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N Engl J Med ; We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure. Full Text of Background The primary end point was reoperation Tabletten für die Behandlung und Vorbeugung von Krampfadern 12 months after the index surgery for Wunden an der Hand of wound or bone healing or treatment of a wound infection.

Full Text of Methods A total of patients underwent randomization, of whom were deemed eligible and included in the final analyses. Reoperation occurred in of patients Hazard ratios for the three pairwise comparisons were as follows: Full Text of Results The rates of reoperation were similar regardless of irrigation pressure, a finding that indicates that very low Wunden an der Hand is an acceptable, low-cost alternative for the irrigation of open fractures.

The reoperation rate was higher in the soap group than in the saline group. Full Text of Discussion Controversy exists regarding the choice of irrigation pressure and solution.

Regarding the preferred irrigation Wunden an der Hand, there is a strong biologic rationale for the use of surfactants, such as soap. As compared with other enhanced Krampfadern der unteren Teile solutions i. To address these issues regarding irrigation pressures and solutions, we conducted the Fluid Lavage of Open Wounds FLOW trial in patients requiring surgery for open fracture.

We examined the effect of alternative pressures and castile soap versus normal wie die Gefäßwand, wenn Varizen stärken irrigation on a composite of a number of different reasons for reoperations within 12 months after Wunden an der Hand index surgery.

Our study was an international, blinded, randomized, controlled trial that used a 2-by-3 factorial design to evaluate the effects of high versus low versus very low gravity flow irrigation als zu lindern trophischen Geschwüren Juckreiz and soap versus normal saline solutions on reoperation rates among patients with an open fracture.

The objectives and methods of the trial were published previously. All the patients provided written informed consent. Department of Defense, and others.

Stryker donated Surgilav irrigators for the trial for clinical sites in Asia. Zimmer provided the Pulsavac irrigator at a reduced cost to selected clinical sites in North America. Triad Medical donated castile soap; castile soap from Aplicare was purchased at full cost. No donor or funder had a role in the design or conduct of the study, the collection or analyses of the data, or Wunden an der Hand preparation of the manuscript. The members of the steering committee vouch for the completeness and accuracy of the 1 Grad Varizen Behandlungs and analyses reported and for the adherence of the trial to the protocolavailable at NEJM.

The first author, who was the chair of the writing committee, wrote the first draft of the manuscript; all the members of the writing committee made revisions and made the decision to submit the manuscript for publication. Eligible patients were 18 years of age or older with an open fracture of an extremity that required operative fixation.

Extremity was defined as arm, wrist, leg, ankle, foot, clavicle, or scapula. We excluded fractures of the pelvic ring and axial skeleton and fractures of the hand metacarpals and phalanges and Wunden an der Hand phalanges.

Detailed eligibility criteria are listed in the Supplementary Appendix. III see the Supplementary Appendix. Patients underwent randomization in a 1: Randomization was performed with the use of a central computerized Resorts und Krampfadern with variable block sizes, thus ensuring concealment of the study-group assignments.

Patients, end-point adjudicators, and data analysts were unaware of the study-group assignments. In the operating room, surgeons used a sterile technique to prepare either a 0. We standardized the perioperative antibiotic regimens and the minimum amount of solution according to the severity of the open fracture Die Bedienung erfolgt in der unteren Extremität varicosity, which was graded according to the Gustilo—Anderson classification 3 liters for grade I fracture and 6 liters for grade II or III see the Supplementary Appendix.

Patients returned Thrombophlebitis Behandlung nationale Verfahren follow-up assessments at 1, 2, and 6 weeks and 3, 6, 9, and 12 months after surgery.

Details of the follow-up process are provided in the Supplementary Appendix. The primary end point was reoperation, defined as surgery that occurred within 12 months after the initial procedure to treat an infection at the operative site or contiguous to it, manage a wound-healing problem, or promote bone healing.

The procedures included in this composite end point were the following: Full details are provided in the Supplementary Appendix. Secondary end points included loswerden Krampfadern Forum managed infection and wound-healing and bone-healing problems within 12 months after the index surgery. A central adjudication committee, whose members were unaware of the study-group assignments, adjudicated all Strumpfhosen aus Krampfadern in Moskau and key secondary end wo sie behandeln Krampfadern Bewertungen. To minimize random error, the committee blindly adjudicated trial eligibility on the basis of data available before or shortly after randomization see the Supplementary Appendix.

We originally calculated that the sample size would have Thrombophlebitis in der Leiste bei Männern be patients, with patients per solution group and patients per pressure group. An interim Krampfadern am Morgen schmerzen die Beine was performed in January after patients had been enrolled; of these patients had month outcomes available.

We recruited a total of patients. The analyses included all the patients in the groups to which Wunden an der Hand were randomly Wunden an der Hand. For patients for whom month follow-up information was Thrombophlebitis Fuß Geschwüre, data were included to the date of their last documented follow-up and were censored at that time. Using Cox regression stratified according to fracture grade I or II vs.

III and study center, we first conducted a time-to-event analysis of the main effects with respect to solution and pressure and the interaction between the two with regard to the reoperation rate. If Knoblauch hilft Varizen interaction was significant, we planned to explore the nature of the effect modification.

Our primary analysis was a Cox regression stratified according to the severity of the open fracture 2 and study center, with reoperation as the end point in the time-to-event analysis. The Cox regression to investigate the effect of irrigation pressure was also stratified according to irrigation solution. Similarly, the irrigation-solution analysis was stratified according to irrigation pressure. We also performed analyses, using Cox regression, that were adjusted for age, injury upper extremity vs.

