Novel silicone dressing in full thickness skin grafts - A retrospective controlled case series.

PURPOSE: The right choice of dressing after skin grafting, especially in the anatomically complex and aesthetically important head and neck area, is difficult. It is important to have a dressing which is durable and doesn't need a lot of dressing changes. This study introduces a novel, individually moulded silicon dressing; and investigates the number of dressing changes, durability of the dressing and the aesthetic outcome of patients receiving this new type of dressing, in comparison to a control group. MATERIALS AND METHODS: The present retrospective single center controlled case series study reports our experiences using two different types of dressing on patients undergoing full thickness skin grafts in the head during the period 01 May 2016 to 01 May 2020. Data were analysed according to the type of dressing with either a transparent moulded silicone dressing or an established silicone sheet dressing. RESULTS: 52 patients were included in the study. We found no difference in the aesthetic outcome and complication rate (p > 0.05) between the two groups. The number of days until first dressing change after surgery, the number of dressing changes or follow up visits in the outpatient care until complete wound healing, and the overall number of dressing changes were all statistically significantly reduced (p < 0.05). CONCLUSION: Addition-cured silicone used as a moulded dressing in full thickness skin grafts has longer durability and leads to a significant reduction of dressing changes with equal aesthetic outcome compared to an establishes silicone sheet dressing.

Individually moulded silicone dressing in full thickness skin grafts.

BACKGROUND: Full thickness skin grafting is a common technique for reconstructing defects in the head and neck area. We propose the use of an addition-cured silicone as an individually moulded silicone dressing to keep the vulnerable skin graft in place, prevent shearing forces and create a moist environment. METHOD: The silicone dressing is applied directly on the graft, using a double cartridge system. The silicone is moulded to the skin graft and hardens quickly, integrating thread knots into its material and creating good adherence to the graft. Charts of 24 patients who had undergone reconstruction with full thickness skin graft from the neck after surgery for skin tumors in the head from November 2017 to October 2020, were reviewed retrospectively to quantify the degree of post-operative graft loss and durability of the dressing. CONCLUSION: Medical silicone based on venylpolysiloxane is a safe and durable dressing which makes postoperative dressing changes expendable. Trial registration The study was approved by the institutional review board of the Brandenburg state medical association (S 4(bB)/2021).

Mortality due to bloodstream infections and necrotizing enterocolitis in very low birth weight infants.

BACKGROUND: We evaluated the mortality due to nosocomial bloodstream infection (BSI) and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants in 229 neonatal departments participating in the German national neonatal infection surveillance system between 2000 and 2011. METHODS: For each infection type, we conducted a retrospective cohort study and a case-control study. In the cohort studies, the mortality risk due to BSI and/or NEC was estimated by calculating adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) using Cox proportional hazard regression with time the dependent variable infection. In the matched case-control studies, the attributable mortality was calculated. RESULTS: A total of 43,116 VLBW infants, of which 6911 patients had at least 1 BSI and 1271 patients had at least 1 NEC, were analyzed. Overall mortality was 6.6%. Patients with at least 1 BSI had a mortality of 5.6%, and patients with at least 1 NEC had a mortality of 19.2%. The cohort studies revealed that BSI (AHR=1.83; 95% CI: 1.61-2.08) and NEC (AHR=6.35; 95% CI: 5.47-7.37) are independently associated with increased mortality. In the case-control study for BSI, 5187 (75.1%) patients with BSI were matched. Attributable mortality was 1.4% (95% CI: 0.7-2.2). In the case-control study for NEC, 1092 (85.9%) patients with NEC were matched. Attributable mortality was 14.7% (95% CI: 12.2-17.1). CONCLUSIONS: Nosocomial BSI and NEC increased mortality in VLBW infants. BSI, however, was associated with a relatively small attributable mortality of 1.4%, whereas NEC had a high attributable mortality of 14.7%.