Integra Dermal Regeneration Template in reconstructive surgery for cutaneous tumours: a two-year retrospective review.

OBJECTIVE: Integra Dermal Regeneration Template (IDRT) (Integra LifeSciences, US) is a bioengineered dermal matrix that has been widely used in burn reconstruction since its first description. However, little is reported on its use in oncologic dermatological defects. Our objective was to evaluate reconstruction using IDRT on cutaneous tumour defects. METHOD: We conducted a two-year retrospective review of patients with skin tumours who had an excision surgery, followed by reconstruction with IDRT, as a mid-step towards a final autograft procedure: a split-thickness skin graft. The records of all patients at a single academic institution were queried from the electronic medical record using data obtained from the operating surgeon. RESULTS: We identified 13 patients with different tumour types and locations. The mean defect size was 105.92cm². The matrix take rate was 92.3% and average postoperative day for definite autograft was 20 days. Patients were followed for a period of up to 12 months. Of the patients, one had exposed bone without periosteum; another patient showed recurrence six months after matrix placement, requiring a new second two-stage IDRT-autograft procedure before radiation therapy. Patients reported complete satisfaction with the cosmetic, functional and oncological results. No cases of infection were encountered. CONCLUSION: IDRT is a valid option for the reconstruction of oncologic surgical defects of the skin and can be used in different anatomical locations. Specifically, it is an alternative to the reconstructive ladder when grafts and local flaps are not possible in those patients, and an option for patients who will eventually need adjuvant radiotherapy.

Utilización de piel cadavérica (aloinjerto) en la preparación del lecho en úlceras de miembros inferiores / Use of cadaveric skin in the preparation of the receptor bed in lower limb ulcer

Introducción y objetivo: Considerando que las úlceras crónicas de miembros inferiores son de evolución tórpida y de difícil tratamiento, con la presencia de biofilm en el lecho de la herida asociado a un proceso de inflamación crónica que interrumpe el desarrollo de la cicatrización normal, proponemos un tratamiento con sustitutos cutáneos (piel cadavérica y piel artificial) para adecuar el lecho de la herida y prepararlo para la reconstrucción definitiva con autoinjerto.Maaterial y método.Cohorte retrospectiva de 22 pacientes sometidos a cirugía reconstructiva de úlceras crónicas de origen vascular o postraumático en miembros inferiores en el Hospital Alemán de Buenos Aires (Argentina) en el período de febrero de 2017 a diciembre de 2019.En la primera etapa quirúrgica se realizó desbridamiento de lesiones con cobertura inmediata de piel cadavérica (aloinjerto) en toda la superficie de la herida y en un segundo tiempo quirúrgico, retirada del aloinjerto y reconstrucción con autoinjerto de piel de espesor parcial o piel artificial Integra® (Lifesciences Corp., Plainsboro, NJ, EE.UU.) y autoinjerto delgado de piel.Resultados.Analizamos 22 pacientes de los que 15 fueron mujeres (68.18%), con edad promedio de 72.5 años. La media de la superficie de las úlceras crónicas fue de 111.76 cm2. La etiología fue vascular en 12 pacientes (54.54%) y en 10 de origen postraumático (45.45%). El prendimiento de la piel cadavérica se logró en 20 pacientes (90.90%), de los que en 18 fue del 100% y en 2 del 50%. El aloinjerto actuó como sustituto cutáneo transitorio para la preparación del lecho receptor. Todos los pacientes evidenciaron disminución del proceso inflamatorio, exudado y dolor.Conclusiones.En nuestra experiencia, el injerto de piel cadavérica es una opción válida en la preparación del lecho para el tratamiento de úlceras crónicas rebeldes al tratamiento no quirúrgico. (AU)

Background and objective: Considering that chronic ulcers of the lower limbs are of torpid evolution and difficult to treat, with the presence of biofilm in the wound bed associated with a process of chronic inflammation that interrupts the development of normal healing, we propose a treatment with skin substitutes (cadaveric skin and artificial skin) to adapt the wound bed and prepare it for the definitive reconstruction with autograft.Methods.Retrospective cohort of 22 patients who underwent reconstructive surgery for vascular or post-traumatic chronic ulcers in the lower limbs at the Hospital Alemán in Buenos Aires (Argentina) from February 2017 to December 2019. In the first surgical stage, the ulcers were debrided with immediate coverage of cadaveric skin (allograft) and in a second surgical stage, removal of the allograft and reconstruction with a split-thickness skin graft (STSG) or Integra® (Lifesciences Corp., Plainsboro, NJ, USA) and STSG.Results.A total of 22 patients were analyzed, 15 of them women (68.18%) with an average age of 72.5 years. The average surface area of the chronic ulcers was 111.76 cm2. The etiology of the ulcers was vascular in 12 patients (54.54%) and post-traumatic in 10 patients (45.45%). In 20 patients (90.9%) the acceptance of the cadaveric skin graft was achieved; in 18 cases the graft was taken 100% and in 2 cases 50%. The allograft was applied as a temporary skin substitute for the preparation of the receptor bed. All patients showed a decrease in the inflammatory process, exudate and pain.Conclusions.In our experience, cadaveric skin graft is a valid option for the treatment of chronic ulcers resistant to non-surgical treatment. (AU)

