critical are pressure, shearing forces, friction and moisture. Pressure results in ischemia and tissue damage. Shearing forces occur when layers of tissue slide on each other and twisting and stretching of blood vessels result in subsequent ischemia and damage. Friction is the force created when two surfaces in contact move across each other, for example when a patient is pulled across the bed sheets, thus eliminating the outer protective stratum corneum and accelerating the ulcerative process. Moisture from urine, feces, wound exudate, or perspiration leads to skin maceration and an increased risk of ulceration.
Drowning
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Skin maceration, characterized by thickening, wrinkling and whitening of the skin, occurs first on the fingertips, palms and back of the hands, as well as on the toes, soles and backs of the feet, and in cases of prolonged submersion this can sometimes also be visible on the elbows and knees. Further exposure to water causes progressive loosening of the nails and skin peeling from the hands and feet in a ‘glove and stocking fashion’ (Figure 27.4).
Seat Cushions
Published in J G Webster, Prevention of Pressure Sores, 2019
In addition to temperature, the humidity at the interface can also cause skin maceration and discomfort. However, humidity is quite difficult to measure even with electrical devices. Cochran tried to conduct experiments using sensors made by Humidial Corp. (Colton, CA) which ultimately indicated humidity by color changes on a piece of blotting paper. The sensor can measure relative humidity from 20 to 90%. The results showed that humidity was lowest (15%) for the foam cushions and highest for the gel, water, and air cushions (36.5% average). The evidence indicates that all cushions employing waterimpermeable surfaces create greater humidity because moisture is trapped at the interface, whereas porous substances such as foam allow the skin to “breathe.” Foam does not encourage humidity increase but does allow higher skin temperatures at the interface.
Outpatient therapeutic paracentesis for malignant ascites: A short report reviewing local practice that supports procedural safety
Published in Progress in Palliative Care, 2018
Conor Hugh O’Neill, Mary-Ann McCann, Pauline Wilkinson
None of the complications recorded was life threatening with the commonest complication being that of post-paracentesis fluid leakage (3.3% of the procedures). This complication is more frequently associated with tunnelled catheters rather than paracentesis as suggested by Stukan12 who noted zero cases in 275 patients who underwent the latter. The relatively larger calibre of the needle used may be one explanation. A fluid leak is easily managed in this patient group using a small adhesive ostomy bag. Rather than gauze dressings alone, which can rapidly become soaked, necessitating repeated dressing change, and risk development of skin maceration. The leakage generally resolves within 24–48 h. The two cases of cellulitis resolved with oral antibiotics course within 7 days.
Female sex as a risk factor in minimally invasive direct coronary artery bypass grafting
Published in Scandinavian Cardiovascular Journal, 2019
Jan Gofus, Martin Vobornik, Zdenek Sorm, Martin Dergel, Mikita Karalko, Jan Harrer, Marek Pojar
According to EuroSCORE II definition, urgent surgery was defined as a case when the patient was either not admitted for surgery electively, required an intervention or surgery at the time of admission, or could not be sent home for medical reasons [5]. Palliative revascularization was defined as a single-vessel revascularization of LAD in a patient with multi-vessel disease, who was declined complete treatment because of high operative risk. Hybrid revascularization was defined as a combined approach in the treatment of multi-vessel disease – surgical revascularization of LAD, and percutaneous intervention of other affected coronary vessels, regardless of the timing. Smoking status was divided into 3 categories: non-smokers, ex-smokers and smokers. Non-smokers were patients who had never smoked on a regular basis. Ex-smokers were those who had stopped smoking at least 1 month before surgery. Smokers were patients who were actively smoking or had stopped smoking less than 1 month before surgery. Cerebral atherosclerosis was a term used to describe a significant stenosis of cardinal cerebral arteries proven radiologically (by ultrasonography, angiography, or computed tomography). Peripheral atherosclerosis was defined as a significant stenosis of limb arteries proven radiologically as above. Stroke was defined as a history of transient ischemic attack or complete stroke. Wound complications included a wide spectrum of healing problems, from skin maceration to wound necrosis or dehiscence. Hence the category of extensive wound complications was created, to include only patients with the need for secondary wound healing or negative pressure wound therapy (NPWT).
Helix Thigh Lift. A Novel Approach to Severe Deformities in Massive Weight Loss Patients
Published in Journal of Investigative Surgery, 2022
Luigi Losco, Ana Claudia Roxo, Carlos Weck Roxo, Alessandro de Sire, Alberto Bolletta, Roberto Cuomo, Luca Grimaldi, Emanuele Cigna, Carlos del Pino Roxo
Redundancy of skin and adipose tissue is both a functional and esthetic issue, especially in the lower extremities. Those deformities lead to skin maceration and interfere with dressing, walking and sexual activity; furthermore, the quality of life may be impaired, and some psychosocial illness could be triggered (i.e. depression) [6, 7]. The severity of contour deformities is unpredictable and depends on many factors such as age, gender, pre-surgery appearance, rate and speed of weight loss.