Autologous fat grafting and adipose-derived stem cells therapy for acute burns and burn-related scar: A systematic review.

Objectives: The objective of this study was to analyze all available research on the application of autologous fat grafting (AFG) and adipose-derived stem cells (ADSC) to present evidence-based recommendations, particularly in the clinical treatment of acute burns and burn-related scars. Materials and Methods: We conducted a systematic search of PubMed, COCHRANE, and EMBASE, as well as a manual search of previous reviews' reference lists up. The risk of bias (RoB) was assessed using RoB 2.0 and ROBINS-I, where appropriate. Results: Six eligible studies were selected (2 randomized clinical trials [RCT], 1 retrospective cohort, and 3 experimental studies) with subjects ranging from 3 to 100. Only one study evaluated the use of AFG for acute burns. Improvements in wound healing, vascularization, scar characteristics, and tissue architecture were generally observed in some studies, supported by molecular markers, while one study reported nonsignificant results. Subjective patient satisfaction was reported to have improved. Functional outcomes improvement in the treated regions was minimal. However, study heterogeneity arose mainly from treatment protocols. Cautious results interpretation due to potential bias, especially in selection and confounding domains, and limited clinical trials are important to note. More studies are needed to evaluate. Conclusion: AFG and ADSC hold potential as valuable treatment options for burn-related scars, supported by a body of evidence, but further well-designed RCT are needed. The efficacy of acute burn settings is yet to be further evaluated since evidence is limited.

Use of a Three-dimensional Smartphone Scanner in the Quantitative Analysis of Repaired Unilateral Cleft Lip during the Coronavirus Disease Pandemic.

Cleft lip, a major craniofacial abnormality, is highly prevalent among people with low socioeconomic status in Indonesia. Direct two-dimensional measurement of the affected region is the gold standard for surgical preparation; however, its compliance and usability are limited in pediatric patients. Modern smartphones, including iPhones, are equipped with high-resolution cameras, which can record images and videos of a face. Here, we investigated whether a three-dimensional (3D) smartphone scanner can be used for the facial measurements of patients with unilateral cleft lip. Methods: Twelve facial measurements were acquired after cleft lip surgery in three female and seven male patients (aged 11-29 months) with unilateral cleft lip using direct anthropometry and a 3D smartphone scanner. The accuracy and precision of the 3D smartphone scanner were assessed through comparative analyses (t test and Bland-Altman plot). Results: The anthropometric data obtained using the 3D smartphone scanner matched the direct measurement data. The linear measurements did not differ significantly between two-dimensional and 3D modalities (P > 0.05). The intraobserver reliabilities of the two-dimensional smartphone scanner of the first and second observers were high (intraclass correlation coefficient 0.876-0.993 and Cronbach alpha 0.920-0.998) and moderate to high (intraclass correlation coefficient 0.839-0.996 and Cronbach alpha 0.940-0.996), respectively. Inter-observer data showed an intraclass correlation coefficient of 0.876-0.981 and a Cronbach α of 0.960-0.997. Conclusion: The 3D smartphone scanner is effective, efficient, economical, quick, and feasible for facial measurements of patients with unilateral cleft lip and is a viable alternative to direct two-dimensional measurements.

How Safe Is Reverse Sural Flap?: A Systematic Review.

Background: Soft tissue reconstruction of the lower third of the leg, the ankle, and the foot is challenging for reconstructive surgeons. The options for reconstruction are limited. Reverse sural flap is relatively easy to perform and considered a good option for reconstruction. The complication rates are variable in studies. This study aims to systemically review all available articles based on reverse sural flap focusing on complications of the flap. The overall complication of the flap helps to better understand the reliability of the flap. Methods: A comprehensive literature search was performed using MEDLINE, EMBASE, and Google Scholar to identify cases of reverse sural artery flap. Results: A pooled analysis of 89 articles was performed, which yielded 2575 patients (2592 flaps) over a period of 19 years. Most of the cases were performed in Asian countries (1540 flaps, 59.4%) with the majority being performed in China (746 flaps, 28.8%). The most common cause for reverse sural flap surgery was trauma/postsurgical (1785/2592) followed by burn/scarring. Flap complications were recorded in 653 of 2592 flaps (25.20%). The most common complication was partial flap loss, which was recorded in 204 flaps (7.85%) followed by venous congestion (79 flaps, 3.05%). Complete flap loss was observed only in 66 participants (2.5% of all the flaps performed). Conclusions: Reverse sural flap is reliable flap for the reconstruction of lower leg, ankle, and foot. It can give a comparable outcome as free flap when meticulously performed and, in many cases, a better result.

