Burns During Coronavirus Disease 19 Lockdown: a Multi-Center Retrospective Study in Israel.

The coronavirus disease 2019 (COVID-19) pandemic forced many countries into lockdowns to limit the spread of infection. Israel's containment measures included school closures, mobility restrictions, and workforce reductions. Our study evaluated the effect of COVID-19 on the occurrence and patterns of burn injuries. The study data was obtained via retrospective chart review of burn patients treated between March 15, 2020 and April 30, 2020, namely the period of strict national lockdown. This data was compared against data from paralleling periods between 2017 and 2019. A total of 686 patients were treated for burn injuries in the two study periods. Age group analysis revealed an increased ratio of pediatric patients aged 0-3 years during the lockdown (55.91% vs 40.79%, P = .002). In contrast, there were fewer patients presenting with burn injuries in the 7-16 and 17-29 age groups (9.66% vs 3.15%, P = .017; 16.46% vs 7.09%, P = .007, respectively). During both study periods, scald injuries were the most common burn etiology and burn injuries occurred most often at home. This predominance was further pronounced during the lockdown (71.65% vs 58.68%, P = .007; 90.55% vs 74.60%, P = .0001, respectively). The lockdown period underlined the danger faced by pediatric patients in their household environment. This danger was possibly compounded by an improper level of adult supervision as parents transitioned to remote work. These findings can educate us about factors that render burn injuries more likely not only during lockdowns, but also during regular times, thus shaping the development of burn prevention practices.

Trends in Burn Injuries in Northern Israel During the COVID-19 Lockdown.

Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P < .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.

Use of a novel acellular dermal matrix allograft to treat complex trauma wound: a case study.

OBJECTIVE: To report the novel use of acellular dermal matrix allograft to treat a complex open fracture of the arm. METHODS: Case report outlining the steps taken to treat the fracture and soft tissue trauma. RESULTS: The complexity of the wound required multiple types of treatments that ultimately resulted in a healed fracture and full wound closure. CONCLUSIONS: Acellular dermal matrix has shown promise in closing the wound of a complex open fracture within the limitations of a single patient case study.

The role of the plastic surgeon in dealing with soft tissue injuries: experience from the second Israel-Lebanon war, 2006.

During the 2006 war between Israel and Lebanon, 282 Israeli soldiers were evacuated to Rambam Health Care Campus. Of these, 210 were admitted for observation or treatment, and 15 of these were admitted to the Department of Plastic and Reconstructive Surgery. Thirty-five other soldiers, hospitalized in other departments, required the care of Plastic Surgeons, either for conservative or surgical treatment. The injury profile observed was consistent with data from previous low-intensity warfare, which demonstrated that over 80% of injuries were produced by fragmentation weapons, such as artillery, mortarshells, rockets, and missiles. It differs, however, from our experience in previous wars and our expectations regarding burn wounds, both in incidence and severity, which were significantly lower as compared with the past. This article presents our management of extensive soft tissue injuries, and details 3 representative cases. It highlights the role of the Plastic Surgeon as part of the whole treatment in this type of injury and helps to predict the needs of the medical system in preparation for the future.

The sounds of music in the operating room.

BACKGROUND: Little information is available about the effect of music on the operating room (OR) staff. PURPOSE: The objective of this study was to evaluate the perception of the influence of music on physicians and nurses working in the OR. METHODS: A questionnaire was designed and 250 copies were distributed to the doctors and nurses working in the OR at three hospitals. One hundred and seventy-one returned the completed questionnaire and were included in this study. RESULTS: 63% of the participants listen to music on a regular basis in the OR. Classical music is the most requested (58%) and most of the responders do not choose the type of music according to the type of the procedure. In our study, the nurses were more likely to listen to music and the willingness is higher among the female responders. The desired volume is lower as age increases and 78.9% of the participants claimed that music in the OR makes them calmer and more efficient. CONCLUSION: According to our study, music has a positive effect on the staff working in the operating rooms.

Pharmacokinetics of high-dose diluted lidocaine in local anesthesia for facelift procedures.

The maximal recommended local anesthetic dose of lidocaine is 7 mg/kg; higher doses are used in tumescent liposuction. The objective of this study was to characterize the pharmacokinetics of high-dose diluted lidocaine administered together with epinephrine for local anesthesia in facelift procedures. This was a prospective study of six female patients undergoing elective facelift surgery. The local anesthetic solution consisted of 0.33% lidocaine, 0.07% sodium bicarbonate, and 1:600,000 epinephrine in normal saline. Plasma lidocaine levels were determined in the course of 24 hours and were subjected to pharmacokinetic analysis. Patients' age was 58.5 +/- 8 years and weight 68.5 +/- 18.7 kg. Mean lidocaine dose was 21.6 +/- 3.6 mg/kg (range, 17.5-26.3 mg/kg) infiltrated subcutaneously over 20 minutes or less. No lidocaine-related adverse effects were recorded. Major bleeding was not observed. Postoperative analgesia was required only at 11.8 +/- 4.6 hours after surgery. Pharmacokinetic analysis was peak concentration 1.41 +/- 0.4 microg/mL, time to reach peak concentration 9.3 +/- 1.6 hours, terminal half-life 6.2 +/- 1.5 hours, area under the curve from time zero to last data point 1379.8 +/- 470 microg/min/mL, and area under the curve from time zero to infinity 1530.6 +/- 471.6 microg/min/mL. Plasma lidocaine concentrations formed almost a plateau between 2 and 12 hours (ie, at approximately 1.2 microg/mL) after infiltration. It is concluded that local anesthesia with diluted lidocaine at a dose 3.1 times higher than the currently recommended dose (7 mg/kg) administered with epinephrine yielded a peak plasma lidocaine level that was 72% below the level considered safe (5 microg/mL).

