Usage of Dermal Regeneration Templates (Pelnac) for Coverage of Exposed Hand Tendons in Acute Setting.

Background: The loss of soft tissue coverage of tendons is a challenging reconstructive problem after acute hand trauma. Subsequent tendon adhesions and the loss of range of movement in addition to the poor aesthetic outcome and donor site scarring should be avoided when deciding the plan of management. Pelnac is one of the commonly used skin substitutes in reconstructive surgery that can be used for coverage of exposed tendons, but the postoperative functional outcome needs to be addressed in detail. Methods: Twenty-six patients with acute isolated tendon injuries distal to the wrist joint were included. Two-stage reconstructive procedures were performed; the first one was the application of Pelnac. The second stage was carried out after the complete integration of Pelnac via the application of a split-thickness graft. The function outcome assesses the return of the normal range of motion to the affected hand and the QuickDASH score questionnaire. The aesthetic outcome was assessed using the Vancouver scar scale. Results: The Pelnac was integrated in 100% of cases, with complete grafts taken in 22 of 26 patients. The mean QuickDASH score was 20.5 ±â€…15.7, and mean Vancouver scar scale was 3.53 ±â€…3.2. The full range of motion returned in 22 of 26 patients. Conclusions: Using Pelnac to cover the exposed hand tendons in an acute setting is a convenient and efficient procedure with minimal morbidity. It can offer a good option for their coverage with preservation of hand function and acceptable aesthetic outcome.

The effect of tranexamic acid on blood loss in liposuction: a randomized controlled study.

Background: Liposuction is one of the most common procedures in the practice of plastic surgery. Since it evolved, continuous modifications have been to decrease blood loss so that patients are hemodynamically stable intra- and postoperatively. Tranexamic acid (TXA) has long been used for its antifibrinolytic properties that were beneficial in reducing blood loss, rate of transfusion, and hemoglobin drop in major trauma and surgeries. Its use in plastic surgery, however, is still limited. In this study, we aim to illustrate the effect of intravenous (IV) and local infiltration of TXA on blood loss in liposuction surgery. Methods: Between April 2019 and April 2021, 90 patients who requested liposuction for various body parts were randomly allocated into 3 equal groups: control group, IV TXA, and local infiltration of TXA. A sample was taken from infranatant and sent for hematocrit calculation. Volume of blood in lipoaspirate was then calculated. Patients were assessed for blood loss and postoperative bruising. Results: Volume of blood loss in lipoaspirate was considerably lower in the TXA groups, with 60% decrease in blood loss for the local TXA group in comparison with the control group. TXA has also been shown to markedly decrease bruising tendency in postoperative liposuction patients. Conclusions: TXA can be used to decrease blood loss in large-volume liposuction, modify the need for blood transfusion intra- and postoperative, and improve the results of liposuction procedure without the need for multiple sessions. Level of evidence: Level II, Risk/Prognostic Study.

Comparative study between skin micrografting (Meek technique) and meshed skin grafts in paediatric burns.

BACKGROUND: Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique. PATIENTS AND METHODS: A prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS - Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively. RESULTS: The percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer's overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001). CONCLUSION: The Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive.

Crane Principle Revisited.

BACKGROUND: Scalp and forehead defects represent one of the most complex defects for reconstruction. The nature of these sites being hair bearing, together with the complicated nature of the injuries, for example, electrical burns and motor vehicle accidents, and of course the aesthetic concern being in the face, all add to the complexity of reconstruction. METHODS: This is a case series representing the experience of the authors in using the "crane principle" in the reconstruction of various defects in the forehead and the scalp presented to emergency department, Cairo University Hospital, for the period between January 2018 and January 2019. RESULTS: Twenty patients, 15 men and 5 women, presented with various soft tissue defects of the forehead and the scalp. The injuries of eighteen patients were due to motor vehicle accidents, and 2 patients had postelectrical burns. Age range was from 20 to 65 years, with a mean follow-up of 8 months. The number of total complications was 5. Three patients had wound dehiscence, and 2 patients had ulceration in the grafts placed at the flap donor site. CONCLUSION: Crane principle represents an adequate reconstruction tool for forehead and scalp defects especially when the access to free flap and more complex reconstruction techniques is not available.

Liposuction-Gadgets and Widgets: Save Your Money.

In the past few decades, numerous adjunctives and devices have been introduced to body contouring surgeries, especially liposuction. Most of these devices require special maintenance and accessories for their proper functionality, which might be expensive in many parts of the world or for young surgeons starting their own practice. In this article, we suggest some tools that could be used during liposuction to save money, minimize complications rates, and enhance the results without endangering the patient's overall safety.