Knowledge and Attitudes in First Aid Practices for Thermal Burns: a Cross-sectional Study Among Adults in Northern Greece.

Background: Burns are a major cause of morbidity, including prolonged hospitalization, disfigurement, disability, and emotional trauma. Long-term absence from work and high healthcare costs for burn treatment have a significant socio-economic impact. Objective: his study aims to evaluate the level of knowledge for burn management in the adult population of Thrace in Northern Greece and to determine factors associated with a better level of knowledge. Methods: A questionnaire-based cross-sectional study was conducted οn a random sample of the adult population of Thrace. Data were collected using a structured pre-coded questionnaire, which included subjects' socio-demographic characteristics and the first aid practices for burns. Multivariate logistic regression analysis was used to determine the effect of subjects' characteristics on their knowledge of burn first aid practices. Results: A total of 711 subjects (49.6% males; mean age, 41.89±16.48 years) were included in the study. The incidence of a previous burn was 55.4%. Only 10.5% of the subjects would apply the optimal practice, consisting of rinsing the burn wound with cool running water for at least 10 minutes, applying only non-adhesive dressing on it and leaving the blisters intact. The optimal practice was independently associated with female gender (aOR=1.86, p=0.016), high education level (aOR=2.00, p=0.023), the presence of >3 children (aOR=2.27, p=0.009) and previous training in first aid (aOR=2.36, p=0.001). A large number of participants reported the application of toothpaste (38%), moisturizer (35.4%), aloe (31.8%) or yogurt (27.7%) to the burn surface. Conclusion: Only a small proportion of the participants were aware of the optimal burn first aid practices, most of them female, of high socioeconomic status. We recommend a more targeted approach in the design of health campaigns in the future, in order to reach vulnerable parts of the population.

The Ageing Foot.

Feet suffer significant stress throughout a lifetime and undergo ageing-associated problems due to gradual tissue degeneration affecting the skin, connective tissue, and nerves. Oxygen supply to the tissues may be diminished. The skin gets dry and calluses, ulcers and fungal infections of the skin and nails are not uncommon. Ligaments and tendons degenerate and, without proper prevention, deformities including claw toes, hammer toes, tendonitis, and bursitis may occur. Skeletal toe deformities such as bunions, bony spurs, and hallux valgus may increase discomfort, while stress fractures may have an adverse impact on the patients' quality of life. The ageing foot pathology may add up to common age-related problems, such as crystal deposition arthropathies, diabetes mellitus, peripheral circulatory disorders, and peripheral edema, increasing morbidity. This review summarizes ageing-related feet problems, focusing on prevention and treatment. Foot health has a paramount role in overall wellbeing, therefore prevention, proper foot care, and prompt diagnosis and management of ageing-related changes are vital for maintaining a healthy, active status.

A Linear Waxy Verrucous Plaque of the Scalp.

Nevus sebaceous of Jadassohn (NSJ) is an inborn, cutaneous hamartoma that is presented as a round-oval, or linear, yellowish-orange hairless plaque with an excess of sebaceous glands, typically localized to the head or neck. NSJ disease progresses slowly in three general stages. Due to its embryological origin, it yields an already documented potential for a variety of epidermal and adnexal tumors. The incidence of secondary neoplasms within NSJ is 10-30%, and the risk of neoplastic transformation increases with age. The majority of neoplasms are benign. Regarding malignant tumors, NSJ is usually associated with basal cell carcinoma. All neoplasms are typically encountered in long-standing lesions. Owing to NSJ's ample variety of associations with neoplasms, its management demands a case-driven tailored treatment. We present the case of a 34-year-old female with NSJ.

Dermal Matrices: Game Changers in Leg and Foot Soft Tissue Reconstruction? A Case Series.

The present article aims to present the use of dermal matrices in severe degloving, avulsion, and necrotizing injuries of the leg and foot in 3 patients. Conventional reconstruction would require the use of free flaps, since exposure of vessels, nerves, joints, and tendons rendered the mere resurfacing with skin grafts insufficient, and extensive cutaneous detachment precluded the use of local fasciocutaneous flaps. All injuries underwent thorough and repeated surgical debridements and wash outs, followed by negative pressure wound therapy (NPWT). Once negative tissue cultures were obtained, the extremities were resurfaced with dermal matrix and immediately covered by split thickness skin grafts. NPWT on the grafted area for a week effectively secured the grafts on the recipient area. Complete healing was achieved in all grafted areas within 7 to 12 days. The function of joints and tendons as well as the quality of resurfacing at the weight bearing areas were tested and found satisfactory within a follow-up period of 5 to 15 months. The use of combined NPWT and dermal matrices in carefully selected patients provides a reliable and durable reconstructive option for leg and foot injuries with satisfactory functional outcomes.