The effect of lidocaine and adrenaline on the viability of injected adipose tissue--an experimental study in nude mice.

Adipose tissue injection as a free graft for the correction of soft tissue defects is a widespread procedure in plastic surgery. The main problem in achieving long-term soft tissue augmentation is partial absorption of the injected fat, and hence the need for over-correction and re-injections. Lidocaine, used for local anesthesia, has been suspected as an inhibitor of growth of adipocytes in culture and slowing down glucose transport and lipolysis in adipocytes. In addition, reduced blood supply by local application of epinephrine was accused of having a negative effect on the graft. The purpose of this study was to examine the effect of local anesthesia, administered to the fat donor site, on the take of the injected fat. Human adipose tissue, obtained by suction-assisted lipectomy, was injected subcutaneously into the scalp of nude mice. Local anesthesia of the fat donor site consisted of a solution with 600 mg of lidocaine (0.06%) and epinephrine 1:1000000. In a control group, normal saline with no local anesthesia or epinephrine was administered to the donor site. One cc of fat was injected after centrifugation into each animal scalp. There were 10 animals in each group. The animals were sacrificed 15 weeks after the procedure. Graft weight and volume were measured, and histologic evaluation was performed. No significant differences were demonstrated between the groups in regard with the grafts' weight and volume and the histologic parameters investigated. In conclusion, local anesthesia solution, consisting of lidocaine and epinephrine, does not alter the take of fat grafts, and has no influence on the adipocytes viability.

The effect of interleukin-8 on the viability of injected adipose tissue in nude mice.

Adipose tissue injection as a free graft for the correction of soft-tissue defects is a widespread procedure in plastic surgery. The main problem in achieving long-term soft-tissue augmentation is partial absorption of the injected fat and hence the need for overcorrection and re-injection. The purpose of this study was to improve the viability of the injected fat by the use of interleukin-8. The rationale for the use of interleukin-8 was its abilities to accelerate angiogenesis and attract inflammatory cells and fibroblasts, providing the injected adipocytes more feeding vessels and a well-established graft bed to enhance their viability. Human adipose tissue, obtained by suction-assisted lipectomy, was re-injected into the subcutis in the scalp of nude mice. Interleukin-8 (0.25 ng) was injected subcutaneously to the scalp as a preparation of the recipient site 24 hours before the fat injection and was added to the fat graft itself (25 ng per 1 cc of injected fat). In the control group, pure fat without interleukin-8 was injected and no interleukin-8 was added for the preparation of the recipient site. One cubic centimeter of fat was injected in each animal in both the study and control groups. There were 10 animals in each group. The animals were euthanized 15 weeks after the procedure. Graft weight and volume were measured and histologic evaluation was performed. In addition, triglyceride content and adipose cell sizes were measured as parameters for fat cells viability. Histologic analysis demonstrated significantly less cyst formation in the group treated with interleukin-8. No significant differences were found between the groups with regard to graft weight and volume or the other histologic parameters investigated. No significant differences were demonstrated in adipose cell sizes and their triglyceride content. In conclusion, less cyst formation, indicating improved quality of the injected fat, can be obtained by the addition of interleukin-8. Further studies of various dosages of interleukin-8 and their long-term effect are required before these encouraging results could be applied clinically.

Enhancing the take of injected adipose tissue by a simple method for concentrating fat cells.

Injection of aspirated fat for the correction of tissue defects is a common procedure in plastic surgery. The reported rates of fat cell survival vary greatly in the medical literature, and different techniques of harvesting, processing, and reinjecting the fat cells are claimed to be responsible for these differences. However, there is no agreement concerning the best way to process the harvested fat before reinjection. The present study was initiated to examine and evaluate the effect of a simple method of isolating the fat particles on the outcome of fat graft survival. In this study, the nude mouse model was used to examine the survival and take of the fat graft concentrated before injection by the cumbersome recommended closed centrifugation technique in comparison with the authors' recommended open method, using an operating room cotton towel as a platform for concentrating the fat cells and separating them from fluids, oil, and debris. One milliliter of concentrated human fat cells preprocessed by towel separation was injected into the nuchal subcutis of 11 nude mice in the study group, and the same amount of fat that was preprocessed by centrifugation was injected into 11 control mice. Injected fat survived in both groups. No significant differences were found regarding fat graft weight and volume, although a tendency for better survival was noticed in the experimental group. Histologic evaluation of the grafts revealed significantly less fibrosis within the study group, meaning that the quality of the fat grafts was better. The authors found this method to be simple, cheap, and friendly to the surgeon in comparison with traditional processing using the centrifuge.