Comparison of Efficacy of Povidone-Iodine, Ethanol, and an Aerosol Formulation of Silver Sulfadiazine in Controlling Microbial Burden on Sutures From Clean Surgeries.

In the surgical suture, the implanted thread can be a source of microbial contamination. Implanted materials are frequently described as being substrates prone for biofilm development provoking surgical site infections. Treatment of postsurgical wounds with different topical antimicrobial agents is a current practice applied to every patient. However, to date, there is little evidence on the efficacy of different antiseptic treatments on suture materials in preventing environmental or skin bacterial adhesion and further infection. Here, the authors compared the ability of an aerosol formulation of silver sulfadiazine, vitamin A, and lidocaine (AF-SSD) and of two of the most frequently used topical treatments, povidone-iodine and ethanol, in eradicating or controlling the microbial contamination of suture threads in patients who have undergone clean surgeries. Postsurgical suture threads treated with AF-SSD showed a significantly reduced proportion of contaminated samples containing viable microbial cells compared with those treated with povidone-iodine or ethanol. Furthermore, those samples that were positive for bacterial growth showed a lesser number of viable cells in AF-SSD-treated sutures than those treated with povidone-iodine or ethanol. Confocal laser scanning microscopy showed that AF-SSD-treated postsurgical sutures presented significantly less attached microbial cells than povidone-iodine and ethanol, with scarce observable microbial cells on the surface of the suture. Taken together, the results suggest that treatment with AF-SSD is more effective than the other two antiseptics, and there is a potential for improvement in reducing the microbial burden of implanted materials such as the suture thread.

Catheter infection risk related to the distance between insertion site and burned area.

A prospective observational study of central venous catheters (CVC) was carried out in order to determine if a CVC inserted near an open burn wound increases catheter infection risk in burned patients. The study was carried out during a 12-month period (1998-1999) at the Benaim Foundation's Burn Unit in Buenos Aires (C.E.P.A.Q.). Eighty-three CVCs were inserted in 20 burned patients during the study period. Twenty-six catheters were inserted near an open wound (NOW) and 57 far from an open wound (FOW). NOW CVCs were considered when 25 cm2 surrounding the catheter's insertion site overlapped the wound. Colonization rates were 84% (22/26 CVCs) in those inserted NOW and 47% (27/57 CVCs) in FOW (P = 0.001). Colonization relative risk of NOW-CVCs was 1.79 (95% confidence interval, 1.3-2.46). Bacteremia rates were 27% (7/26 CVCs) in CVCs inserted NOW and 6% (3/57 CVCs) in FOW (P = 0.004). Bacteremic risk of NOW-CVCs was 5.12 (95% confidence interval, 1.44-18.22). Colonization rates were higher and sooner in NOW-CVCs than in FOW-CVCs. We suggest that insertion of catheters near an open burn wound should be avoided and, if inevitable, should not be left in place for period exceeding 3 days.

Valor de la presión constante en el neumoperitoneo progresivo experimental / Constant pressure value in experimental progressive pneumoperitoneum

Se investigó en conejos el neumoperitoneo progresivo a presiones constantes y su relación con las variaciones de la capacidad abdominal. Los volúmenes ynyectados para mantener constante la presión intraabdominal se incrementaron al doble entre la 1ª y la 4ª sesión, triplicándose en la 8ª independientemente de las características físicas de cada animal

Valor de la presión constante en el neumoperitoneo progresivo experimental / Constant pressure value in experimental progressive pneumoperitoneum

Se investigó en conejos el neumoperitoneo progresivo a presiones constantes y su relación con las variaciones de la capacidad abdominal. Los volúmenes ynyectados para mantener constante la presión intraabdominal se incrementaron al doble entre la 1¬ y la 4¬ sesión, triplicándose en la 8¬ independientemente de las características físicas de cada animal (AU)