Cartilage Curvature Reshaping: A Quantitative Assessment.

BACKGROUND: Horizontal mattress suturing is frequently performed during rhinoplasty and otoplasty procedures to control the curvature of the cartilages. Despite the popularity of this technique, there are no quantitative methods for determining the effects of mattress sutures in the cartilage reshaping. OBJECTIVES: The aim of this experimental study was to quantify the straightening effect of mattress suturing on the convexity of ear cartilage in a rabbit model. METHODS: Eleven young adult male New Zealand white rabbits were used in this study. A horizontal mattress suture with spacing 3 mm × 6 mm was placed in a rectangle demarcated on the left ear in the area with maximum convexity. Preoperative and postoperative photographs were taken before and immediately after surgery, respectively. The radius of curvature (ROC), the first-order derivative (FOD), and the second-order derivative (SOD) were calculated to quantify the net cartilage reshaping, the changes in each point, and the homogeneity of the newly shaped cartilage, respectively. RESULTS: The mean ROCs were 1.112 cm and 2.169 cm before and after surgery, respectively, and this increase was statistically significant. The mean FOD for each point slope index was statistically lower after surgery (0.269 before surgery vs 0.135 after surgery). The mean SOD also significantly decreased after surgery (0.007 before surgery vs 0.003 after surgery). The values of the SOD remained positive after surgery, indicating that changes in the curvature were homogeneous. CONCLUSIONS: A quantitative measurement method was introduced to directly quantify the controlling effect of a mattress suture. This method makes it possible to achieve the important task of comparing the effect of horizontal mattress suturing with that of other cartilage-reshaping techniques.

Prevalence of HIV infection among burn patients: is there a relationship with patients' outcomes?

The aim of the present study was to determine the prevalence of human immunodeficiency virus (HIV) infection among acute burn patients and its impacts on patient's outcomes in an Iranian burn care hospital. A cross-sectional study was conducted in a tertiary burn care hospital in Iran, retrospectively reviewing the data records of all patients admitted between February 2011 and February 2012. The HIV status of all the patients was assessed in relation to clinical outcomes and the patient's prognosis. A total of 969 patients were included in this study. Five patients (0·5%) were HIV positive, and all of them were male. Mean burn area was significantly larger in HIV-positive patients than the healthy group (P < 0·05). HIV-positive patients had a longer period of hospitalisation than HIV-negative patients (23·2 ± 16·3 versus 13·1 ± 14·6, P = 0·008). Nonetheless, the average number of procedures and the mortality rate did not significantly differ between the study groups (P > 0·05). Comparison of age, sex and burn extent between HIV-positive patients and HIV-negative cases also revealed similar results. Prevalence of HIV infection among our burn population was 0·5%; thus, HIV status may be related with more extensive injuries and longer hospital stays.

A Dermal Equivalent Engineered with TGF-ß3 Expressing Bone Marrow Stromal Cells and Amniotic Membrane: Cosmetic Healing of Full-Thickness Skin Wounds in Rats.

Transforming growth factor beta-3 (TGF-ß3) has been shown to decrease scar formation after scheduled topical applications to the cutaneous wounds. This study aimed to continuously deliver TGF-ß3, during the early phase of wound healing, by engineering a dermal equivalent (DE) using TGF-ß3 expressing bone marrow stromal cells (BM-SCs) and human dehydrated amniotic membrane (hDAM). To engineer a DE, rat BM-SCs were seeded on the hDAM and TGF-ß3 was transiently transfected into the BM-SCs using a plasmid vector. Pieces of the dermal equivalent were transplanted onto the full-thickness excisional skin wounds in rats. The process of wound healing was assessed by image analysis, Manchester Scar Scale (MSS), and histopathological studies 7, 14, 21, and 85 days after the excision. The results confirmed accurate construction of recombinant pcDNA3.1-TGF-ß3 expression system and showed that the transfected BM-SCs seeded on hDAM expressed TGF-ß3 mRNA and protein from day 3 through day 7 after transfection. After implantation of the DE, contraction of the wounds was measured from day 7 through 21 and analyzed by linear regression, which revealed that the rate of wound contraction in all experimental groups was similar. Histologic evaluation demonstrated that transfected BM-SCs decreased retention and recruitment of the cells during the early stage of wound healing, decreased the formation of vascular structures and led to formation of uniformly parallel collagen bundles. MSS scores showed that TGF-ß3 secreting cells significantly improved the cosmetic appearance of the healed skin and decreased the scar formation. From these results, it could be concluded that transient secretion of TGF-ß3, during the early phase of healing, by BM-SCs seeded on hDAM can improve the cosmetic appearance of the scar in cutaneous wounds without negatively affecting the process of wound repair.

A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities.