Long-term fat preservation.

The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated harvesting and injection. Fat preservation for future re-injection is indicated to avoid repeated fat harvesting procedures. A previous study has shown that fat obtained by suction can be preserved by freezing for at least 2 weeks. The purpose of the present study was to investigate the effect of freezing autologous free fat for 7 months on the take of the fat graft. Human fat obtained by suction-assisted lipectomy was centrifuged and stored in a domestic refrigerator at -18 degrees C for 7 months. After thawing, the fat was injected into the scalp of 10 nude mice, which served as the study group. In the control group (n = 10), fresh fat was injected. Fifteen weeks later, the fat grafts were dissected out. Volumes, weights, and histological parameters were compared between the groups. The injected fat survived in both the study and the control groups but the histological parameters were significantly inferior in the frozen fat. The weight of the frozen fat was also significantly less compared with the fresh fat. The volume of the frozen fat was inferior but not significantly. Based on this in vivo experiment, it is suggested to refrain from using fat that has been frozen for 7 months or longer. The longest period and the optimal conditions for fat preservation should be further investigated.

Using intense pulsed light for cosmetic purposes: our experience.

The authors' experience using intense pulsed light for skin rejuvenation is summarized and analyzed with regard to its efficacy, safety, and complications. Rejuvenation using intense pulsed light was performed on 59 patients over a 6-month period (January of 2002 to July of 2002); these patients served as the study group. The areas treated were the face, neck, chest, hands, and legs. The parameters used during the procedure, patient satisfaction, and complications are described. Ninety-five percent of the patients included in the study had one or two sessions. Good to very good results were reported by 93.1 percent. Most patients had minor side effects and only three patients (5 percent) experienced complications (hyperpigmentation or scars). Intense pulsed light is an effective and safe method for skin rejuvenation. Its efficacy is mainly manifested by eliminating senile pigmentation and telangiectasias and a achieving a younger and fresher appearance of the skin. Although in the literature intense pulsed light skin rejuvenation is mainly reported for the face, the authors have obtained good results by using it for other areas of the body. The majority of the patients were satisfied. The authors conclude that intense pulsed light skin rejuvenation is a safe and effective method for facial and nonfacial rejuvenation.

Fate of exposed breast implants in augmentation mammoplasty.

Exposure of silicone breast implants usually leads to infection and extrusion. According to the literature, implant extrusion rates are not higher than 2% 1 and removal of the implant is recommended. 2 During the past 3 years, the authors dealt with eight implant exposures (six women: two cases of bilateral exposure and four cases of unilateral exposure). All the pockets were infected. Patients were offered two alternatives: immediate removal of the implant and reimplantation after a few months or conservative treatment with an effort to close the exposed area after the discharge stopped. All the patients in this study chose the latter alternative. Four out of eight implants were saved. The authors had to remove the other four. The average follow-up of these women was 2 years and there were no signs of capsular contracture or any other problems. According to this series, 50% of eight exposed breast implants could be saved with conservative treatment.

Four parallel flaps for correction of a wide forehead defect.

A simple method for closure of a defect in the forehead area by four parallel flaps along the forehead wrinkle lines is illustrated. The main advantage of this method lies in its simple design, which enables the surgeon to close large defects with no elevation of the eyebrow, while preserving the hairline, and most of the suture lines are parallel to the forehead wrinkle lines.

Early nonsurgical correction of congenital auricular deformities.

Congenital auricular deformation is not an uncommon phenomenon, and it may cause substantial annoyance to the growing child. Many parents of affected children will seek surgical correction of the deformed auricles. The variety of techniques that have been described for the correction of this anomaly suggests that none has been considered satisfying. The consequent possible surgical complications should also be considered, when the surgical procedure can be replaced by an effective conservative treatment. The authors describe their experience using early splinting for congenital auricular deformities. Fifty-two newborn infants with lop, prominent, Stahl's, and constricted ears referred to us by the neonatal department staff were enrolled in this study. Putty Soft, a vinyl polysiloxane impression material, has been used for early molding of the auricles. Surgical tapes were used for the fixation of the mold and to fix the auricle to the scalp. The results were evaluated by one of the parents and by a layperson (medical student) 6 months after completion of the procedure. The above-described early splinting procedure was applied onto 92 auricles of 52 newborn infants aged 1 to 10 days, mostly around day 3. The mean treatment time was 6.8 weeks. All treated auricles were improved, 87 percent were rated as excellent improvement, and there were no complications related to the treatment. The authors conclude that early splinting of deformed auricles should be offered to parents of affected children, and the awareness of this procedure by neonatologists, pediatricians, and nursery staff should be increased.