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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case Series
Full Version
A Harrowing Experience of Pinna Lacerations
Correspondence Address :
Dr. S Prabakaran,
3/286, Pachaiyappar Street, Periyar Salai, Palavakkam, Chennai, Tamil Nadu, India.
E-mail: somu.prabakaran@gmail.com
Otological injuries are not rare presentations to the Emergency Department but they may sometimes be harrowing. These injuries can sometimes lead to haematoma and perichondritis which may lead to cosmetic disfigurement. Hence, opportune and prudent intervention is required to prevent the complications. The present study was conducted to examine the wide range of pinna lacerations, various methods of repair to obtain best cosmetic results and outcome, prevention of development of complications. This case series is about 27 patients with pinna laceration and its management in patients who attended the Emergency Department at a tertiary care hospital. All lacerations of pinna due to any cause were included in the study except chemical and thermal burns. Detailed history was recorded. These patients were managed with wound debridement, suturing and were followed-up regularly to monitor the development of complications. Out of 27 patients, 21 patients had a complete wound healing without any complications. Two patients developed wound gapping and underwent resuturing under local anaesthesia. Perichondritis of pinna has occurred in three patients. Timely intervention is very important for healing and prevention of complications. Normal anatomical contour and good cosmetic results is achieved by adequate wound debridement, maximum tissue restoration, meticulous suturing and wide antibiotic coverage.
Perichondritis of pinna, Pinna abrasions, Pinna avulsion, Pinna deformity
Trauma to the ear is complex occurs due to various harmful agents which affect different parts of the ear (1). Most of the pinna lacerations are due to road traffic accidents but other causes include assault, sporting injury. Trauma to the external ear can cause abrasions, lacerations, auricular haematomas, and partial or total avulsions (2). Pinna lacerations may range from a simple laceration to complex avulsions. The proper recognition of the injuries and time management is very important to improve the treatment and outcomes and, to avoid the development of complications (1).
These injuries can sometimes lead to haematoma and perichondritis resulting in cosmetic disfigurement. Hence, opportune and prudent intervention is required to prevent the complications. The golden rule in the management is to balance minimal wound debridement with maximal tissue preservation under adequate anaesthesia (3). Under aseptic precautions, a good approximation of a wound with adequate vascularity with wound care will result in the best outcome (4). The type of reconstruction will depend on the extent, size of the injuries, and cosmesis expected by the procedure (2). The involvement of the cartilage, poor vascularity of the region, and need for high cosmetic satisfaction are the complicating factors while reconstructing the pinna making it difficult to manage and chance for deformity is more common (5).
The objective of documenting this series of cases is to present the wide range of pinna lacerations and repair of the same to obtain best cosmetic results and outcome, prevention of development of complications.
A total of 27 cases who presented to the Emergency Department of the tertiary care centre in the last one year have been presented here. All lacerations of pinna due to any cause were included in the series, except chemical and thermal burns (Table/Fig 1). Detailed history was recorded.
Tetanus toxoid injection was given through intramuscular route for prophylaxis. All patients were locally anaesthetised in the form of auricular block with 4% xylocaine with adrenaline after giving test dose. Thorough wash was done with saline followed by metronidazole. Devascularised tissues have been debrided. The lacerated wound was sutured with 4-0 ethilon and dressing done following which patient was given prophylactic oral ciprofloxacin 500 mg twice daily with aceclofenac and serratiopeptidase. Patient was kept on regular follow-up and the complications were recorded.
Out of 27 patients, 15 patients were male and 12 patients were female. These patients belonged to the age range of 18-40 years (Table/Fig 2). All the patients were treated with a standard protocol (Table/Fig 3).
All patients were followed up regularly to assess the wound healing and development of complications (Table/Fig 4). Out of 27 patients, 21 had a complete wound healing without any complications (Table/Fig 5), (Table/Fig 6), two patients developed wound gapping (Table/Fig 7) and underwent resuturing under local anaesthesia. Perichondritis of pinna has occurred in three patients and were admitted for intravenous antibiotics to prevent further complications and one patient developed perichondria abscess which leads to fibrosis, scarring, and finally minimal pinna deformity (Table/Fig 8).