BACKGROUND: Tissue expansion has evolved reconstruction surgery by providing a great source of additional tissue for large skin defects. Nevertheless, wide application of tissue expander reconstruction is challenging due to high complication rates and uncertainty about final outcomes. Recently, endoscopy has shown promise in reconstructive surgeries using tissue expander placement. AIMS: This study aimed to compare outcomes between open and endoscopic-assisted neck tissue expander placement in reconstruction of post-burn facial scar deformities. METHODS: Through a randomized clinical trial, 63 patients with facial burn scars were assigned to an open group or endoscopic group for placement of 81 tissue expanders. The complication rate, operative time, length of hospital stay, and time to full expansion were compared between the two groups. RESULTS: Thirty-one patients were assigned to the open group and 32 patients to the endoscopic group. The average operative time was significantly reduced in the endoscopic group compared with the open group (42.2 ± 3.6, 56.5 ± 4.5 min, p < 0.05). The complication rate was significantly lower in the endoscopic group than the open group (6 vs. 16, p < 0.05). Hospital stay was also significantly diminished from 26.3 ± 7.7 h in open group to 7.4 ± 4.5 h in endoscopic group (p < 0.0001). There was a significant reduction in time to full expansion in the endoscopic group as compared with the open group (93.5 ± 10.2 vs. 112.1 ± 14.2 days, p = 0.002). CONCLUSION: Endoscopic neck tissue expander placement significantly reduced operative time, the postoperative complication rate, length of hospital stay, and time to achieve full expansion and allowed early initiation of expansion and remote placement of the port in relation to the expander pocket. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Endoscopic-assisted neck tissue expansion in reconstruction of facial burn injuries.

BACKGROUND: Endoscopic-assisted tissue expansion has been recently used in plastic surgery. However, there is limited evidence regarding its efficacy in reconstruction of facial burn injuries. AIMS: Our study aimed to evaluate the utility of endoscopic-assisted neck tissue expansion in reconstruction of facial burn deformities. METHODS: Through a prospective study, 42 consecutive patients with facial burn injuries attending a major referral center of plastic and reconstructive surgery in Iran underwent reconstruction of facial defects with endoscopic-assisted neck tissue expansion. Intraoperative events, expansion process, and postoperative outcomes were measured for this group of patients. RESULTS: The mean ± SD injected volume for intraoperative expansion was 66 ± 3.7 mL (range, 35-80 mL). The mean ± SD operative time was 45.6 ± 3.5 minutes. Moreover, the mean ± SD distance between the main access incision and the expander pocket was 5.6 ± 1.2 cm. Time to achieve full expansion ranged between 12 and 16 weeks, and the expanded volume at the time of reconstruction ranged from 400 to 800 mL. All the patients had less than 24 hours of hospital stay after placement of tissue expanders. There were only 2 minor complications during the postoperative follow-up including 1 case of seroma and 1 case of severe pain, which were treated conservatively. CONCLUSIONS: Endoscopic-assisted neck tissue expansion is associated with lower complication rate, shorter duration of hospitalization, reduced operative time, earlier initiation of expansion, and faster expansion process. It could be a feasible alternative to open technique in reconstructing facial burns, allowing smaller incision at port site, far placement of tissue expander, and excellent visualization of operation site.

Rib Diced Cartilage-Fascia Grafting in Dorsal Nasal Reconstruction: A Randomized Clinical Trial of Wrapping With Rectus Muscle Fascia vs Deep Temporal Fascia.

BACKGROUND: Rib cartilage is an abundant source for cartilage grafts when significant dorsal nasal augmentation or structural support is indicated. Diced cartilage wrapped in fascia was developed to counteract warping, visibility, and displacement of rib cartilage as a dorsal solid graft. The technique for wrapping diced cartilage has evolved during the past several years. OBJECTIVES: The authors compared 2 distinct fascial sleeves for wrapping rib diced cartilage in the treatment of patients who required major dorsal nasal augmentation. METHODS: Thirty-six patients who planned to undergo major dorsal nasal reconstruction with diced costal rib cartilage were assigned randomly to 1 of 2 groups: the intervention group, which received grafts wrapped with rectus muscle fascia from the rib cartilage harvesting site, or the control group, which received deep temporal fascia harvested separately. Outcomes were compared between the groups. RESULTS: Patients in the intervention group had significantly shorter operating times, significantly higher average satisfaction scores, and significantly shorter postoperative hospital stays than did patients in the control group. CONCLUSIONS: Harvesting rectus muscle fascia for wrapping diced rib cartilage is a feasible and reliable technique in dorsal nasal reconstruction surgery. It is associated with favorable outcomes and a high level of patient satisfaction. LEVEL OF EVIDENCE: 4.

Assessment of Erectile Dysfunction Following Burn Injury.