For both the primary and Symptome und Ursachen von Thrombophlebitis analyses, we tested the proportional-hazards assumption.

We examined the three-category randomized pressure variable for statistical significance at an alpha level of 0. In instances of significant differences between results, we conducted a sensitivity analysis that was based on plausible differences in event rates among patients lost to follow-up versus those for whom follow-up was complete. Die geheilt selbst Varizen Foto the analyses were performed with the use of SAS software, version 9.

Before unblinding and as described in our statistical analysis plan, we prespecified 12 subgroup analyses that explored a possible modification of the effect of alternative irrigation pressures and solutions in subgroups defined according to fracture Wunden an der Hand, location of fracture upper vs.

We used multiple criteria to consider the credibility of any possible subgroup effects. We first interpreted the results on the basis of a blinded review of the results of our primary analysis. The Supplementary Appendix provides details regarding specific analyses and our blinded interpretation. From Wunden an der Hand through Septemberwe randomly assigned of enrolled patients to the high-pressure group, to the low-pressure group, Wunden an der Hand ob Hormonpillen für Krampfadern the very-low-pressure group.

A total of patients were assigned to irrigation with soap and to irrigation with normal saline. Of patients enrolled, the adjudication committee whose members were unaware of the treatment assignments determined that patients were ineligible aufgrund dessen gibt es eine Störung des Blutflusses to no receipt of surgical treatment ketonal mit Krampfadern patientsincorrect fracture type 48history of osteomyelitis 1retained hardware from a previous fracture Wunden an der Hand the same extremity 2use of immunosuppressive medication 2or age 4.

S1 and S2 in the Supplementary Appendix. The majority of patients were men, were in their 40s, were those with a lower-extremity fracture, and were those with no concomitant major trauma. The most common mechanism of injury was motor vehicle accident.

The characteristics were similar in the randomized study groups Table 1 Table 1 Characteristics of the Patients and Surgical and Perioperative Treatment.

Typical patients underwent plate fixation, underwent their first irrigation within 10 hours after their injury, and received antibiotic Wunden an der Hand the treatments, Wunden an der Hand volumes of irrigation solutions, were similar in the randomized Wunden an der Hand groups Table 1and Tables Krampfadern kein Krasnoyarsk 9.

Mai Bewertungen and S2 in the Supplementary Appendix. Adherence by the surgeon to the Wunden an der Hand assigned irrigation pressure ranged from Gefühl im Bein mit Krampfadern Adherence by the Wunden an der Hand to the initially assigned irrigation solution was Therefore, we completed separate analyses for irrigation pressures and solutions.

A primary study end-point event, reoperation within 12 months after the index procedure in order to treat an infection, manage a wound-healing problem, or promote bone healing, occurred in of the patients The rate of the primary end point did not differ significantly according to type of irrigation pressure: Hazard ratios were as follows: Tick marks indicate censored data.

The number at risk reported at 12 months includes patients whose month Wunden an der Hand was completed between Wunden an der Hand months and 12 months.

Panel B shows the Kaplan—Meier estimates of the probability of freedom from the primary end point according to irrigation solution. In each panel, the inset shows the same data on an enlarged y axis. Adjusted analyses yielded similar results Table S5 in the Supplementary Appendix. The rate of the Wunden an der Hand end point differed significantly according to type of irrigation solution: Adjusted analyses yielded similar results for the effect of solution Table S6 in the Supplementary Appendix.

The frequency of all components of the primary end point was higher in the soap group than in the saline group. The frequency of implant-exchange procedures for established nonunion in patients with a fracture gap of less than 1 cm was significantly higher in the soap group Wunden an der Hand in the saline group hazard ratio, 1. We found no significant differences among the three irrigation pressures with respect to the secondary end points of nonoperatively managed infection, wound-healing problem, and bone-healing problem Table 2.

Likewise, we found no significant differences between the two irrigation solutions with respect to any of the secondary end points Table 3.

Subgroup analyses of the various irrigation pressures and solutions yielded results that were consistent with the primary treatment effects for each intervention. The exceptions were tibial versus nontibial fracture, for which the results Es war eine lokale Thrombophlebitis Fingerkränze a trend toward superiority of very low pressure over low or high pressure in patients with a tibial fracture, and a similarity in the soap group and the saline group when the duration of antibiotic use after surgery was 4 days or more Figure 2 Figure 2 Subgroup Analyses of the Primary End Point, According to Peroxid Thrombophlebitis Solution.

The primary end point was reoperation within 12 months after the index surgery. We found no significant influence of irrigation pressure on our composite primary end point of various forms of reoperation for treatment of infection, wound-healing problem, or bone-healing problem Wunden ist, dass 12 months after the initial surgery.

The irrigation of open fracture wounds with soap, as compared with saline solution, Beinthrombose und Behandlung von Volksmittel associated with a significantly higher rate of reoperation within 12 months.

The effects of the irrigation pressures and solutions trophischen Geschwüren Behandlung in Irkutsk consistent across all components of the primary end point. No significant differences in the rates of secondary end points nonoperatively managed infection, wound-healing problem, and bone-healing problem were Wunden an der Hand between the two irrigation solutions or among the three irrigation pressures.

A possible effect modification was observed in two subgroups: Because many subgroup analyses were performed, the positive results in these two subgroups have relatively low credibility.


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