Anatomical Variations of the Axillary Arch and Implications in Breast Surgery.

INTRODUCTION: Langer's axillary arch (AA), the most common anatomical variant in the axillary area of definite clinical significance. This is an updated review of the reported variations in the structure, highlighting its morphological diversity and its potential in complicating axillary lymph node biopsy, lymphadenectomy, or breast reconstruction. METHODS: A review of the literature concerning the AA published between 1812 and 2020 was performed using the PubMed, Scopus, Embase, and Cochrane medical databases. The frequency, laterality, morphology, origin, lateral attachment points, vascularization, and neurosis of the AA were the parameters retrieved from the collected data. RESULTS: The prevalence of AA ranged from 0.8% to 37.5%. It is more often unilateral, muscular in nature, and extending from the latissimus dorsi to the pectoralis major. It is vascularized by the lateral thoracic vessels or the subscapular artery and innervated by the thoracodorsal nerve. CONCLUSIONS: Langer's AA, when present, may complicate surgical procedures in the area; therefore, every surgeon performing breast or axillary surgery should be aware of this entity and its variations to ensure maximal effectiveness and safety in the management of patients.

Tracking the risk factors associated with high-risk cSCC: A 10-year, Two-Institution, Greek study.

PURPOSE: We sought to identify independent risk factors for positive sentinel lymph node biopsy (SLNB), local recurrence (LR), metastasis (M) and death caused by cutaneous squamous cell carcinoma (cSCC) (DCS) in high-risk cSCC patients. Moreover, we compared the Brigham and Women's Hospital (BWH) system with the previous used in Greece (based on tumor size) and proposed a new classification system. METHODS: 1,524 cSCC patients were enrolled between January 2004 and December 2014, from two medical institutions. Potential risk factors for SLNB (local recurrence/LR, metastasis/M, death caused by SCC/DCS) were analyzed by univariate and multivariate Cox logistic regression models. RESULTS: Of the included patients with a median follow-up of 60 months 107 developed local recurrence (7%) while 84 developed metastases (5.5%). Among 36 patients undergoing sentinel lymph node biopsy (SLNB), 25% showed a positive SLNB with a false-negative result (11%). On multivariate analysis, key prognostic factors for LR were tumor diameter ≥2 cm, poor differentiation, incomplete excision and perineural invasion and for M were high-risk tumor site, tumor diameter ≥2 cm, poor differentiation, invasion beyond subcutaneous tissue, incomplete excision, perineural invasion and recurrence. DCS seems to be affected by tumor diameter ≥ 2 cm, poor differentiation, invasion beyond subcutaneous tissue, incomplete excision, perineural invasion and recurrence independently. CONCLUSIONS: These suggest the determined role of tumor diameter of cSCCs. Harnessing knowledge and collecting the up-to-date data along the clinical journey of high-risk cSCC, the future looks bright (development of new clinical trials, adjuvant therapies and tumor staging with SLNB).

Adipose-Derived Mesenchymal Stem Cells in the Treatment of Diabetic Foot Ulcers: A Review of Preclinical and Clinical Studies.

This review provides an outline of the use of adipose-derived mesenchymal stem cells (AMSCs) in the treatment of diabetic foot ulcers (DFUs). A systematic search of PubMed and the Cochrane database was performed on October 2, 2019. Eighteen studies were identified (14 preclinical and 4 clinical). Studies in animal models have demonstrated that AMSCs enhance diabetic wound healing, accelerate granulation tissue formation, and increase reepithelialization and neovascularization. Only 1 randomized control trial has been published so far. Patients (n = 25) with DFUs were treated using an allogeneic AMSC directly on the wound bed as a primary dressing, and improvements were found in complete wound closure in the treatment group (n = 16). Three clinical studies showed that autologous AMSC might be a safe alternative to achieve therapeutic angiogenesis in patients with diabetes and peripheral arterial disease. Based on the available evidence, AMSCs hold promise in the treatment of DFUs. However, this evidence requires confirmation by well-designed trials. Additional studies are also required to understand some issues regarding this treatment for DFUs. For example, the potential application of autologous or allogeneic AMSCs in different types of DFUs, optimal dose/infusion schedules, safety evaluations, and cost-effectiveness.

