Effect of chronic heavy tobacco smoking on ankle fracture healing.

INTRODUCTION: Tobacco smoking is linked to an elevated risk of osteomyelitis and delayed healing in long bone fractures. However, the impact of smoking on bone union and soft tissue recovery following ankle fractures remains unclear. This study presents a retrospective comparative analysis evaluating the effects of chronic heavy tobacco smoking on the healing process and outcomes of ankle fractures after surgical interventions. MATERIALS AND METHODS: We examined 220 consecutive cases of chronic heavy smokers (CHS) with closed ankle fractures who were referred to our unit for further treatment. A control group, consisting of 220 age- and sex-matched individuals (non-smokers with closed ankle fractures), was identified for comparative analysis. We collected clinical data, including pre-existing comorbidities, Lauge-Hansen fracture classification, necessity for surgery, and the surgical procedures performed. The primary outcomes investigated were the time required for fracture union and wound healing. Secondary outcomes included postoperative complications such as prolonged pain, bleeding, swelling, infection, compartment syndrome, and neurovascular impairment, as well as the incidence of delayed union, non-union, and the need for further intervention. Both cohorts were monitored for a minimum of 24 months. RESULTS: Our analysis revealed that the surgical cohort of chronic heavy smokers exhibited a statistically significant delay in fracture union compared to both the conservatively managed smokers and the control group. Further scrutiny of the surgical cohort of chronic smokers indicated a significant correlation between smoking and extended postoperative pain duration, persistent swelling at the fracture site, and both superficial and deep wound infections. Additionally, these patients experienced delays in both fracture union and wound healing when compared to the control group. Similarly, the conservatively managed chronic smokers showed a marginal increase in the incidence of post-injury pain duration, extended swelling at the fracture site, and delayed union compared to the control group. CONCLUSION: Patients who are chronic heavy smokers and require surgical intervention for ankle fractures should be made aware of their increased risk for delayed fracture union and poor wound healing. Orthopedic surgeons should proactively encourage these patients to participate in smoking cessation programs.

Epithelial tissue thickness improves optical coherence tomography's ability in detecting oral cancer.

BACKGROUND: OCT is a non-invasive imaging technique that enables the measurement of epithelial thickness and architectural changes, which can help in the diagnosis of pre-cancerous and cancerous lesions. The purpose of the study was to assess whether epithelial tissue thickness improves optical coherence tomography's ability in detecting oral cancer. PATIENTS AND METHODS: Surgically resected oral margins from 60 patients diagnosed with oral squamous cell carcinoma were subjected to OCT. Three OCT measurements (immediate, 1 h and 24 h post-resection) were conducted per resected tissue specimen to look at the effect of saline and formalin on the specimen and its effect on the reproducibility of the OCT. OCT was, then, used to measure the epithelial tissue thickness in cancer-free and cancer-involved margins in eight oral anatomical locations. This data was, then, combined with architectural changes data to calculate the sensitivity and specificity. RESULTS: An overall of 189 cancer-free margins and 51 cancer-involved margins had their epithelial thickness measured using OCT and compared to histopathology. With regards to the validity of the OCT and histopathological measurements, epithelial thickness showed good correlation between different readings at all oral sites. With regards to the reproducibility of the OCT measurements, the mean epithelial thickness for all measurements at first (immediate) and second (1 h post-resection - saline preserved) measurements was not significantly different. Underestimation of the epithelial depth in cancer-free margins was 20 µm, while in the cancer-involved margins was 10 µm. Combining data from architectural changes and epithelial thickness, a sensitivity of 92% and a specificity of 94% was achieved. CONCLUSION: Oral epithelium measurements using OCT were valid compared to those made with gold standard pathology. Measurements made using OCT was also reproducible with minor underestimation. Epithelial thickness, combined with architectural changes, led to high accuracy in differentiating between cancer-free and cancer-involved margins.

Non-metastatic cutaneous squamous cell carcinoma treated with photodynamic therapy using intravenous mTHPC.

INTRODUCTION: Photodynamic therapy (PDT) is a method of treating various pathologies. In this retrospective study with prospective intent, a total of 22 patients with T1/T2 N0 cutaneous squamous cell carcinoma (SCC) were treated with intravenous mTHPC (meta-tetrahydroxyphenylchlorin) and surface illumination PDT. Comparisons with the clinical features, rate of recurrence and overall outcome were made. MATERIALS AND METHODS: Surface illumination PDT was offered under local anaesthesia. 0.05 mg/kg mTHPC was administered intravenously into the midcubital vein 48 h prior to tissue illumination. A single-channel 652 nm diode laser was used for illumination and light was delivered at 20 J/cm2 per site. Lesion response evaluation was carried out according to Response Evaluation Criteria In Solid Tumors (RECIST). RESULTS: Clinical assessment revealed that 16 patients had lesions of <2 cm in size (T1), while the rest were T2. No nodal involvement was identified in any of the patients. None of the patients had a locally recurrent lesion. During the 3-year follow-up, 20/22 patients had complete response (CR) and this was after one round of treatment. Two patients suffered from recurrent disease within 3 years of the follow-up, and they underwent surgical resection. CONCLUSION: PDT achieved high efficacy in the treatment of T1N0 cutaneous squamous cell carcinoma with greatly reduced morbidity and disfigurement. The technique is simple, can commonly be carried out in outpatient clinics, and is highly acceptable to patients.