OBJECTIVE: To determine the prevalence of erectile dysfunction (ED) following burn injury. MATERIALS AND METHODS: A cross-sectional study was conducted in 2013, recruiting 125 male patients with thermal and electrical burn injury. Using the simplified and validated Persian translation of the abridged, 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire, the patients were evaluated for the presence and severity of the ED following burn injury. RESULTS: ED was detected in 66 patients (53%). There was a significant association between the total body surface area (TBSA) and severity of ED, in which by increase in the TBSA, the severity of ED increased. There was a significant negative correlation between IIEF-5 score and age (r = -0.247, P = .005) and TBSA (r = -0.481, P < .001). The logistic regression analysis revealed that TBSA was significantly associated with ED (P < .001). CONCLUSION: Our study estimated the prevalence of ED among burn survivors to be higher than the general population. We found that TBSA is a significant risk factor of ED.

Evaluation of Amniotic Membrane Effectiveness in Skin Graft Donor Site Dressing in Burn Patients.

Although the recipient site in burn wounds is dressed with universally accepted materials, the ideal management of split-thickness skin donor sites remains controversial. The aim of our study is to compare two methods of wound dressing in donor sites of split-thickness skin graft in patients undergoing burn wound reconstructive surgery. Forty-two consecutive patients with second- and third-degree burns with a total body surface area between 20 and 40 % were enrolled in this randomized clinical trial conducted in Motahari Burn Hospital in Tehran, Iran. In each patient, two anatomic areas with similar features were randomly selected as intervention and control donor sites. The intervention site was dressed with amniotic membrane, whereas the control site was treated with Vaseline-impregnated gauze. Wounds were examined daily by expert surgeons to measure the clinical outcomes including duration of healing, severity of pain, and infection rate. The mean ± SD age of patients was 31.17 ± 13.72 years; furthermore, burn percentage had a mean ± SD of 31.19 ± 10.56. The mean ± SD of patients' cooperation score was 1.6 ± 0.79 in the intervention group compared with 2.93 ± 0.71 in the control group, revealing a statistically significant difference (P < 0.05). Duration of wound healing was significantly shorter (P < 0.05) in the intervention group (17.61 ± 2.56 days) compared with the control group (21.16 ± 3.45 days). However, there was no significant difference in terms of wound infection rate between donor sites in the control and intervention groups (P > 0.05). Amniotic membrane as an alternative for dressing of skin graft donor sites provides significant benefits by increasing patients' comfort via diminishing the number of dressing changes and facilitating the process of wound healing.

Soft-tissue response rate to chin skeletal advancement in patients with lower facial burn scar.

BACKGROUND: This study aimed to evaluate the long-term outcomes and the soft-tissue response to osseous genioplasty in patients with chin retrusion caused by early life facial burn injury. METHODS: Twenty-two consecutive patients with retrusive chin as a result of severe childhood facial burn were included in this study. Cephalometric analysis and photographs were used to assess the patients for eligibility of a surgical correction. Horizontal hard-tissue advancement and soft-tissue responses were measured as the primary outcomes at the early and late postoperative follow-up visits. RESULTS: A total of 22 patients fulfilled the study requirements. Average preoperative distance between the pogonion, as the most anterior point of the anterior mandibular contour, and a perpendicular line connecting the nasion and the supramental point of the mandible was 0.82 ± 1.1 mm, which increased significantly to 7.8 ± 0.8 mm after genioplasty (p < 0.0001). Soft tissue was repositioned on average 6.1 ± 0.4 mm anteriorly on average, which is in comparison with the amount of chin skeleton advancement, and a response ratio of 0.8:1 was calculated at late follow-up. CONCLUSION: Burn-related retrusive chin can appropriately be treated with sliding osseous genioplasty and will require slight overcorrection compared with patients without a history of lower face burn. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Assessment of substances abuse in burn patients by using drug abuse screening test.

There has been an increase in the frequency of substance abuse among hospitalized burn injury patients. However, few studies have investigated substance abuse among burn patients. This study was aimed to identify the incidence of substance abuse in burn injury patients using the "Drug Abuse Screening Test" (DAST-20). We determined the validity of DAST-20 in spring 2010. Subsequently, this descriptive study was performed on 203 burn injury patients who fit the study's inclusion criteria. We chose a score of 6 as the cutoff and thus achieved a sensitivity of 89% and a specificity of 85% for the DAST-20. During the study, we gathered demographic data, burn features and DAST-20 results for all patients. Patients with scores of 6 or more were considered to be substances abusers. A statistical analysis was conducted using SPSS v16 software. According to the DAST-20 results, 33% of the patients were in the user group. The mean score of DAST-20 was significantly higher among users than it was among nonusers (P<0.05). The level of substance abuse was severe in 77% of users. No significant differences were found among the substances, with the exception of alcohol. Substance abuse is an important risk factor for burn patients. In addition, this study showed that DAST-20 is a valid screening measure for studies on burn patients.