Lower Limb Pain Attributed to Bone Marrow Edema Syndrome: A Commonly Ignored Pathology.

Bone marrow edema syndrome (BMES) is a highly uncommon, self-limited syndrome of unclear etiology. The syndrome most commonly affects middle-aged men. Magnetic resonance imaging is essential for the diagnosis because of the characteristic pattern of bone marrow edema. The diagnosis of BMES is a challenge for clinicians. Other causes of lower extremity pain, with poor prognosis, must be excluded. We present three cases of BMES. All three patients initially complained of mild lower extremity pain, which progressively deteriorated and led to a severe limitation of their daily activities. They were all treated conservatively by weight-bearing restriction and symptoms resulted within a few months. The aim of the present study is to outline this rare, benign pathology.

The Use of Pistacia Lentiscus Chia Resin Versus Omeprazole in Protecting Male Rats Peptic Mucosa Against Cold Restraint Stress.

INTRODUCTION: Peptic mucosal damage induced by acute stress is a serious cause of morbidity and mortality in critically ill patients. The study aimed to investigate the protective, antioxidant and anti-inflammatory effects of pretreatment with Chios mastic gum (CMG), a traditionally consumed herbal resin naturally deriving from the trunk of Pistacia Lentiscus var. Chia compared to Omeprazole, a standard medication used in the prevention and treatment of gastritis, against the effects of cold restraint stress (CRS) in rat gastric and colonic mucosa. METHODS: Twenty-one male Wistar rats were randomly assigned to three groups: Control (C), Omeprazole (O), and CMG (M), according to the pre-treatment regime, and were subjected to CRS at 40C for 3 hours. The gastric and colonic mucosal lesions were histologically assessed. ELISA measured blood concentrations of TNF-α, IL-1ß, peroxidase, superoxide dismutase (SOD) and total antioxidant capacity (TEAC). RESULTS: In both groups, O and M, gastric mucosal hyperemia, haemorrhagic infiltration and mucosal oedema, as well as colonic mucosal hyperaemia and haemorrhagic infiltration were significantly reduced compared to the controls (p<0.05). No significant differences were observed between Groups O and M. TNF-α levels were significantly lower in group M compared to Group O (p=0.013). IL-1ß levels were significantly depressed in groups M and O compared to control (p≤ 0.001). The activity of both peroxidase and SOD enzymes decreased in group M compared to group O (p= 0.043 and p=0.047 respectively) and the control (p=0.018 and p< 0.001 respectively). CONCLUSIONS: The natural Chios mastic gum is a promising nutritional supplement with protective properties to the peptic mucosa against CRS, exerting anti-inflammatory and antioxidant effects.

Advances in Dermoepidermal Skin Substitutes for Diabetic Foot Ulcers.

Diabetic foot ulcers (DFUs) are one of the major complications of diabetes, representing a leading cause of hospitalisation and non-traumatic lower limb amputations. Multidisciplinary management, patient education, glucose control, debridement, off-loading, infection control, and adequate perfusion are the mainstays of standard care. Despite all these, at least 30% of DFUs fail to heal within 20 weeks. Therefore, dermoepidermal skin substitutes (DSS) have been used as a new therapeutic adjunct for DFUs. This brief review outlines the recent advances in DSS for the treatment of DFUs. PubMed and Cochrane databases were systematically searched in May to July 2018 for systematic reviews published after 2013 and for randomised controlled trials (RCTs). A retrospective evaluation of 28 RCTs was performed. Rates of complete wound closure and time to healing were examined for 17 commonly available DSS. Healing rates after 12 weeks and time to complete closure in DFUs are heterogeneous among the 28 RCT. The best healing rates at 12 weeks were accomplished with dermal cellular substitutes (Epifix®, 100% and Amnioband®, 85%) and with dermal acellular substitutes (Allopatch®, 80% and Hyalograft®, 78.8%). Based on these studies, DSS used in conjunction with standard care appear to improve the healing rates of DFUs, as compared with standard care alone. Nonetheless, new studies with more homogeneous samples are needed to ascertain the role of ulcer size, duration, depth and/or type in the efficacy of DSS. Moreover, future RCTs should include patients with severe comorbidities, in order to be more representative of clinical reality.

