Selective Enzymatic Debridement For The Management Of Acute Upper Limb Burns.

Upper limb burn treatment represents a major medical and surgical challenge. Enzymatic escharolysis is a rather new technique to treat thermal burns in an easy and rapid way, as an alternative to the standard of care. The aim of the study was to investigate and describe the efficacy of treatment of upper limb burns with NexoBrid® in a non-burn referral center. All patients suffering from upper limb burns and admitted within 36 hours to the Hand and Microsurgery Unit of the ASST Sette Laghi from December 2016 to June 2018 were enrolled in the study. A retrospective analysis was performed, evaluating time to wound healing, time of hospitalization, and scar aesthetic appearance with patient and observer scar assessment scale (POSAS) and disabilities of the arm, shoulder and hand score (DASH). A total of 18 patients with burns involving the upper limb from December 2016 to June 2018 were treated. The mean TBSA% involved was 3%; 4 out of 18 patients suffered circumferential burns. The mean POSAS score was 14; the mean DASH score at 6-month follow up was 21, while it reduced to 11 at the last follow up visit. Enzymatic escharolysis is a novel, rapid and selective treatment option that allows early physiotherapy with overall satisfying functional results. We believe that enzymatic escharolysis should be considered, in most cases, as the standard of care in the treatment of upper limb burn wounds in non-burn referral centers.

Le traitement des brûlures du membre supérieur (MS) est un défi médico- chirurgical majeur. Le débridement enzymatique est une technique relativement récente, facile et rapide, représentant une alternative au traitement classique. Le but de cette étude est d'évaluer l'utilisation du Nexobrid® dans le traitement, hors CTB, des brûlures du MS. Les 18 patients souffrant de brûlure du MS, hospitalisés entre décembre 2016 et juin 2018 dans le service de microchirurgie et de chirurgie de la main du Groupement Hospitalier de Territoire Sette Laghi dans les 36 h suivant l'accident ont été étudiés selon une étude rétrospective évaluant le délai de cicatrisation, la durée d'hospitalisation, l'aspect esthétique de la cicatrice (échelle POSAS), la fonction du MS (échelle DASH). La surface atteinte moyenne était de 3%, 4 patients avaient une atteinte circulaire. Le POSAS moyen était de 14, le DASH moyen à 6 mois de 21, s'abaissant à 11 à la dernière consultation de suivi. Le débridement enzymatique permet une rééducation plus précoce, avec des résultats fonctionnels satisfaisants. Nous pensons que cette technique est à privilégier dans le traitement hors CTB des brûlures du MS.

Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training.

OBJECTIVE: Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries. MATERIALS AND METHODS: A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test. RESULTS: From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery. CONCLUSIONS: The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.

Treatment of multiple wounds of aplasia cutis congenita on the lower limb: a case report.

INTRODUCTION: Aplasia cutis congenita (ACC) is a rare congenital disease, characterised by absence of skin, that can affect different parts of the body. ACC is more frequent on the scalp, but can involve limbs, with partial-or total-thickness loss of skin, with a functional impairment of the joint affected. There is no clear indication for surgical or conservative treatment, therefore, it would be helpful to find scientific support for the optimal treatment strategies. CLINICAL PRESENTATION: We present a case of a newborn female, with six wounds on the inferior limbs, treated with conservative therapy. To prevent infection and promote healing, the defects were kept moist and covered with non-adherent/antimicrobical dressings. Complete wound healing occurred in eight weeks. The duration of follow-up was three years. RESULTS: In this kind of ACC with superficial partial-thickness wounds of the lower limbs, conservative treatment was successful. The same conservative treatment can be proposed for larger or deeper wounds of lower limbs with no involvement of underlying structures, with delayed scar excision after the complete growth of the patient. ACC scar excision could require complex tissue rearrangement, tissue expansion, or skin grafting. CONCLUSION: In the evaluation for treatment of ACC of inferior limbs, even in cases of total-thickness skin loss, even on joints, the conservative approach could be considered as the first choice. DECLARATION OF INTEREST: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Enzymatic debridement after mobile phone explosion: a case report.

