Look at each of the Case Studies below. What would be your initial concerns rega

Question

Look at each of the Case Studies below. What would be your initial concerns regarding the patient? What additional information or test results would you expect to be ordered for this patient? Based on the brief information provided, what treatment/management would you expect for the patient? ?

1. Jay, a 14-year-old male, recently had abdominal surgery. The wound was appearing to heal as expected; however, a coughing fit resulted in slight re-opening of the wounThe wound is now infected.

2. Alex has a large laceration resulting from a motorcycle accident that has been left open to heal. She is concerned about an increased risk for infection.

3. Lily, a young female athlete, required knee surgery, which resulted in keloid formation. She now has to have surgery on the other knee and is concerned about keloid formation happening again.

4. Cameron, a 22-year-old male, recently required shoulder surgery in order to be able to pitch for his college team. An adhesion developed within the shoulder joint.

5. Luke is a young child who suffered severe burn wounds on his left lower extremity. Skin grafts were performed and the wound healed adequately. However, as he grows, movement of the knee joint has become restricted.

Explanation / Answer

1. The primary concern is the infection control and prevention of herniation through that opening. A swab from the infected wound should be sent for gram stain/culture to rule out serious hospital-acquired infection. Treatment: debridement of the wound, resuturing of the opening and start a broad spectrum antibiotic to control the infection. Analgesic to control pain. Regular antiseptic dressing to speed up the wound healing.

2. The primary concern is tetanus( Clostridium tetani) infection. Swab/ pus from the laceration can send for gram staining and other bacteriological testings. Should be on an antibiotic which will give coverage of gram positive and gram negative bacteria and a second antibiotic to cover anaerobic infection. Her vaccination status ( regarding tetanus toxoid) should be enquired. Anti-tetanus immunoglobin can be used prophylactically until bacterial reports are available. Analgesic to control pain and regular anti-septic dressing. Yes keep the wound open but keep it clear.

3. As stated the major concern is the success of the knee surgery and second concern is the formation of keloid tissue at the excision site of surgery. In this case, the careful history is needed to be taken, Histopathological findings from the keloid tissue of another knee can point towards the cause. Treatment is: prevention is the best option to avoid keloid formation, avoid unnecessary cosmetic surgery. Definitive therapy for existing keloid tissue are occlusive dressings, compression therapy, cryosurgery, excision, radiation therapy, laser therapy, interferon (IFN) therapy, 5-fluorouracil (5-FU), doxorubicin, bleomycin, retinoic acid, imiquimod 5% cream, tamoxifen, tacrolimus application, botulinum toxin, hydrogel application, intralesional corticosteroid injections, etc.

4. The primary concern is the movement of a shoulder joint( which is restricted due to frozen shoulder ). Investigation: X-ray of the affected shoulder joint or MRI of the affected shoulder joint. Treatment: pain management with analgesics, physiotherapy to restore shoulder movement. Surgical treatment is to remove adhesive tissue from the shoulder joint. Steroid injection in the shoulder can help in some cases, Joint distension is another surgical procedure to restore shoulder movement.

5. Luke's primary concern is the muscle and tendon contracture due to the burn injury in his lower limb. Xray and MRI can give a clear picture of the conditions. Treatment includes physiotherapy, More exercise of the affected limb, wearing a splint in the affected limb to prevent further contracture. surgical incision like quadra Z techniques can cure burn contractures.

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