The Greek Surgeon-Gynecologist Savvas Georgiadis (1857-1942) and the First Vaginal Reconstruction in Smyrna.

The Greek surgeon-gynecologist Savvas Georgiadis from Phocaea in Asia Minor had performed in 1897 an innovative surgical operation in a young female patient, reconstructing her vagina. Having been educated both in Greece and France, specialized in gynecology, he became a famous surgeon in the Hellenic Hospital of Smyrna "Agios Charalampos," where the operation was masterfully executed. Although among the pioneers in neovagina techniques, Georgiadis still is searching his place among the important figures in the history of plastic surgery.

Sentinel lymph node metastasis in primary cutaneous basosquamous carcinoma. A cross-sectional study.

BACKGROUND AND OBJECTIVES: Basosquamous carcinoma (BSC) is a rare, biologically aggressive tumor. This cross-sectional study aims to define risk factors for subclinical nodal metastasis in primary BSC, and identify the patients who would benefit from routine sentinel node biopsy (SLNB) as part of the initial management. METHODS: A total of 142 patients, with histologically proven BSC without palpable lymph nodes, underwent SLNB after the initial excision. Clinicopathological features and demographics were analyzed between the patients with detected micrometastasis (SLNM) and those with negative SLN. RESULTS: In 7.7% patients, subcapsular and <0.1 mm SLNM were found. The frequency of SLNM was 0.9%, 11.8%, and 80.0% in patients with maximum lesion diameter ≤ 2 cm, 2.1-3.0 cm and >3.0 cm, respectively (P < 0.001) and was strongly associated with perineural (P < 0.001; OR = 26.46, 95% CI = 5.62-124.52) and lymphatic invasion (P < 0.001; OR = 17.35, 95% CI = 4.44-67.91). Within 18-84 months, no recurrence or metastasis were observed in SLNM positive patients. False negative SLNB rate of 15.4% was recorded. CONCLUSION: Cutaneous BSC is associated with early nodal metastatic potential. Tumor size >2 cm, lymphatic and perineural invasion are significant determinants for SLN micrometastasis. In the absence of palpable lymphadenopathy, wide resection and SLNB with long-term follow-up are highly recommended in these patients.

The Efficacy of Versajet™ Hydrosurgery System in Burn Surgery. A Systematic Review.

Prompt debridement of burns and early grafting increase survival rates while reducing morbidity and length of hospitalization. Among the debridement methods, hydrosurgery is gaining popularity during the last decade. This review aims to review all available clinical evidence regarding the efficacy, safety, and cost-effectiveness of the hydrosurgical management of burns.This is a systematic review based on a MEDLINE and Scopus databases search of articles in English from 2015 to October 2016. The terms "hydrosurgery," "hydrodebridement," "hydroscalpels," "water jet surgery," and "Versajet" were used in combination and with the terms "acute wound" and "burns." Retrieval of included studies and critical appraisal of data were assessed following the PRISMA structure.There is good but limited evidence regarding the efficacy and safety of the method (level of evidence I-II). No significant differences compared to the conventional surgical debridement are yet documented by currently available literature. There is fair and limited evidence (level III) concerning the cost-effectiveness of the method.Although there is increasing evidence on the safety, efficacy, and cost-effectiveness of hydrosurgery in burns, large-scale prospective randomized control trials with long-term follow-up are necessary to establish the superiority of the method over conventional surgical debridement in terms of selectivity of removed tissues, reduced necessity for dressings and reoperations, healing time, engraftment, and scar quality. All cost-influencing dynamics of this per se expensive modality need to be thoroughly analyzed to resolve its cost-saving potential.

Mandibular Condyle Reconstruction With Fibula Free-Tissue Transfer: The Role of the Masseter Muscle.

