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Second Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
The hands-on method (also described by Ritgen) involves employing pressure on the infant’s head upon crowning and supporting the perineum with the other hand. The aim is to protect against lacerations. In the hands-poised method, the fetal head and perineum are not touched or supported by the delivering personnel. These two methods are associated with similar incidences of perineal and vaginal tears, but the hands-on method is associated with a 42% higher incidence of episiotomies [28]. A policy of hands-poised has also been supported by a meta-analysis of five RCTs. The hands-on method does not protect against severe perineal trauma and was associated with increased risk of third-degree lacerations (RR 3.41, 95% CI 1.39–8.37) [42]. In summary, the hands-on method should be avoided in labor.
Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Lacerations are caused by blunt force tearing tissues. Incised wounds are caused by sharp objects cutting the skin. Assessment of the neurovascular status and underlying structures is imperative. The possibility of an underlying fracture must also be considered. An essential part of wound care which must not be overlooked is adequate cleaning and removal of foreign bodies. To be confident that these have been carried out well may require local anaesthesia. Once anaesthetized, wounds can be more formally explored painlessly to check for damage to deeper structures. Radiography may be helpful for radio-opaque foreign bodies (metal and most glass); ultrasound can be helpful for other objects such as wood, plastic, thorns, etc.
Scalp, facial and gunshot injuries
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Many doctors as well as non-medically qualified people call all wounds lacerations, not differentiating a laceration from an incised wound (see next section). A laceration is a splitting or tearing of the skin caused by blunt trauma. The head is a particularly common area for lacerations to occur because the skin is closely associated with underlying bone in this region and, therefore, when blunt force is impacted on the skin, the skin is rapidly compressed against the bone. In comparison, considerably more force is required to inflict a laceration in the chest or abdomen. Lacerations on the face may result from a punch, but a punch would not be expected to cause a laceration on the scalp, unless a ring, knuckleduster or similar object was worn. On the face, lacerations occur over bony prominences, including the orbital ring, and over the maxillae. With severe damage to the underlying skeleton, the bones may break through the skin, lacerating it in the process. An unusual example of this mechanism was described by Ainsworth and Hunt (1993) where a blow to the nose, which pushed the nose upwards, resulted in the nasal bone penetrating the skin, before returning to its original position. This resulted in a curved laceration of the tip of the nose. Punches to the lower jaw do not typically cause a laceration of the skin, even with a fractured jaw, although the assailant's hand may be lacerated from the blow, especially if he strikes the teeth of the victim.
Experiences and coping behaviors of patients with psoriasis: a qualitative study
Published in Journal of Dermatological Treatment, 2023
Lin-Lin Lee, An-Ping Huo, Shu-Ling Chen
The experience of psoriasis-related skin pain is complex. Pain has a major negative impact on patients’ emotional and psychological health. Most patients reported that psoriasis caused cracked skin pain in repeated attacks, which were very painful, and even had thoughts of self-harm and suicide. In this regard, as Ljosaa et al. (24) found, psoriasis-related skin pain reduced their physical activity levels, impaired their sleep, and made them irritable, depressed, distracted while performing tasks, and withdrawn from other people and social activities. Although their lives were largely affected by the pain, patients stated that they chose tolerate it rather than taking analgesics for symptom relief. However, the pain was described as feeling like lacerations, needle pricks, or open wounds. Ljosaa et al. (24) reported several metaphors for painful skin: like the skin is ripped off of you or the skin feels like an open wound. The patients also reported encountering discrimination and feeling stigmatized, so their social interactions were disrupted or they became socially withdrawn. In this regard, Reich et al. (31), who conducted a study on 100 patients with psoriasis, suggested that the stigmata cause disturbances in social interaction; disappoint the person; create feelings of hatred, inferiority, isolation and worthlessness in the individual; and reduce the social status of the individual in the family and society.
Efficacy and safety of stromal vascular fraction on scar revision surgery: a prospective study
Published in Journal of Dermatological Treatment, 2023
Hyeokjae Kwon, Seokui Lee, Jiyoung Kim, Seung Han Song
A scar is an abnormal remodeling of a wound that can be caused by trauma, burns, or surgery (1,2). Due to their cosmetic appearance, scars impair patients’ self-esteem and may cause functional discomfort, such as pain, itchiness, and a restriction of joint movement due to contracture, thereby reducing normal social function (2). Therefore, various medical treatments have been used to prevent and treat scars (3). Approximately 12 million lacerations are sutured every year in the United States alone, with 250 million surgical incisions made worldwide, and more than 20 billion USDs are spent on scar management every year (4). In addition, 170,000 scar revisions have been performed per year in the United States alone (5), and several treatments, such as topical and intralesional therapies, have been also used in parallel, but the effects are limited (3).
Craniofacial and traumatic brain injuries in mixed martial arts
Published in The Physician and Sportsmedicine, 2021
Mohamad Y. Fares, Hamza A. Salhab, Jawad Fares, Hussein H. Khachfe, Youssef Fares, Hasan Baydoun, Joseph A. Abboud, Nada Alaaeddine
Head injuries were further categorized according to type. According to the American Association of Neurological Surgeons (AANS), a traumatic brain injury (TBI) is defined as a blow to the head that disrupts a person’s normal brain function [13]. Symptoms depend on the extent of the injury and can vary from a brief change in mental state to a total loss of consciousness, coma, or even death. As stated before, a KO occurs when a fighter experiences a total loss of consciousness, and a TKO occurs when the fighter experiences an impaired consciousness that prevents him/her from defending properly. According to these definitions, we considered any of these three situations to constitute a TBI: 1) when a TKO/KO finish occurs due to head strikes, 2) when the fighter’s consciousness appears visibly impaired, or 3) when a brain MRI is required for post-fight evaluation due to repetitive head strikes [13,14]. On the other hand, injuries that affected the face or the cranium were considered craniofacial injuries, and those included ‘Lacerations’, ‘Fractures’ or ‘Other’. ‘Lacerations’ were defined as any head injury that resulted in cuts, lacerations or abrasions. ‘Fractures’ were defined as any recorded fracture injury that involved the nose, orbital bone, jaw, or skull. ‘Other’ injuries were defined as those that were not ‘TBI’, ‘lacerations’ or fractures.