Evaluating Shifts in Perception After a Pilot Trauma Quality Improvement Training Course in Cameroon.

Peritendinous adhesion is a common complication after tendon injury, which seriously affects the function of the limb []. In clinical practice, various absorbable biomaterials have been developed as antiadhesion commodities []. They are devised to provide a barrier around the tendon, preventing peritendinous adhesion growth from surrounding tissues to the injured tendon after tenolysis and tendon repair [, , , ]. The semiliquid property of hydrogel enables it to have good plasticity. Therefore, hydrogel can completely wrap the tendon and is suitable for the complex and changing application scenarios in clinical practice. In addition, hydrogels have a high porosity, which allows nutrients from the synovial fluid to reach the severed end smoothly, reducing the impact on tendon healing []. Previous clinical trials have confirmed the antiadhesion properties of intraoperative application of hydrogels. In an earlier randomized, controlled, multicenter study, patients in the hydrogel group achieved better outcomes of finger motion at all follow-up times after tenolysis []. Furthermore, hydrogels as an antiadhesion barrier material were also used to prevent mediastinal adhesion after congenital heart disease []. Among many hydrogel biomaterials, carboxymethyl chitosan (CMC) hydrogel, due to its nontoxicity, good biocompatibility, and antimicrobial properties, has become popular in medical usage [, , ]. After positive effects were observed in animal models, CMC hydrogel was tested in a clinical series with promising results toward reducing postoperative adhesion that patients experience [, ]. Despite these promising results, during late-stage postoperative tendon healing without limb motion, CMC hydrogels degrade rapidly—they degrade in less than 10 days in vivo, which limits their longtime antiadhesion effect []. On the other hand, with analysis of the results of animal experiments, we found that in the early inflammatory stage, macrophages infiltrated around the tendon injury site, but there was no adhesion tissue formation in the peritendinous site. Subsequently, adhesion tissues begin to occur about 7 days after injury []. That is to say, when hydrogels are implanted intraoperatively, they work as barriers during the early inflammatory stage; however, when tissue adhesions begin to occur postoperatively, the hydrogels have already degraded. In addition, early implantation of antiadhesion materials can cause foreign body reactions, leading to pain []. Therefore, to solve the problems of inflammatory pain at the early stage and limited antiadhesion time involved in the use of CMC hydrogel, we tried to apply hydrogels at the correct time and location where adhesions occur. Currently, musculoskeletal ultrasound applies high-frequency ultrasound probes to clearly display superficial soft tissue structures such as muscles, tendons, and ligaments. Our choice of ultrasound as the primary means of exploration is conducive to determining the injection location and timing. Based on continuous ultrasound detection, we found that human peritendinous adhesions began to form around 5 days after surgery. However, the clinical efficacy of ultrasound-guided application of hydrogels on Day 5 after surgery is unclear. A randomized controlled trial was performed to validate the pain control and antiadhesion effect of this novel treatment. We asked: (1) Compared with intraoperative hydrogel application, does ultrasound-guided postoperative application result in better total active motion (TAM) at 12 months after tendon injury? (2) Does ultrasound-guided postoperative application of hydrogel result in lower pain, better function, and better satisfaction?