Comparison of Negative Pressure Wound Therapy with or without a Split-Thickness Skin Graft in the Surgical Management of Axillary Hidradenitis Suppurativa: A Retrospective Cohort Study.

Introduction: Negative pressure wound therapy (NPWT) alone or with the addition of a split-thickness skin graft (STSG) are 2 reconstructive options available after surgical excision of axillary hidradenitis suppurativa (HS). The aim of this study was to retrospectively examine patients undergoing these treatments and to assess clinical and patient-related outcome measures. Methods: A single-centre, retrospective analysis was conducted, evaluating surgical excision of axillary HS, with STSG and NPWT, or NPWT alone. Data collected included No. of post-operative clinic visits, time to heal, size of wound, disease recurrence, follow-up time, Dermatology Life Quality Index (DLQI), the Generalised Anxiety Disorder Assessment (GAD-7), the Patient Health Questionnaire Depression Scale (PHQ-9), Pain Visual Analogue Scale (PAINVAS2), the Brief Illness Perception Questionnaire (BIPQ), and Dermatology Visual Analogue Scale (DERMVAS). Two-tailed t-test and Mann-Whitney Wilcoxon U-tests were used to assess for significant relationships. Results: One hundred five patients were included in the study, 44 who received NPWT alone, and 61 who received NPWT + STSG. There was no significant difference in follow-up time (P = .934) or No. of follow-up appointments between groups (P = .287). There was a significant difference in time to heal between groups, with STSG + NPWT observing a mean time of 2.77 months and NPWT alone observing a mean time of 4.40 months (P = .0006). There was no difference in patient-reported outcomes between the 2 groups. Conclusion: There is no difference in patient-reported outcomes with the addition of an STSG to NPWT after surgical excision of HS. Wide excision and use of NPWT alone is an effective procedure for the treatment of axillary HS.

Introduction: Le traitement des plaies par pression négative (NPWT) seule ou associée à une greffe de peau d'épaisseur partielle (STSG) sont les deux options disponibles pour la reconstruction après excision chirurgicale d'hidradénite suppurée (HS) axillaire. Le but de cette étude rétrospective était d'examiner les patients subissant ces traitements et d'évaluer les mesures des résultats cliniques et liés aux patients. Méthodes: Une analyse rétrospective monocentrique a été menée pour évaluer l'excision chirurgicale de l'HS axillaire avec NPWT et STSG ou NPWT seule. La collecte de données a inclus : le nombre de visites cliniques postopératoires, le délai de guérison, la taille de la plaie, la récidive de la maladie, la durée du suivi, l'indice de qualité de vie dermatologique (DLQI), l'évaluation du trouble anxieux généralisé (GAD-7), l'échelle de dépression du Questionnaire sur la santé du patient (PHQ-9), l'échelle visuelle analogique de la douleur (PAINVAS2), le Court Questionnaire sur la perception de la maladie (BIPQ) et la DERMVAS. Un test t de Fisher bilatéral et un test de Mann-Whitney Wilcox ont servi à évaluer les relations significatives. Résultats: 105 patients ont été inclus dans l'étude : 44 ont reçu uniquement le traitement par pression négative et 61 ont reçu NPWT + STSG. Il n'y a pas eu de différence significative dans la durée du suivi (P = 0934) ou le nombre de rendez-vous de suivi entre les groupes (P = 0287). Il y a eu une différence significative sur le délai de guérison entre les groupes avec un délai moyen de 2,77 mois pour le groupe STSG + NPWT et de 4,40 mois pour le groupe NPWT seul (P = 0,0006). Il n'y a pas eu de différence entre les deux groupes pour ce qui concernait les résultats signalés par les patients. Conclusion: L'ajout d'une greffe de peau d'épaisseur partielle (STSG) au traitement par pression négative (NPWT) n'a pas entraîné d'augmentation de problèmes signalés par les patients après excision chirurgicale d'une hidradénite suppurée. Une excision large et l'utilisation du NPWT seul constituent une procédure efficace pour le traitement de l'HS axillaire.

Severe dissecting scalp cellulitis successfully treated with serial excisions in combination with anti-TNF therapy.

The management of dissecting scalp cellulitis involves medical treatment with oral antibiotics and isotretinoin, as well as surgical input in more severe cases. In extensive disease, a full scalpectomy with reconstruction can be required. We report a case of severe dissecting scalp cellulitis in a 34-year-old man who underwent serial scalp excisions over three years, with wounds being left to heal by secondary intention. Initially, the excisions helped to control symptoms but, once the patient was on concurrent anti-TNF therapy, further excisions were successful in reducing disease load and inducing remission. He remained disease free at the 20 months follow-up. This case is the first of its kind to be described in the literature and it highlights how a conservative, staged surgical approach, in combination with anti-TNF therapy, can be effective in the management of severe dissecting scalp cellulitis. In doing so, it offers an alternative to full scalpectomy with reconstruction.

Traceability and calibration in temperature measurement: a clinical necessity.

Patient temperature is a fundamental physiological measurement used primarily for observation and diagnosis, for example during surgery, intensive care, recuperation, or treatment. A variety of thermometers are used clinically and these can be separated into two categories, either contact (oral thermometers, rectal thermometers and temporal strips), or non-contact (ear thermometers, temporal thermometers and thermal imagers). To have the maximum confidence in the clinical performance of the temperature measurement instrument it is strongly desirable that the device be traceably calibrated to the International Temperature Scale of 1990 (ITS-90). Lack of traceable calibrations accredited to ISO17025 can lead to unreliability in temperature measurement and in some cases can have a deleterious effect on patient care. The National Physical Laboratory (NPL) maintains and disseminates the ITS-90 for contact and non-contact thermometry in the UK. The importance of accredited traceable calibrations and an outline of contact and non-contact thermometry standards are given here.

Quantification of the ultraviolet radiation (UVR) field in the human eye in vivo using novel instrumentation and the potential benefits of UVR blocking hydrogel contact lens.

BACKGROUND/AIMS: Certain degenerative eye conditions occur predominantly nasally, at the limbal region, and are associated with solar ultraviolet radiation (UVR) induced damage. The relative contribution to the in vivo ocular flux of (a) the reflection of UVR incident on the skin of the nose onto the nasal limbus, and (b) the focusing of UVR incident on the temporal side of the cornea onto the nasal limbus were examined. METHODS: A novel photodiode sensor array was used to measure the UVR field across the eye. In addition, a novel spectrometer set-up was used to measure the spectrum of radiation refracted across the cornea. The efficacy of UVR blocking hydrogel contact lenses in filtering incident UVR was assessed in vivo. RESULTS: Qualitative and quantitative data indicated an increase nasally of UVR. Photodiode readings showed a net UVR increase from the temporal to the nasal side. Transmission curves showed that most UVR incident on the limbal region is either absorbed by, or transmitted through, the ocular tissues. This radiation is filtered by UVR blocking soft contact lens. CONCLUSIONS: An increased UVR flux on the nasal side of the eye, due to reflection off the nasal skin, was identified in vivo. Any UVR passing through the cornea is either absorbed by the conjunctiva and/or transmitted through it onto the sclera where it is absorbed. UVR blocking hydrogel contact lenses can eliminate these sources of UVR.