Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?

Cold therapy has been used regularly as an immediate treatment to induce analgesia following acute soft-tissue injuries,however,a prolonged ice application has proved to delay the start of the healing and lengthen the recovery process.Hyperbaric gaseous cryotherapy,also known as neurocryostimulation,has shown the ability to overcome most of the limitations of traditional cold therapy,and meanwhile promotes the analgesic and anti-inflammatory effects well,but the current existing studies have shown conflicting results on its effects.Traditional cold therapy still has beneficial effect especially when injuries are severe and swelling is the limiting factor for recovery after soft-tissue injuries,and therefore no need to be entirely put out to pasture in the rehabilitation practice.Strong randomized controlled trials with good methodological quality are still needed in the future to evaluate the effects of different cryotherapy modalities.

Etiology, Prevalence, and Management of Oral and Maxillofacial Soft Tissue Injuries in Children at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

Background: Maxillofacial injury may vary from simple soft tissue lacerations to complex fractures of the orofacial region. Soft tissue injuries, whether isolated or in combination with other injuries, form part of the frequent traumatic craniofacial injuries seen at the emergency department. The force of impact and the injury type is directly related to the severity of the injury sustained. This study aimed to analyze the etiological factors, prevalence, and management of oral and maxillofacial soft tissue injuries at the Komfo Anokye Teaching Hospital. Methods: This was a prospective study that involved children presenting with oral and maxillofacial injuries at the Accident and Emergency Department and the Oral and Maxillofacial Surgery unit of the Komfo Anokye Teaching Hospital in Kumasi between the period of April to October 2020 (6 months). Patient selection was by convenience sampling targeting all children with injuries who met the inclusion criteria. Inclusion criteria were children below the age of 18 years whose parents or caregivers consent to participation. Children with maxillofacial injuries as a result of burns were excluded from the study. Results: During the study period a total of 134 children were reviewed with oral and maxillofacial injuries at KATH. Of these, 107 (78.9%) were recorded cases of orofacial soft tissue injuries. There were 63 (58.9%) males and 44 (41.1%) females and the male-to-female ratio was 1.5:1. The age range of patients studied was 8 months – 17 years, with mean age ± SD being 9.5 ± 5.3 years. Road Traffic Crash (50.5%) was the most common etiology of which Motor cycle crash constituted 24.3% and Pedestrian knockdown was 19.6%. Falls (42.1%) were the next most common etiology. The lips (19.8%) and the forehead (18.5%) were the most frequently injured sites on the face whiles the tongue (3.3%) had the most injuries intraorally. Laceration (45.7%) was the most frequent injury reviewed, followed by abrasions (35.8%). Most of the soft tissue injuries underwent primary closure (56.3%). A complication rate of 21.2% was recorded in this study and hypertrophic scarring (11.3%) was the most observed.

Terrorist attacks in the largest metropolitan city of Pakistan: Profile of soft tissue and skeletal injuries from a single trauma center

BACKGROUND: Pakistan has been hugely struck with massive bomb explosions(car and suicide bombs) resulting in multiple casualties in the past few years. The aim of this study is to present the patterns of skeletal and soft tissue injuries and to review the outcome of the victims who presented to our hospital.METHODS: This is a retrospective chart review from January 2008 to December 2012. The medical record numbers of patients were obtained from the hospital Health Information and Management Sciences(HIMS) as per the ICD-9 coding.RESULTS: During the study period, more than 100 suicide and implanted bomb blast attacks took place in the public proceedings, government offices, residential areas and other places of the city. Altogether 262 patients were enrolled in the study. The mean age of the patients was 31±14 years. The shrapnel inflicted wounds were present on to the upper limb in 24 patients and the lower limb in 50.CONCLUSION: Long bone fractures were the most common skeletal injuries. The fractures were complicated by penetrating fragments and nails which result in post operative infections and prolonged hospital stay.

Visual Analysis of the Treatment for Soft Tissue Injury with TCM Based on CiteSpace

Objective To explore the research hotspots and main content of the treatment of soft tissue injury with traditional Chinese medicine(TCM)in CNIK in the past 20 years,and to provide reference for the formulation of relevant policies and further research.Methods Based on CNKI,relevant literature was retrieved through subject terms.CiteSpace software was used for visualization analysis of authors,institutions and keywords.Finally,correlation analysis was carried out based on specific content.Results and Conclusion The cooperation networks between authors and research institutions were scattered,and most of them were independent studies.The establishment of cooperation network of research institutions is obviously limited by region.Based on keywords collinear,cluster and emergent analysis,during the sample statistical period,the research content of the treatment for soft tissue injury with TCM focused on clinical trials,especially the clinical therapeutic effects of different treatment schemes.The keywords cluster map mainly forms 10 clusters which are effective and can be analyzed.The treatment for soft tissue injury with TCM focuses more on the external application.

