Mangled Extremity Severity Score in the Assessment of Extremity Injuries - Is it Reliable?

The mangled extremity severity score (MESS) was established 28 years ago to decide performing an amputation in cases of limb trauma. It assigns points for 4 aspects of the injury: the extent of soft tissue and skeletal injury, limb ischemia and ischemic duration, shock, and age. A score of 7 or higher indicates that primary amputation is required. Thirty-one patients with MESS scores of 7 to 8 underwent limb salvage surgeries, with 13 limbs being saved and 18 limbs being amputated. Upper extremities trauma had a salvage rate of 62.5%, whereas lower extremity trauma had a salvage rate of 20%. MESS is not a sensitive predictor of amputation in upper limb trauma, but it is useful in lower limb injuries.

Saphenous Artery-based Posteromedial Leg Fasciocutaneous Flap for Knee Reconstruction.

Soft tissue knee defects are frequently seen in surgical practice. The saphenous artery (SA)-based flap is a management option with variable suggested donor sites. The present study describes the use of an SA-based flap harvested from the posteromedial aspect of the leg in management of soft tissue knee defects. Methods: The present study recruited 30 patients with soft tissue knee defects due to miscellaneous causes. All patients were treated with an SA-based flap harvested from the posteromedial aspect of the leg. All patients were followed up for 6 months. Outcome parameters included flap survival, flap complications, and restoration of knee function. Results: After 6 months of follow-up, all flaps survived; the reported complications were distal flap necrosis (6.7%), wound dehiscence (6.7%), seroma (3.3%), and small contracture band (3.3%). All patients restored normal range of motion around the knee. Conclusion: An SA-based flap harvested from the posteromedial aspect of the leg is a feasible, safe, and effective option for management of soft tissue knee defects.

Recurrent cutaneous basal cell carcinoma after surgical excision: A retrospective clinicopathological study.

Background: Recurrence of basal cell carcinoma (BCC) after complete surgical excision is rarely reported. Risk factors for this negative outcome are not well-studied. We present the clinical and histological features of recurrent BCCs in our institution. Methods: All patients between January 2016 to December 2020 whose primary BCCs were excised with free surgical margins according to the histopathology report, and represented later with local recurrence were included. The medical files were retrieved to record patient's age, sex, sun exposure, tumor site, size, clinical diagnosis, histopathology variant of primary lesion, least free margin distance of the original lesion, and recurrence time. Results: Eighteen patients (11 males and 7 females ranged between 50 and 75 years old) fulfilled the inclusion criteria; all of their lesions were located in head and neck regions. The mean recurrence time was 31.2 months (11-86) and the histological variant was the same of primary in 17/18 patients. Primary tumors showed nodular subtype in 77.8% of patients and 55.6% of the primary tumors were less than 15 mm in diameter. Sun exposure history was given by 77.8% of patients while the rest of patients had non-significant exposure. All recurrent excised lesions were of free margin less than 4 mm. Conclusion: We found that the primary tumors of all studied recurrent BCCs were excised with surgical margins less than 4 mm. We recommend follow up for all excised BCCs either those of low or high risk histological variants. Tumor size does not appear a considerable risk factor for local recurrence.

Objective assessment of Platelet-Rich Plasma (PRP) potentiality in the treatment of Chronic leg Ulcer: RCT on 80 patients with Venous ulcer.

BACKGROUND: Chronic venous leg ulcer reduces the patients' activities and their overall quality of life. Platelet-rich plasma (PRP) was previously investigated as promising less invasive management for leg ulcers. THIS STUDY AIMS: To re-assess the efficacy and safety of PRP in the management of chronic leg ulcers due to venous factors. PATIENTS/METHODS: RCT enrolled 80 patients who clinically presented with chronic venous leg ulcers. Forty patients were allocated randomly for the treatment with autologous platelet-rich plasma (PRP). Intradermal and subdermal injection of PRP by 27guage syringe weekly, in all edges and in the granular floor of the ulcer for 4-6 sessions. Another 40 patients managed by conventional treatment by compression and dressing for the same period were allocated as Group B. Objective assessment achieved by the percentage of reduction of the size of the ulcer area, rate of healing, incidence of recurrence, and if side effects have been reported. RESULTS: PRP therapy showed better results and high p value significance when compared to conventional therapy. CONCLUSION: This study shows that PRP is effective and significant in promoting the wound healing process in chronic leg venous ulcers. PRP is simple, safe, and has a short learning curve technique.

Facial skin cancer reconstructive and cosmetic outcomes: Analysis with algorithm for its management.

BACKGROUND: Management of facial skin cancer and its complications is important research topics needing continuous update to improve the outcome. OBJECTIVE: The study is to share our findings with surgeons and healthcare providers. The authors provide their efforts by pooling data from multiple institutions; as reporting surgical outcomes is significantly lacking and much needed in the Middle East and North Africa region in order to meaningfully improve quality of care. This study proposes an algorithm for management that could aid a surgical decision-making for reconstruction of defects after excision of facial skin cancer. METHODS: Retrograde simple descriptive analysis study is conducted for multicenter data about management of facial skin cancer and its cosmetic outcome. The analysis involves 159 male patients and 95 females. RESULTS: Nonmelanoma skin cancer was reported in 250 (98.4%) of 254 cases. Reconstructive procedures were complicated in 16 cases (~6.3% of the study). Skin cancer recurrence in head and neck has happened in five cases (~1.9% of the study). Flaps used survived without major complications; however, V-Y advancement flaps showed the best aesthetic outcome. CONCLUSION: This study reports data in order to meaningfully improve the quality of care. Disease incidence, reconstructive complications, recurrences, and aesthetic outcome of facial skin cancer are included in the study. Based on the data pooling, the study proposes a simple treatment algorithm that could aid in surgical decision-making. V-Y advancement flaps showed the best aesthetic outcome.