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Advanced Wound Care Therapies for Non-Healing Diabetic, Venous, and Arterial Ulcers: A Systematic Review [Internet]

Chronic ulcers (i.e., ulcers that are unresponsive to initial therapy or that persist despite appropriate care) are estimated to affect over 6 million people in the United States. The incidence is expected to increase as the population ages and as the number of individuals with diabetes increases. Chronic ulcers negatively affect the quality of life and productivity of the patient and represent a substantial financial burden to the health care system.

Evidence-based Synthesis Program - Department of Veterans Affairs.

Version: November 2012
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Surgical interventions for treating acute Achilles tendon ruptures

Rupture of the Achilles tendon is common and said to be increasing. It typically occurs in males in their 30s and 40s who play sport intermittently. People present with severe pain in the tendon, at the back of the ankle. Signs include a palpable gap at the rupture site, and marked weakness of ankle plantar‐flexion (movement so toes point downwards). Options for management include non‐surgical interventions (plaster of Paris, bracing or splinting) or surgical repair of the tendon. Following either method of treatment, the ankle may be immobilised for up to 12 weeks (in a cast, allowing no movement at the ankle and variable weight‐bearing), or mobilised early (in a brace, allowing movement at the ankle and partial to full weight‐bearing).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Non‐removable pressure‐relieving interventions help to heal foot ulcers in people with diabetes

Foot ulceration is a complication of diabetes and can lead to amputation. Ulcers can occur due, in part, to abnormal pressures on the sole of the foot. The studies included in this review compared non‐removable pressure‐relieving interventions (foot casts) with other ways of relieving pressure on the ulcer site to improve healing. The comparisons included dressings alone, temporary therapeutic shoes, removable pressure‐relieving devices and surgical intervention. The review found that the non‐removable interventions were more effective than any of the other external pressure‐relieving methods. Non‐removable casts used with Achilles tendon lengthening were more successful in one forefoot ulcer study than using a non‐removable cast alone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Injection treatment for painful Achilles tendons in adults

The Achilles tendon connects the calf muscles to the heel bone. Painful and stiff Achilles tendons are common overuse injuries in people undertaking sports, such as running, but also occur for other reasons in inactive people. The underlying cause is an imbalance between the damage and repair processes in the tendon. Painful Achilles tendons are often disabling and can take a long time to get better. Many treatments exist for this condition and this review set out to find out whether treatment with an injection, with a variety of agents, decreases pain and allows people to return to their previous activities.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

A systematic review of rehabilitation protocols after surgical repair of the extensor tendons in zones V-VIII of the hand

STUDY DESIGN: Systematic review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Negative Pressure Wound Therapy Technologies for Chronic Wound Care in the Home Setting [Internet]

To systematically review the efficacy and safety of negative pressure wound therapy (NPWT) for treatment of chronic wounds in the home setting.

Technology Assessment Report - Agency for Healthcare Research and Quality (US).

Version: September 15, 2014
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A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture

Achilles tendon ruptures are a common injury afflicting predominantly the young male occasional sportsman. Previous studies have shown that outcome is better with surgical repair for the young active patient. There is no consensus as to whether there is a difference in outcome between open and percutaneous minimally invasive surgery (MIS). A meta-analysis was undertaken to compare the clinical outcomes of MIS with conventional open surgical repair. Six randomised controlled trials of 277 Achilles tendon repairs were eligible for review. This included 136 minimally invasive repairs and 141 conventional open repairs. On analysis, there was no significant difference between the two surgical approaches in respect to the incidence of re-rupture, tissue adhesion, sural nerve injury, deep infection and deep vein thrombosis (p>0.05). However, MIS had a significantly reduced risk of superficial wound infection, with three times greater patient satisfaction for good to excellent results compared with conventional open surgical approaches.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Wound complications with posterior midline and posterior medial leg incisions: a systematic review

There is no consensus on the optimal incisional approach at the posterior leg to avoid wound healing complications. The purpose of this systematic review is to report and compare complication rates associated with two common incisions used to approach the Achilles tendon in order to provide additional recommendations for optimal incision placement.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Using a scalpel compared with electrosurgery for making surgical incisions in the abdomen

During abdominal operations, surgeons may need to make cuts (incisions) in the body. This can either be done by using scalpels or electrosurgery. A scalpel is an extremely sharp bladed instrument used to cut the skin and underlying tissue. Electrosurgery is a method of separating tissues using electricity. An electrical current is passed from the tip of the instrument which causes the tissue to rapidly heat up. As they heat up, the cells burst and vaporise. The surgeon will move the instrument along the tissue, causing more cells to be destroyed and a cut, or incision, to be created. The potential benefits of using electrosurgery include reducing the amount of blood lost, dry and rapid separation of tissues, and a reduced risk of surgeons accidentally cutting themselves. The disadvantages of this technique include the possibility of poor wound healing, there are concerns that large or excessive scars may form, and it is thought that there is the potential for an increase in the risk of adhesions forming. Adhesions are potentially painful links of tissue that develop between the site of the incision and organs or other surfaces in the abdomen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Systematic review of flexor tendon rehabilitation protocols in zone II of the hand