A Novel Twist Deformation Model of Soft Tissue in Surgery Simulation

Real-time performance and accuracy are two most challenging requirements in virtual surgery training.These difficulties limit the promotion of advanced models in virtual surgery,including many geometric and physical models.This paper proposes a physical model of virtual soft tissue,which is a twist model based on the Kriging interpolation and membrane analogy.The proposed model can quickly locate spatial position through Kriging interpolation method and accurately compute the force change on the soft tissue through membrane analogy method.The virtual surgery simulation system is built with a PHANTOM OMNI haptic interaction device to simulate the torsion of virtual stomach and arm,and further verifies the real-time performance and simulation accuracy of the proposed model.The experimental results show that the proposed soft tissue model has high speed and accuracy,realistic deformation,and reliable haptic feedback.

The torsion model of soft tissue in virtual surgery

In order to solve the problem of real-time soft tissue torsion simulation in virtual surgeries,a torsion model based on coil spring is proposed to actualize real-time interactions and applications in virtual surgeries. The proposed model is composed of several connected coil springs in series. The sum of torsion deformation on every coil is equivalent to the soft tissue surface deformation. The calculation of the model is simple because the method for calculating the torsion deformation for each coil spring is the same. The virtual surgery simulation system is established on PHANTOM OMNI haptic device based on the Open GL 3 D graphic interface and VC + + software,and it is used to simulate the torsion deformation of virtual legs and arms. Experimental results show that the proposed model can effectively simulate the torsion deformation of soft tissue while being of real-time performance and simplicity,which can well meet requirements of virtual operation simulations.

Advantages of Ilizarov External Fixation in an Elderly Patient with Pilon Fracture with Severe Soft Tissue Injury and Severe Osteoporosis: A Case Report

Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompanies the fracture to induce secondary injury to skin tissue. In addition, initiation of postoperative weight-bearing is delayed due to bone fragility and difficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for elderly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe osteoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe osteoporosis. The present case provides evidence that this procdure can be successfully applied to the management of such pilon fractures in elderly patients.

Soft Tissue Deformation Model Based on Marquardt Algorithm and Enrichment Function

In order to solve the problem of high computing cost and low simulation accuracy caused by discontinuity of incision in traditional meshless model,this paper proposes a soft tissue deformation model based on the Marquardt algorithm and enrichment function.The model is based on the element-free Galerkin method,in which Kelvin viscoelastic model and adjustment function are integrated.Marquardt algorithm is applied to fit the relation between force and displacement caused by surface deformation,and the enrichment function is applied to deal with the discontinuity in the meshless method.To verify the validity of the model,the Sensable Phantom Omni force tactile interactive device is used to simulate the deformations of stomach and heart.Experimental results show that the proposed model improves the real-time performance and accuracy of soft tissue deformation simulation,which provides a new perspective for the application of the meshless method in virtual surgery.

Multidisciplinary treatment of soft tissue sarcomas:An update

Standard treatment for soft tissue sarcoma,based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy,has not substantially changed during the last several decades.Nevertheless,recent advances have contributed to considerable improvement in the management of these patients;for example,new magnetic resonance imaging sequences such as diffusionweighted imaging and magnetic resonance imaging radiomics can better assess tumor extension and even estimate its grade.Detection of circulating genetic material(liquid biopsy)and next-generation sequencing are powerful techniques for genetic analysis,which will increase our understanding of the underlying molecular mechanisms and may reveal potential therapeutic targets.The role of chemotherapy in non-metastatic disease is still controversial,and there is a need to identify patients who really benefit from this treatment.Novel chemotherapeutic regimens have entered clinical praxis and can change the outcome of patients with metastatic disease.Advances in radiotherapy have helped decrease local adverse effects and sustain good local control of the disease.The following report provides an updated view of the diagnosis,treatment,and future perspectives on the management of patients with soft tissue sarcomas.

