Diabetic ulcer superficial swab cultures have a low specificity for guiding antibiotic treatment. Some studies have recently re-assessed and advocated the role of superficial swabs. We have performed an analysis of microbiology results in patients with infected diabetic ulcers to further appraise the need for using deep tissue cultures as a guide for antimicrobial treatment. We reviewed 23 consecutive diabetic patients in 2013. All patients underwent investigation and treatment by the Orthopaedic department for deep, intractable diabetic ulceration. Microbiology culture results from superficial swabs were compared to deep tissue and bone biopsies.Introduction:
Methods:
Long-term ankle pain, stiffness or swelling are frequent following ankle fracture. We investigated whether engineered compression stocking (ECS) influenced functional outcome and quality of life (QoL). Ninety patients < 72 hours following ankle fracture, (59 conservative and 31 operative fixation) were randomised to i) ECS + air-cast boot or ii) air-cast boot alone. Patients were followed at 2, 4, 8, 12 weeks and 6 months for Olerud Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Score (AOFAS) and SF12v2 score with duplex imaging for deep vein thrombosis (DVT) at 4 weeks. 22 controls managed by plaster of paris (POP) were also assessed at 6 months only.Introduction
Methods
Closure with interrupted mattress sutures is useful where careful skin apposition is required following hindfoot surgery. However, suture removal can be technically difficult and painful. Modification with an additional suture loop creates a “traction loop suture”. We hypothesise this technique makes suture removal quicker and reduced tension placed on sutures during their removal reduces pain. 37 patients undergoing elective hindfoot surgery took part in a prospective clinical trial comparing traditional interrupted sutures with traction loop sutures. Each patient underwent half of each wound sutured with both types. Sutures were removed at 2 weeks and pain levels were determined during removal using the 10 cm visual analogue pain scale. Duration of time taken for each type of suture removal was measured. Wound complications were recorded at 2 and 6 weeks post-operative. Results demonstrated traction loop sutures were 43% less painful to remove per wound than normal interrupted sutures (mean difference 1.06; standard deviation 1.56; 95% confidence interval 0.50 to 1.62; p-value 0.001). Traction loop sutures were also 31% quicker to remove per wound (mean difference 15.72 seconds; standard deviation 19.98; confidence interval 8.51 to 22.93; p-value <
0.001). At 2 weeks, 1 normally sutured wound suffered dehiscence. At 6 weeks, no complications were noted in either group. Our results demonstrate that traction loop sutures provide a quick and simple means of reducing patients’ pain and time during suture removal. Traction loop suturing technique could be applied to other surgical specialities where interrupted suture closure is indicated.