It is estimated that over 90% of people own a mobile phone. Although rare, lithium-ion battery explosions can cause varying degrees of thermal burn injury. Recently, selective enzymatic debridement has gained importance in the management of burn patients, thanks to its simplicity, minimum invasiveness and safety. In this work, we describe a case of a burn injury caused by the explosion of a lithium-ion battery and treated with selective enzymatic debridement in a paediatric patient.

On estime que plus de 90% de la population possède un téléphone portable. Bien que rare, l'explosion des batteries lithium/ions peut entraîner des brûlures de gravité variable. La détersion enzymatique a récemment pris plus d'importance dans le traitement des brûlures, grâce à sa simplicité, son invasibilité faible et sa sécurité. Nous exposons ici l'utilisation de cette technique chez un enfant victime d'un accident de batterie de téléphone portable.

Effects of heat deproteinate bone and polynucleotides on bone regeneration: an experimental study on rat.

This experimental study evaluated the effects of polynucleotides on bone regeneration on rats. Defects with a diameter of 2mm were prepared in the thickness of cortical bone of 32 rat tibiae and filled with different compounds: polynucleotide gel (PDRN), deproteinated porcine cortical bone (HDB) obtained by high temperature heating in the form of granules and a paste made of HDB granules and PDRN gel. Bone regeneration of the gaps was histologically analysed after a treatment time ranging from 1 to 12 weeks. Both PDRN and HDB stimulated bone growth and repair, but the paste prepared combining HDB granules and PDRN showed the best performance with faster filling, better osteconductive and biocompatible properties and easier handling. This study suggests that the paste prepared combining HDB and PDRN gel induces rapid bone regeneration in different clinical situations.

Neurovenous superficial inferior epigastric flaps in rats.

BACKGROUND: We performed an experimental study on 46 male rats to evaluate the vitality of superficial inferior epigastric neurovenous flaps performed following different procedures. METHODS: Rats were divided into 5 groups: A (n=6), B (n=10), C (n=10), D (n=10) and E (n=10). On each rat a hemi-abdominal flap based on the superficial inferior epigastric pedicle was raised. In group A the flap was sutured into its original position, isolating it from underlying tissues by a latex glove patch. In group B an arteriectomy of the superficial inferior epigastric artery was performed. In group C the superficial inferior epigastric artery was sectioned at its origin, without dissecting it out of the pedicle. In group D and E the same procedures performed respectively in group B and C were followed, but the epigastric pedicles were immediately explanted for optic microscope observation. Flap vitality in groups A, B and C was checked after 7 days. RESULTS: Flaps in group A appeared completely vital: the glove did not interfere with flap survival. All flaps in group B looked necrotic. In group C, 9 flaps survived completely and 1 flap underwent complete necrosis. Pedicle specimens of the viable flaps (group C) were explanted for observation under the optic microscope. Each specimen from groups C, D, E revealed a rich vascular plexus in the connective tissue around the pedicle. Seven days after surgery, neo-microangiogenesis was evident. CONCLUSIONS: The results witness the importance of perivenous and perineural arterioles for neurovenous flaps survival, also considering the adaptive increase in capillary development in the days following surgery.

A case of life-threatening sepsis after breast augmentation by fat injection.

A case is presented in which an aesthetic breast augmentation by fat injection led a young woman to a life-threatening sepsis due to bilateral mammary abscesses. Immediate and late complications of this procedure are considered; infection is the frightful complication that can lead to septic shock, affecting survival, aesthetic outcome, and reconstruction possibilities of the patient's breasts.

Ultrasound assisted liposuction for the palliative treatment of Madelung's disease: a case report.

Benign Symmetric Lipomatosis (Madelung's disease) is a rare disease, characterized by massive fatty deposits in the neck, the shoulders, and the upper extremities. The deformity is associated with chronic alcohol use, malignant tumors of the upper airways, neuropathy, diabetes mellitus, hyperlipidemia, and other metabolic disorders. Although the deformity is prone to recurrence, surgical removal via lipectomy or liposuction provides the only way of palliation. This paper describes the treatment of a 51-year-old man with a history of alcoholism and liver cirrhosis. He reported masses in his cervical and facial regions that had gradually enlarged over a period of 6 years. He also developed respiratory symptoms due to the fatty compression of his upper airways. Our experience with ultrasound-assisted liposuction for the palliative treatment of this disease is reported.