A New Model to Study Healing of a Complex Femur Fracture with Concurrent Soft Tissue Injury in Sheep

High energy bone fractures resulting from impact trauma are often accompanied by subcutaneous soft tissue injuries, even if the skin remains intact. There is evidence that such closed soft tissue injuries affect the healing of bone fractures, and vice versa. Despite this knowledge, most impact trauma studies in animals have focussed on bone fractures or soft tissue trauma in isolation. However, given the simultaneous impact on both tissues a better understanding of the interaction between these two injuries is necessary to optimise clinical treatment. The aim of this study was therefore to develop a new experimental model and characterise, for the first time, the healing of a complex fracture with concurrent closed soft tissue trauma in sheep. A pendulum impact device was designed to deliver a defined and standardised impact to the distal thigh of sheep, causing a reproducible contusion injury to the subcutaneous soft tissues. In a subsequent procedure, a reproducible femoral butterfly fracture (AO C3-type) was created at the sheep’s femur, which was initially stabilised for 5 days by an external fixator construct to allow for soft tissue swelling to recede, and ultimately in a bridging construct using locking plates. The combined injuries were applied to twelve sheep and the healing observed for four or eight weeks (six animals per group) until sacrifice. The pendulum impact led to a moderate to severe circumferential soft tissue injury with significant bruising, haematomas and partial muscle disruptions. Posttraumatic measurements showed elevated intra-compartmental pressure and circulatory tissue breakdown markers, with recovery to normal, pre-injury values within four days. Clinically, no neurovascular deficiencies were observed. Bi-weekly radiological analysis of the healing fractures showed progressive callus healing over time, with the average number of callus bridges increasing from 0.4 at two weeks to 4.2 at eight weeks. Biomechanical testing after sacrifice showed in- creasing torsional stiffness between four and eight weeks healing time from 10% to 100%, and increasing ultimate torsional strength from 10% to 64% (relative to the contralateral control limb). Our results demonstrate the robust healing of a complex femur fracture in the presence of a severe soft tissue contusion injury in sheep and demonstrate the establishment of a clinically relevant experimental model, for research aimed at improving the treatment of bone fractures accompanied by closed soft tissue injuries.

Mechanism of Olibanum and Myrrha for the Acute Soft Tissue Injury Based on Network Pharmacology

Objective The objective of this study was to screen the therapeutic target of olibanum and myrrha on acute soft tissue injury(ASTI)by network pharmacology and to clarify their mechanisms.Methods The main chemical constituents and the targets of olibanum and myrrha were obtained by using traditional Chinese medicine systems pharmacology database and analysis platform database.The disease targets of ASTI were searched by GeneCards.The intersection targets of herbs and diseases were selected for protein interaction analysis,protein–protein interaction network was constructed,and potential protein functional modules in the network were explored.A compound–target–disease network was constructed using Cytoscape3.8.2 software.The targets were analyzed by gene ontology analysis and Kyoto Encyclopedia of Genes and Genomes enrichment analysis based on the Metascape database.Results The core active components of olibanum and myrrha were quercetin,β-sitosterol,and stigmasterol.The core targets were PGR,NCOA2,PTGS2,PRKCA,and NR3C2.Pathways in cancer,AGE-RAGE signaling pathway in diabetic complications might play a potential role in olibanum and myrrha in the treatment of ASTI.Conclusion Olibanum and myrrha have the characteristics of multiple components,multiple targets,and overall regulation in the treatment of ASTI.

Experimental study on early repair of oromaxillofacial perforating soft tissue defect due to gunshot in dogs

The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.

EIGHTY CASES of SOFT TISSUE INJURY TREATED WITH LOCAL CONTRALATERAL NEEDLING METHOD

Contralateral needling method is a common and effective one of acupuncture analgesicmethods.It is used to treat a local pain in the limbs and trunk with a short course of disease,pain and swelling will disappear or be relieved immediately for one or two treatments.Really,there isan effect of relieving pain as soon as the needle is inserted.When the local contralateral needlingmethod is used,the key to improving the effectiveness lies in determining the pain position and its correspondingpoint correctly,the more correct the pain position and its corresponding point are determined,the better the effectiveness will be.In this group,80 cases soft tissue injury were treatedwith local contralateral needling method,the cure rate was 82％,and the total effective rate was100％.

