Patient-centered wound teleconsultation for cutaneous wounds: a feasibility study.

INTRODUCTION: The purpose of this study was to investigate the feasibility of patient-centered teleconsultation for various cutaneous wounds by using store-and-forward technology. MATERIALS AND METHODS: From July 2011 to November 2011, 53 patients with various wound conditions were enrolled in this study. The patients took their own wound images shortly before face-to-face consultations with a plastic surgeon, and the images were sent via e-mail to another 3 remote plastic surgeons along with brief medical information. All 4 surgeons completed a standard questionnaire individually, which addressed questions regarding the presence of wound conditions (gangrene, necrosis, erythema, and cellulitis/infection), as well as suggested clinical treatment with antibiotics and debridement. The evaluations were compared among the 3 remote surgeons as well as the remote and onsite surgeons. RESULTS: The 53 wounds included in our study exhibited different causative mechanisms and locations on the body. The concordances between the remote and onsite surgeons were 92%, 79%, 83%, and 85% regarding the presence of gangrene, necrosis, erythema, and cellulitis/infection, respectively. The agreement rates regarding the treatment suggestion with antibiotic use and debridement between the remote surgeons and the onsite surgeon were both 83%. The remote surgeons reported high specificity, at least 84%, in all parameters of wound descriptions or treatment suggestions. CONCLUSIONS: The patient-centered teleconsultation system based on store-and-forward technology is a feasible tool for wound management, and it shows promises in future clinical applications by decreasing clinic visits.

ENERGI-F703 gel, as a new topical treatment for diabetic foot and leg ulcers: A multicenter, randomized, double-blind, phase II trial.

Background: Diabetic foot and leg ulcers are a major cause of disability among patients with diabetes mellitus. A topical gel called ENERGI-F703, applied twice daily and with adenine as its active pharmaceutical ingredient, accelerated wound healing in diabetic mice. The current study evaluated the safety and efficacy of ENERGI-F703 for patients with diabetic foot and leg ulcers. Methods: This randomized, double-blind, multicenter, phase II trial recruited patients from eight medical centers in Taiwan. Patients with intractable diabetic foot and leg ulcers (Wagner Grade 1-3 without active osteomyelitis) were randomly assigned (2:1) to receive topical ENERGI-F703 gel or vehicle gel twice daily for 12 weeks or until complete ulcer closure. The investigator, enrolled patients and site personnel were masked to treatment allocation. Intention to treat (ITT) population and safety population were patient to primary analyses and safety analyses, respectively. Primary outcome was complete ulcer closure rate at the end of treatment. This trial is registered with ClinicalTrials.gov, number NCT02672436. Findings: Starting from March 15th, 2017 to December 26th, 2019, 141 patients were enrolled as safety population and randomized into ENERGI-F703 gel (n = 95) group or vehicle gel (n = 46) group. In ITT population, ENERGI-F703 (n = 90) and vehicle group showed ulcer closure rates of 36.7% (95% CI = 26.75% - 47.49%) and 26.2% (95% CI = 13.86% - 42.04%) with difference of 9.74 % (95 % CI = -6.74% - 26.23%) and 25% quartiles of the time to complete ulcer closure of 69 days and 84 days, respectively. There were 25 (26.3%) patients in ENERGI-F703 group and 11 (23.9%) patients in vehicle group experiencing serious adverse events and five deaths occurred during the study period, none of them related to the treatment. Interpretation: Our study suggests that ENERGI-F703 gel is a safe and well-tolerated treatment for chronic diabetic foot and leg ulcers. Further studies are needed to corroborate our findings in light of limitations. Funding: Energenesis Biomedical Co., Ltd.

Combined first dorsal metacarpal artery flap and dorsal transposition flap for correction of extensive first web space contracture: a case report and literature review.

First web space contracture is a common sequela after hand trauma and exerts tremendously negative effects on hand function. To restore hand function, it is mandatory to release contracted first web structures, which usually results in a large skin defect. Dorsal transposition flaps sometimes are not sufficient to cover the whole defect. Microvascular flaps provide abundant soft tissue, but they are lengthy procedures and exhibit risks of complete flap failure. In this study, we present an alternative approach to address this difficult clinical problem. A 25-year-old man developed extensive contracture over the first web space after trauma. After release of the contracted structures, the extensive skin defect was covered by a dorsal transposition flap with an extension to the territory of the first dorsal metacarpal artery flap. The functional and cosmetic results were excellent, without recurrence of contracture postoperatively. The combined first dorsal metacarpal artery flap and dorsal transposition flap appeared to be an effective and relatively simple method for the reconstruction of severe first web space contracture.

Forehead galeal pericranial flap for single-staged total upper eyelid reconstruction in sebaceous gland carcinoma excision.

PURPOSE: To present a successful case of single-staged total upper eyelid reconstruction after sebaceous gland carcinoma excision by using forehead galeal pericranial flap. OBSERVATIONS: An 80-year-old female with a progressively enlarged left upper eyelid mass presented with ocular irritation, blurred vision, and gritty sensation despite topical antibiotics treatment. This multinodular mass involved the left total upper eyelid, compromised corneal surface integrity, and caused complete ptosis. Excisional biopsy confirmed advanced sebaceous gland carcinoma, which was followed by extensive excision. The resultant total upper eyelid defect was reconstructed by a forehead galeal pericranial flap accompanied by anterior and posterior lamellar grafts. For the 34-month follow-up period, patient remained symptom-free without tumor recurrence and achieved acceptable cosmetic outcome. CONCLUSION: The forehead galeal pericranial flap appears to be effective as single-staged total upper lid reconstruction following extensive sebaceous gland carcinoma excision to restore eyelid function, avoid corneal exposure, and achieve acceptable cosmesis.

Surgical treatment of persistent dysphagia in stroke patients using a newly reconstructed conduit from the anterior mouth.

Dysphagia is common after stroke and may result in malnutrition and aspiration. To prevent the risk of aspiration and to improve the nutritional status, patients with dysphagic stroke have to give up oral intake and become dependent on tube feeding. Restoration of the patients' ability to resume aspiration free oral feeding is important. A 55-year-old male presented following a brainstem stroke and dysphagia. He was treated with a free jejunal flap to divert food from the anterior mouth to the cervical esophagus. Although the flap underwent partial loss, this was reconstructed with a tubed deltopectoral flap, and following a revision procedure for stricture, the patient's diet was advanced to a regular diet. At follow-up, the patient was able to eat by mouth without tube feeding. The application of this diversion technique to treat patients with a medical disease (i.e., stroke) is a step toward resuming oral feedings in this group of patients.