BACKGROUND: Free fibula flap is an option for primary restoration after disarticulation mandibular resection, though literature on technique refinements is scarce. The authors hypothesized that inset of the masseter, the key mandibular elevator muscle, at the reconstructed mandible may optimize functional recovery. METHODS: All patients undergoing reconstruction of mandibulectomy-condylectomy defect (January 2009 to January 2014) by means of a fibular flap were prospectively studied. The neocondyle was formed by the distal portion of the fibula and placed directly into the glenoid fossa with preservation of the temporomandibular disc. The deep portion of the masseter was inset at the angle of the reconstructed mandible.Condylar position was postoperatively evaluated by panoramic radiographs. Patients self-evaluated speech, chewing, swallowing, and facial appearance. RESULTS: Two patients had immediate and 3 delayed reconstruction involving condyle ramus body, in the study period. During a mean follow-up of 32 months, 4 patients had satisfactory occlusion, 1 patient had an open-bite deformity, but was able to masticate solid food and maintain an oral diet. Although no significant condyle dislocation was recorded, 2 patients had slight ipsilateral deviation on mouth opening. Nevertheless, cosmesis was satisfactory and all patients maintained intelligible speech. Functional score was 13.6 ± 1.14 and facial appearance score was 4 ± 0.7. CONCLUSION: The free fibula transfers with direct seating of the fibula into the condylar fossa followed by masseter muscle reinsertion provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.

Dermal Matrix for Intraoral Lining Following Composite Mandibular Defect Reconstruction With Chimeric Fibular Osseocutaneous Flap.

BACKGROUND: This report aims to first present Integra as an adjunct to complex mandibular reconstruction for intraoral lining resurfacing, and to review the literature on the use of dermal matrices for mucosal resurfacing of the floor of the mouth. CLINICAL REPORT: A 62-year-old female patient with previous ablation surgery for squamous cell carcinoma of the floor of the mouth, presented with extrusion of the mandibular plate through the chin skin and serious tongue tethering. The patient was managed with a chimeric osseocutaneous free fibula flap to restore the mandibular bone and chin skin defect, followed by a second-stage reconstruction of the intraoral defect with bilayer Integra. Complete release of tongue tethering was achieved enabling normal speech and deglutition and allowing for dental rehabilitation. CONCLUSIONS: Integra was safely used as an alternative for intraoral lining, in composite mandibular reconstruction, downgrading reconstructive demands and offering optimal functional results.

Tips and Outcomes of a New DIEP Flap Inset in Delayed Breast Reconstruction: The Dual-Plane Technique.

Purpose The dual-plane deep inferior epigastric perforator (DIEP) flap inset technique is herein presented with tips for optimizing the aesthetic outcome in delayed autologous breast reconstruction after radiation therapy. Patients and Methods A total of 42 women who underwent microsurgical reconstruction with a free DIEP flap participated in this prospective study. The flap was inset in a dual plane lying behind the pectoralis major at the upper pole and in front of the muscle at the lower pole of the reconstructed breast. Results The dual-plane flap inset resulted in natural transition from native and reconstructed tissues, excellent scar quality, optimal outline of the breast, and overall breast appearance. Moreover, dual-plane reconstruction was associated with constantly high patient satisfaction without wearing brassiere due to fullness of the upper pole and minimal ptosis with time. Conclusion The dual-plane DIEP flap inset results in optimal scar quality, breast shape, and fullness of the upper pole, resulting in high patient satisfaction.

Histological Comparison of the Human Trunk Skin Creases: The Role of the Elastic Fiber Component.

OBJECTIVE: Skin creases are features of major anatomical, morphological, surgical, and functional interest. This study focuses on the histological comparison of creases of the trunk and participation of the elastic fibers in their formation. The histological structure is a key consideration for the reconstructive planning of the relevant area and its knowledge may contribute in such direction. METHODS: Fresh cadaver specimens were collected from the inframammary (n = 15), infragluteal (n = 16), and inguinal creases (n = 14), the anterior axillary fold (n = 14), and the surrounding skin (n = 10). Specimens were fixed in 10% buffered formaldehyde. Collagen and muscle fibers were stained by Masson Trichrome and Van Gieson stains, reticular and collagen type III fibers by Reticulin stain, and elastic fibers by Verhoef and Orcein stains. RESULTS: Skin creases of the trunk present well-defined dense bundles of collagen fibers, creating a beehive pattern with broad attachment to the dermis and denser in deeper sites related to the fascia of the underlying muscle. The elastic fibers participate in the collagen pattern and radiate in a parallel pattern in the reticular dermis and in a perpendicular fashion in the papillary dermis. The skin surrounding the creases lacks such organization. CONCLUSIONS: Creases of the trunk are formed by well-organized collagen bundles in a beehive pattern, attached to the dermis and related to the underlying muscle fascia. The elastic fibers participate in this structure and radiate in a parallel fashion in the reticular dermis and perpendicularly in the papillary dermis.