A Soft Tissue Acupuncture Model Based on Mass-Spring Force Ne

In the simulation of acupuncture manipulation,it is necessary to accurately capture the information of acupuncture points and particles around them.Therefore,a soft tissue modeling method that can accurately track model particles is needed.In this paper,a soft tissue acupuncture model based on the mass-spring force net is designed.MSM is used as the auxiliary model and the SHF model is combined.SHF is used to establish a three-layer soft tissue model of skin,fat,and muscle,and a layer of the MSM based force network is covered on the surface of soft tissue to realize the complementary advantages and disadvantages of spherical harmonic function and MSM.In addition,a springback algorithm is designed to simulate the springback phenomenon of soft tissue skin during acupuncture.The evaluation results show that the soft tissue acupuncture modeling method based on mass-spring force net can effectively simulate the springback phenomenon of soft tissue surface during acupuncture surgery,and has good comprehensive performance in the application of virtual acupuncture surgery simulation.

A local high-resolution deformation model of soft tissue based on element-free Galerkin method

In order to solve the problem that the existing meshless models are of high computational complexity and are difficult to express the biomechanical characteristics of real soft tissue, a local high-resolution deformation model of soft tissue based on element-free Galerkin method is proposed. The proposed model applies an element-free Galerkin method to establish the model, and integrates Kelvin viscoelastic model and adjustment function to simulate nonlinear viscoelasticity of soft tissue. Meanwhile, a local high-resolution algorithm is applied to sample and render the deformed region of the model to reduce the computational complexity. To verify the effectiveness of the model,liver and brain tumor deformation simulation experiments are carried out. The experimental results show that compared with the existing meshless models, the proposed model well reflects the biomechanical characteristics of soft tissue, and is of high authenticity, which can provide better visual feedback to users while reducing computational cost.

Electrical Resistance as A Measure of Soft Tissue Injuryfrom Delayed Onset Muscle Soreness

Assessment of muscle damage relies commonly on subjective sensation of pain. The purpose of this research was to test thevalidity of microcurrent conductance on skin over injured tissue to quantify soft tissue injury and recovery following heavy exercisecompared to other indexes of muscle soreness. A randomized, controlled, single-blinded, 1-week trial on 60 subjects.Setting-University Interventions： Subjects did 3 sets of squats for 5 min each. There were 3 groups of 20 subjects. One did nothing andone had heat applied for 8 h post exercise. The final group had heat 24 h after exercise. Tissue resistance and muscle strength force tomove the knee, analog visual pain scale. In the control group, microcurrent continually decreased, eventually decreasing 32% by thethird day post exercise. When heat was given immediately following exercise, microcurrent was 26% greater （P 〈 0.001）. The painscale rose to 3.1/10 as opposed to 5.4/10 for controls. Strength and muscle elasticity stayed mostly constant after heat as opposed to a28% decrease in strength and increase in stiffness in the control subjects. For 24 h delayed heat, microcurrent was 14% greater（P 〈 0.02）, and was unchanged for the first 24 h when no therapy was given. Pain scale rose to 4.8/10. Stiffness was unchanged whilemuscle strength decreased the same as controls. Microcurrent shows agreement with loss of strength, and stiffness from DOMS but notthe subjective pain measure. It appears that microcurrent is a good measure of muscle damage.

Therapeutic Effect and Mechanism of Jipei Dilong Ointment on Acute Soft Tissue Injury in Rats

[Objectives]This study was conducted to observe the therapeutic effect of Jipei Dilong Ointment on rats with acute soft tissue injury caused by heavy objects and to explore its action mechanism.[Methods]Thirty six rats were randomly divided into six groups(control group,model group,high-dose Jipei Dilong Ointment group(JP-H),medium-dose Jipei Dilong Ointment group(JP-M),low-dose Jipei Dilong Ointment group(JP-L)and diclofenac group).Except for the Control group,other groups were subjected to modeling of acute soft tissue injury by the weight impact method.All administration was performed once a day for nine consecutive days.The local appearance score and activity disorder score were determined after soft tissue injury in rats.HE staining was used to detect the pathological changes of injured soft tissues in rats.RT-PCR was used to detect the relative mRNA expressions of Bax,Bcl-2,MMP-9 and TIMP-1 in injured soft tissues of rats.Western Blot was used to detect the protein expressions of MMP-9,TIMP-1,TLR4,MyD88 and NF-κB p65 in injured soft tissues of rats.Results were statistically analyzed.[Results]Compared with the model group,Jipei Dilong Ointment could significantly improve the appearance symptoms such as swelling and ecchymosis in the injured area and the movement function of the affected limb(P<0.05).It could also improve the infiltration of inflammatory cells and widening of the intermuscular space caused by injury.Among them,the JP-H group and the diclofenac group had more significant curative effects.After 9 d of administration,each administration group could significantly up-regulate the ratio of Bcl-2/Bax mRNA expression level(P<0.05 or P<0.01),and the ratio of MMP-9/TIMP-1 mRNA expression level showed a downward trend(P>0.05).The expression level of NF-κB p65 protein in each administration group was significantly decreased(P<0.01).The protein expression levels of TLR4 and MyD88 and the ratio of MMP-9/TIMP-1 protein expression level in each administration group decreased to varying degrees.Among them,the JP-H group and diclofenac group significantly decreased(P<0.05).[Conclusions]Jipei Dilong Ointment has the functions of relieving pain,swelling and inflammation.It could improve the local appearance,functional activity and tissue morphology of affected limbs in rats,and has a therapeutic effect on acute soft tissue injury in rats.Its mechanism of action might be related to the inhibition of TLR4/MyD88/NF-κB p65 signaling pathway and the regulation of Bcl-2/Bax and MMP-9/TIMP-1 balance.