BACKGROUND: Restoration of function following flexor tendon repair in zone II represents a difficult clinical problem. Despite many publications on rehabilitation methods, there exists no consensus as to which method is superior. This study was undertaken to determine which flexor tendon rehabilitation protocol provides the best outcome after surgical repair in zone II.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence

PURPOSE: The aim of this study was to evaluate, in a meta-analysis, the clinical effectiveness of operative treatment for acute Achilles tendon rupture (AATR) compared with nonoperative treatment.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Treatment Options for Rotator Cuff Tears: A Guide for Adults

This guide will tell you about what research has found regarding the different choices for treating your rotator cuff tear. You can use it to help you and your doctor or other health care provider (nurse practitioner, physician’s assistant, physical therapist) discuss and decide what treatments are best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: October 29, 2010

Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand: a systematic review of controlled trials

There is no consensus on the most effective rehabilitation regimen following extensor tendon repair of the hand. This systematic review evaluates the outcomes of the various regimens. The Cochrane, MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker databases were searched for any prospective randomised clinical trials comparing rehabilitation regimens for acute extensor tendon injuries in adults. Five papers met the inclusion criteria. The regimens were static immobilisation, dynamic splinting and early active motion (EAM). There was no standard format of reporting. The sample size ranged from 27 to 100 patients. The duration of follow-up ranged from 8 to 24 weeks. Overall, patients' total active motion improved with time. Early mobilisation regimens (active and passive) achieve quicker recovery of motion than static immobilisation but the long-term outcome appears similar. Given the comparable outcomes between dynamic splinting and EAM, we therefore favour EAM which is simpler and more convenient.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Complications after flexor tendon repair: a systematic review and meta-analysis

The authors concluded that the evidence was supportive of using the modified Kessler repair technique with epitendinous suture to minimise complications after flexor tendon repair. A lack of information on study characteristics and potential limitations of the meta-analysis mean the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

A systematic review of 2-strand versus multistrand core suture techniques and functional outcome after digital flexor tendon repair

PURPOSE: To determine published evidence to evaluate the hypothesis that multistrand techniques result in a poorer outcome than 2-strand techniques for digital flexor tendon repairs.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Accelerated rehabilitation following Achilles tendon repair after acute rupture — development of an evidence-based treatment protocol

The acute rupture of the Achilles tendon is a protracted injury. Surgery is only the beginning of a long rehabilitation period. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. We performed a systematic literature search in Medline, Embase and Cochrane library. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Five trials compared full to non weight bearing, all applying immobilization in equinus. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Four trials compared early ankle mobilization to immobilization. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. This combination was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. No study found an increased rerupture rate for the more progressive treatment. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0° should be applied.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Effect of aftercare regimen with extensor tendon repair: a systematic review of the literature

Over the past several years, advances in the treatment of extensor tendon injuries have focused mainly on changes to postoperative protocols. Traditional static splinting has been found often to result in loss of flexion as well as extension lags at the metacarpophalangeal and interphalangeal joints. In addition, early motion, once thought to increase the risk of tendon rupture, has shown encouraging results. The purpose of this article was to conduct a systematic review of the literature to determine the optimal postoperative protocol following extensor tendon repair. A systematic review was conducted of PubMed and Cochrane databases to identify all English-language clinical papers reporting results on the surgical treatment and rehabilitation of extensor tendon injuries. Returned articles were reviewed and included in the study if they reported clinical outcomes following surgical repair. A statistical consultation was placed to aid with data analysis. Nineteen studies were included. Of these, eight studies used static splinting (437 tendons), 12 used dynamic splinting (600 tendons), and five used active motion (240 tendons) for their postoperative protocols. Six studies were comparative, two of which reached level I evidence, while the remaining 13 studies were case series, with level IV evidence. Overall, generally favorable results were found for all three regimens with a high degree of variability with respect to outcomes measures reported and methods used for reporting. Quantitative statistical analysis of outcome measures was not possible given this variability. However, complication rates were as follows: static splinting complication rate was 4.1% with 1.8% requiring tenolysis and 0.9% tendon ruptures, dynamic splinting complication rate was 4.3% with 3.2% extensor tendon lags and 0.2% tendon rupture, and early motion complication rate was 1.7% with 0.8% tendon ruptures. Functional results, when reported, were generally favorable for all three postoperative regimens; however, standardized reporting of functional results is needed for quantitative analysis. Early active motion protocols following extensor tendon repair provides a relatively lower complication rate than other postoperative regimens.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Flexor tendon repair rehabilitation protocols: a systematic review

PURPOSE: To systematically review various flexor tendon rehabilitation protocols and to contrast those using early passive versus early active range of motion.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Does immobilization after arthroscopic rotator cuff repair increase tendon healing? A systematic review and meta-analysis

INTRODUCTION: To determine whether immobilization after arthroscopic rotator cuff repair improved tendon healing compared with early passive motion.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Outcomes of arthroscopic and open surgical repair of isolated subscapularis tendon tears

PURPOSE: Reports of the results of subscapularis repairs make up a very small minority of the published literature on rotator cuff repairs, yet subscapularis tears cause significant pain and dysfunction for patients. The goals of this study were to systematically review the published results after subscapularis repair and to compare arthroscopic versus open techniques when appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic Reviews in PubMed

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