Role Of Intravenous Iron Over Nonsurgical Transfusions In Major Burns.

Anemia is a frequent condition in burn patients due to a mixture of blood loss and chronic inflammation. Transfusions increase the probability of serious infections and reduce overall survival, especially when unrelated to perioperative blood loss. Once the surgical phase in burn patients is completed, the role of parenteral iron administration in the reduction of subsequent transfusions is not well established. Burn patients subjected to at least two surgeries and presenting progressive anemia after concluding the surgical phase, without major symptoms, were selected (n=12). Those patients with confirmed iron deficiency were treated with intravenous (i.v.) ferric carboxymaltose (n=8). Subsequently, these patients were compared with a group of 18 control patients selected from our historical database (n=1375), matching controls by age (±5 years), sex, and TBSA burn (±6%). The objective was to verify if i.v. iron administration reduced the need for blood transfusions after the surgical phase. The analysis concluded that none of the cases treated required transfusions compared to 44% of the controls. There were no side effects related to the i.v. iron infusion. This result suggests that i.v. iron supplementation with ferric carboxymaltose could be an alternative in anemic patients without major symptoms once the surgical phase is completed. Iron deficiency should be assessed and i.v. supplementation must be administered if required in burn patients showing progressive anemia.

L'anémie, à la fois par pertes sanguines et inflammation, est fréquente chez les brûlés. Les transfusions, en particulier lorsque l'anémie n'est pas liée à la chirurgie, sont corrélées à la survenue d'infections sévères et à la mortalité. Une fois la phase chirurgicale terminée, le rôle de la thérapie martiale intraveineuse sur l'épargne transfusionnelle est mal connu. Nous avons évalué 12 patients brûlés, ayant été opérés au moins 2 fois et ne devant plus l'être, qui développaient une anémie progressive bien tolérée. Les 8 patients ayant une carence martiale ont reçu du carboxymaltose ferrique intraveineux. Ils ont été comparés avec 18 patients témoins, sélectionnés dans notre base de données de 1 375 dossiers, appariés sur l'âge +/- 5 ans, le sexe et la surface brûlée +/- 6%, l'objectif étant de vérifier si le traitement permettait effectivement de réduire les transfusions. Effectivement, aucun des patients traités n'a été transfusé, contre 44% des témoins. Aucun effet secondaire n'a été observé après administration de fer. Ceci suggère que des patients brûlés, chirurgie terminée, anémiques pauci- symptomatiques par carence martiale devraient recevoir un traitement martial IV.

Surgical treatment and management of the severely burn patient: Review and update.

Since one of the main challenges in treating acute burn injuries is preventing infection, early excising of the eschar and covering of the wound becomes critical. Non-viable tissue is removed by initial aggressive surgical debridement. Many surgical options for covering the wound bed have been described, although split-thickness skin grafts remain the standard for the rapid and permanent closure of full-thickness burns. Significant advances made in the past decades have greatly improved burns patient care, as such that major future improvements in survival rates seem to be more difficult. Research into stem cells, grafting, biomarkers, inflammation control, and rehabilitation will continue to improve individualized care and create new treatment options for these patients.

A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital.

BACKGROUND: Postmastectomy breast reconstruction involves the use of large amounts of hospital resources. This study provides comparative data on the clinical results and long-term economic costs of two methods of breast reconstruction in a public hospital. METHODS: A prospective cohort study was performed to evaluate the costs incurred by delayed unilateral breast reconstruction performed using either the two-stage sequence expander/prosthesis (E-P) or autologous deep inferior epigastric flap (DIEP) method during 2005-2013 in 134 patients. The major evaluated variables included previous clinical records, history of radiotherapy, and number of surgical procedures. Total costs accounted for both direct intra- and extra-hospital costs derived from the initial reconstruction and those resulting from associated reoperations due to aesthetic retouches and/or complications. RESULTS: Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction (3.07 vs. 2.32, p < 0.001) and showed higher rates of surgery-related complications (40.29% vs. 32.82%). No statistically significant differences were found between the two surgical methods in terms of total costs (€18857.77 DIEP vs. €20502.08 E-P; p = 0.89). In the E-P cohort, active smoking and history of radiotherapy were statistically significant risk factors of complications. In the DIEP group, only active smoking was significantly associated with complications. CONCLUSIONS: Compared to the E-P method, breast reconstruction using the DIEP method is more cost-effective and involves fewer serious complications that result in reconstruction failure or undesirable aesthetic results. E-P reconstruction presents a higher number of complications that may cause surgical failure or poor outcomes.

Reconstruction of a severe facial defect by allotransplantation in neurofibromatosis type 1: a case report.

BACKGROUND: On January 26, 2010, our team performed a facial transplant for a patient with neurofibromatosis type 1. We detail the perioperative surgical strategies for the composite tissue allograft (CTA) of the lower parts of the face to restore a severe defect after excision of bilateral massive plexiform neurofibromas. The main distinctive feature included an innovative provisional heterotopic transplantation (PHT) technique of the facial allograft to the femoral vessels before its final orthotopic transplantation. CASE REPORT: A 35-year-old Caucasian man received a CTA of the lower two-thirds of the face, including a chin osseous segment. The face was obtained from a non-heart-beating donor. The sequence of microsurgical procedures began by performing a PHT of the CTA to the recipient's femoral vessels in the right thigh. Intraoperatively, he experienced considerable blood loss that required transfusion of 24 units of packed cells. Surgical revision was required at day 7 to remove an extensive hematoma in the right side of the CTA. The maintenance immunosuppressive regimen included steroids, mycophenolate mofetil, and tacrolimus. CONCLUSION: We have reported a case of successful provisional transplantation of a human facial allograft onto the thigh as an alternative technique in human face transplantation. PHT was a reliable alternative procedure to obtain the facial allograft from a cadaveric donor.

The virtual reality tool VirSSPA in planning DIEP microsurgical breast reconstruction.

BACKGROUND: The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a DIEP (deep inferior epigastric artery perforator) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications. Variability in perforator anatomy makes DIEP flap surgery a suitable candidate for computer and virtual reality bio models. In this context, a study was undertaken to determine the feasibility of CTA-guided by VirSSPA application. VirSSPA is a virtual reality tool developed in our Hospital for surgical planning and training. This application allows surgeons to generate the three-dimensional (3D) model of the patient. OBJECTIVE: In this paper, we present a study about VirSSPA tool for virtual reality navigation in DIEP flap surgery and compare findings with operative measurements. METHODS: We recruited 12 consecutive patients planned for an elective DIEP flap for breast reconstruction. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and VirSSPA 3D reconstruction. Imaging findings were compared to operative findings. RESULTS: 3D reconstruction of the abdominal wall with VirSSPA demonstrated a significant good correlation with perforator location compared to operative findings, showing an average error rate of 0.228 cm (95% CI, 0.17-0.30). The Pearson product-moment correlation coefficient was found to be 0.99 (p = 0.01), reflecting an almost linear relationship between the two distances, intraoperative and the one measured in the 3D reconstruction. CONCLUSION: VirSSPA provides additional and potentially more accurate data over conventional CTA with regard to the site of the best perforators and its course through the muscle for DIEP micro-vascular surgery.