TREATMENT OF SOFT TISSUE INJURY BY PUNCTURING CLEFT-POINTS

Objective: To observe the therapeutic effect of acupuncture of "Xi" (Cleft) points in treatment of soft tissue injury. Methods: 335 cases of soft tissue injury patients were divided into Cleft point group (264 cases) and Ashi point group (control group, 71 cases) randomly. In Cleft point group, the 16 Cleft points were used in combination with Ahshi points. In control group, only local Ahshi points were punctured. The treatment was conducted once every day, with 5 sessions being a therapeutic course. After 2 courses of treatment, the therapeutic effect was analyzed. Results: Results showed that the therapeutic effect of cleft point group was significantly better than that of control group (P<0.05), particularly in treatment of acute soft tissue. Conclusion: Cleft point acupuncture has a better therapeutic effect in treatment of soft tissue injury in comparison with Ashi point.

System describing surgical field extension associated with flap reconstruction after resection of a superficial malignant soft tissue tumor

BACKGROUND Flap reconstruction after resection of a superficial malignant soft tissue tumor extends the surgical field and is an indicator for potential recurrence sites.AIM To describe a grading system for surgical field extension of soft tissue sarcomas.METHODS Grading system:CD-grading is a description system consisting of C and D values in the surgical field extension,which are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,respectively.C1/D1 are positive values and C0/D0 are negative.With a known location,1/0 values can be"p"(proximal),"d"(distal),and"b"(in the tumor bed),and the description method is as follows:flap type,CxDx[x=0,1,p,d or b].RESULTS Four representative patients with subcutaneous sarcomas who underwent reconstruction using fasciocutaneous flaps are presented.The cases involved a distal upper arm(elbow)synovial sarcoma reconstructed using a pedicled latissimus dorsi(pedicled flap:CpDp);a distal upper arm(elbow)pleomorphic rhabdomyosarcoma reconstructed using a transpositional flap from the forearm(transpositional flap:CdD0);an undifferentiated pleomorphic sarcoma in the buttocks reconstructed using a transpositional flap(transpositional flap:C0D0);and a myxofibrosarcoma in the buttocks reconstructed using a propeller flap from the thigh(pedicled flap:CdDd).CONCLUSION The reconstruction method is chosen by the surgeon based on size,location,and other tumor characteristics;however,the final surgical field cannot be determined based on preoperative images alone.CD-grading is a description system consisting of C and D values in the surgical field extension that are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,respectively.The CD-grading system gives a new perspective to the flap reconstruction classification.The CD-grading system also provides important information for follow-up imaging of a possible recurrence.

The Importance of the Multidisciplinary Approach to Surgical Treatment of Extremity Soft-Tissue Sarcomas

Soft tissue sarcomas (STS) are rare neoplasm with frequencies around 1% of all neoplasms. Although it consists of a high heterogeneous group of tumors, surgery is the mean treatment. The STS surgery is still challenging and complex procedure is usually required: this is because STS requires different types of resection and reconstruction due to various tissue-commitments (nerve, arteries, skin and muscle). So, a multidisciplinary team must be prepared for STS approach to obtain the maximum local control and a limited extremity functional impairment. We, here, showing our experience, wish to introduce some technical contrivances in STS surgery, with special reference to tissue reconstruction. This may illustrate the necessity of a multidisciplinary team approach in this surgery.