The effect of a single-strain probiotic administration in the treatment of thermal burns patients.

BACKGROUND AND OBJECTIVES: Between 2007 and 2011, the mortality rate for burns patients at Dr. Soetomo General Hospital, Surabaya, Indonesia was 14.1% and 60% were suspected to be sepsis-related. Immunosuppression, gut barrier disruption, and intestinal hypomotility cause bacterial and bacterial product translocation. Probiotics improve the intestinal microbiome and eventually reduce bacterial translocation, and an increased secretory immunoglobulin A (SIgA) secretion post-administration of a multi-species probiotic has been observed. We aimed to determine whether a single-strain probiotic administration could show strengthened intestinal immunity, through an increase in SIgA levels, as with multi-strain probiotics. MATERIALS AND METHODS: Sixteen burns patients from our hospital Burns Centre were randomized into three treatment groups, and the patients were administered either a placebo, a Lactobacillus reuteri protectis probiotic, or a Bifidobacterium infantis 35624 probiotic for 14 consecutive days. The SIgA levels were analyzed using ELISA pre- and post-treatment. RESULTS: The post-treatment SIgA levels in the placebo, Lactobacillus reuteri protectis probiotic, and Bifidobacterium infantis 35624 probiotic groups were 222.56±74.22 mg/dL, 223.92±68.89 mg/dL, and 332.38±64.27 mg/dL, respectively. Decreased SIgA levels were observed in the placebo (7.19±15.87) and in the Lactobacillus reuteri protectis probiotic (1.9920±14.76) groups, whereas an increase was seen in the SIgA level in the Bifidobacterium infantis 35624 probiotic group (58.26±77.41). CONCLUSION: The Bifidobacterium infantis 35624 single-strain probiotic is generally superior to Lactobacillus reuteri protectis in altering intestinal immunity; however, this finding was not statistically significant. A multi-strain probiotic supplement is recommended for burns patients.

The effect of a single-strain probiotic administration in the treatment of thermal burns patients.

BACKGROUND AND OBJECTIVES: Between 2007 and 2011, the mortality rate for burns patients at Dr. Soetomo General Hospital, Surabaya, Indonesia was 14.1% and 60% were suspected to be sepsis-related. Immunosuppression, gut barrier disruption, and intestinal hypomotility cause bacterial and bacterial product translocation. Probiotics improve the intestinal microbiome and eventually reduce bacterial translocation, and an increased secretory immunoglobulin A (SIgA) secretion post-administration of a multi-species probiotic has been observed. We aimed to determine whether a single-strain probiotic administration could show strengthened intestinal immunity, through an increase in SIgA levels, as with multi-strain probiotics. MATERIALS AND METHODS: Sixteen burns patients from our hospital Burns Centre were randomized into three treatment groups, and the patients were administered either a placebo, a Lactobacillus reuteri protectis probiotic, or a Bifidobacterium infantis 35624 probiotic for 14 consecutive days. The SIgA levels were analyzed using ELISA pre- and post-treatment. RESULTS: The post-treatment SIgAlevelsin the placebo, Lactobacillusreuteri protectis probiotic, and Bifidobacterium infantis 35624 probiotic groups were 222.56±74.22 mg/dL, 223.92±68.89 mg/dL, and 332.38±64.27 mg/dL, respectively. Decreased SIgA levels were observed in the placebo (7.19±15.87) and in the Lactobacillus reuteri protectis probiotic (1.9920±14.76) groups, whereas an increase was seen in the SIgA level in the Bifidobacterium infantis 35624 probiotic group (58.26±77.41). CONCLUSION: The Bifidobacterium infantis 35624 single-strain probiotic is generally superior to Lactobacillus reuteri protectis in altering intestinal immunity; however, this finding was not statistically significant. A multi-strain probiotic supplement is recommended for burns patients.