Do superficial epigastric veins of rats have valves?

The rat is a good model for experimental studies on the haemodynamic patterns of free-flap transfer but models involving the superficial epigastric vein have not been supported by the demonstration of the anatomical presence or absence of valves inside it. We performed a morphological study to assess whether or not valves are present inside the superficial epigastric vein of the rat. Segments of superficial epigastric veins were explanted from fifteen Sprague-Dawley rats. The lumen was studied with scanning electron microscopy after longitudinal or transverse incision of the venous walls. No valves were detected and we saw no evidence of their accidental removal. As most human veins do have valves, the clinical implications of haemodynamic data on reverse-flow island flaps obtained in rats must be considered very carefully.

[Plastic surgery in the setting of a public hospital day care unit]. / La chirurgia plastica nell'ambito di un'unità operativa ospedaliera centralizzata di day surgery.

BACKGROUND: The authors describe the advantages and disadvantages of plastic surgery performed in a day-care public hospital unit. METHODS: A retrospective study was made of the day-surgery activities over 16 months (1998-1999) as part of a centralized system. Data were compared to day-surgery activities undertaken in 1997 using a non-centralized system. The study was based in the Macchi Foundation Hospital in Varese. A total of 179 patients were treated from all age group whose clinical, intellectual and social characteristics enabled them to be treated using a day-hospital regime. The pathologies treated can be classified into six groups: benign skin pathologies, malignant skin pathologies, scar pathologies, hand disorders, burns and others. All operations were performed as planned under general, local or regional anesthesia with the help of an anesthetist. RESULTS: The centralized system has a number of advantages of a social and technical kind; there are few disadvantages, mainly consisting in the impossibility of using this approach for emergency surgery and its overall rigidity. CONCLUSIONS: This form of surgery provides a service that stands out for its quality, organisational efficiency and low cost.

Salvage of a below knee amputation stump with a free sensate total sole flap preserving continuity of the posterior tibial nerve.

We illustrate the use of a free sole flap with intact posterior tibial nerve in the coverage of a below knee amputation 6 months after an explosive injury to a 12-year-old child. We discuss the indications for lower leg amputation in children, modalities of reconstruction of the amputation stump and possible reason for the observed change of colour of the flap persisting for 14 days.

Anatomy of the internal mammary veins and their use in free TRAM flap breast reconstruction.

The anatomy of 61 internal mammary veins (IMV) in the 3rd, 4th and 5th intercostal spaces was studied in 34 fresh human cadavers by injection and corrosion methods and surgical dissection. The IMV was present in all 34 cadavers. Four different patterns of venous anatomy were identified: Types 1 (69%) and 2 (26%) were common, Types 3 (3%) and 4(2%) were rare. The most common arrangement (Type 1) consists of the internal mammary vein running medial and parallel to the artery to the 4th intercostal space where it divides into the medial and the lateral IMV, the lateral crossing the internal mammary artery (IMA) anterior to it in direction from medial to lateral. Both veins are connected by interconnecting branches. The mean diameter of internal mammary veins is 2.7 mm (range 1.1-4.8 mm) for the medial and 1.8 mm (range 0.5-3.5 mm) for the lateral one. The mean distance from the lateral bordoffof the sternum of the medial vein is 9 mm (range 2-18 mm) and 14 mm (range 9-24 mm) for the lateral vepfpff. We present a review of 7 patients in whom internal mammary vessels were used as recipient vessels for breast reconstruction with free TRAM flaps with no complications, as well as the advantages and disadvantages of such a procedure.

Plastic surgery in the early nineteenth century: notes on the collections in the University of Pavia's Museum of History.

The authors present the documents of plastic surgery preserved in the University of Pavia's History of the University Museum. They include clinical papers, drawings, surgical instruments, and anatomic preparations. Most of these documents relate to the activity of Luigi Porta, who was a general and plastic surgeon and professor in the Medical School of the University of Pavia from 1832 to 1875.