The pinna is made up of single elastic cartilage which is tightly adherent to skin on its lateral surface and slightly loose and mobile on medial surface (1). It is supplied by posterior auricular, superficial temporal and occipital artery. The cartilage is present between the skin and its protruded nature is the reason for traumatic injuries and post traumatic infections (5). The incidence of trauma to the face is a common initial presentation in the Emergency Departments (2).
Traumatic pinna injuries vary from simple abrasion to laceration and complete avulsions involves skin, cartilage or both (2). The causes of pinna injuries are road traffic accidents, ballistic injuries and animal/ human bites (Table/Fig 9). These injuries are caused by various mechanisms such as blunt trauma, blow and slaps to the ears which results in various spectrum of injuries (6). The main goal of the treatment is to achieve the normal contour without infection. Immediate suturing, maximum tissue preservation and prevention of perichondritis are very crucial in reducing the cosmetic pinna deformity (3). These external injuries of pinna are managed by oral and maxillofacial surgeons, otolaryngologists and also plastic surgeons (7).
Under local anaesthesia, the wound should be washed thoroughly with saline followed by metronidazole to remove any foreign bodies. Devitalised tissue should be removed and irregular skin edges can be trimmed. Lacerated wound is sutured with non-absorbable suture material. Absorbable sutures can be used in paediatric age groups. After meticulous suturing, pressure dressing and prophylactic antibiotics is necessary for proper healing without any complications (8). Patient should be followed-up regularly to monitor the development of any complications. A study conducted on pinna injuries in 24 patients reported that 16 had complete healing, 3 developed perichondritis, 3 had minor, and 3 had major deformity (1). Singla B et al., reported a case of pinna laceration managed by primary repair with wedge resection and obtained good cosmetic result (3). Shameem Ahmad SV et al., studied 45 cases of pinna injuries, complete healing occurred in 80%, perichondritis developed in 15.5%, and deformity occurred in 4.5% (4).
In the present series, all the patients with various types of pinna lacerations were managed with timely suturing, prophylactic antibiotics and followed up regularly. Out of the 27 patients, a majority (77.8%) had complete wound healing without any complications. 7.4% of patients developed wound gapping and underwent resuturing under local anaesthesia. Perichondritis of pinna has occurred in 11.1% patients and treated with intravenous antibiotics. Deformity was occurred in 3.7% of patients. Immediate suturing and prophylactic antibiotics are essential for proper healing, restore the normal contour and prevention of deformity. Because of various depressions and elevations in the pinna, skin tightly adherent on the lateral surface of pinna, it is difficulty to suture and attain normal contour.
The complications of these injuries are haematoma formation, secondary infection causing perichondritis and finally deformity (4). Haematoma in subperichondrial plane can cause infection, necrosis, new irregular cartilage formation and finally cauliflower ear (1). Ear deformity occurs due to stimulation of mesenchymal cells in the perichondrium and new fibrocartilage production (9). Haematoma can be drained by 18 gauge needle of incision and drainage method (2). Perichondritis is characterised by pain, redness and local rise of temperature and finally abscess formation. Immediate drainage of pus is very important to prevent development of deformity. Patient should be admitted for administration of intravenous antibiotics and daily dressing of the wound. The development of these complications can be prevented by early intervention, wound debridement, timely suturing and good antibiotic coverage (4).
This study concluded that timely intervention like proper exploration of pinna laceration, thorough washing of the wound with metronidazole, immediate suturing, and prophylactic antibiotics to prevent complications helps in attaining the success rate of 77.8% and the development of deformity is reduced to 3.7%.
Traumatic pinna lacerations are very common due to increased incidence of road traffic accidents. Timely intervention is very important for healing and prevention of complications. Normal anatomical contour and good cosmetic results is achieved by adequate wound debridement, maximum tissue restoration, meticulous suturing and wide antibiotic coverage. Regular follow-up will help in early identification of complications and prompt treatment to prevent the incidence of cauliflower ear.
DOI: 10.7860/JCDR/2022/53691.16689
Date of Submission: Jan 03, 2022
Date of Peer Review: Feb 01, 2022
Date of Acceptance: May 23, 2022
Date of Publishing: Aug 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 10, 2022
• Manual Googling: May 20, 2022
• iThenticate Software: Jun 15, 2022 (3%)
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