Use of acellular intact fish skin grafts in treating acute paediatric wounds during the COVID-19 pandemic: a case series.

OBJECTIVE: More specific strategies are needed to support children requiring skin grafting. Our goal was to identify procedures that reduce operating times, post-operative complications, pain and length of hospital stay. Patient safety, optimal wound bed support and quick micro-debridement with locoregional anaesthesia were prioritised. Ultimately, a novel acellular fish skin graft (FSG) derived from north Atlantic cod was selected for use. METHOD: We admitted consecutive paediatric patients with various lesions requiring skin grafting for definitive wound closure. All FSGs were applied and bolstered in the operating room following debridement. RESULTS: In a cohort of 15 patients, the average age was 8 years and 9 months (4 years 1 month-13 years 5 months). Negative pressure wound therapy (NPWT) was given to 12 patients. Rapid wound healing was observed in all patients, with a wound area coverage of 100% and complete healing in 95% of wounds. Time until engraftment in patients receiving NPWT was reduced by about a half (to an average 12 days) from our standard experience of 21 days. Ten patients received locoregional anaesthesia and were discharged after day surgery. The operating time was <60 minutes, and no complications or allergic reactions were reported. Excellent pliability of the healed wound was achieved in all patients, without signs of itching and scratching in the postoperative period. This case series is the first and largest using FSG to treat paediatric patients with different wound aetiologies. We attribute the rapid transition to acute wound status and the good pliability of the new epidermal-dermal complex to the preserved molecular components of the FSG, including omega-3. CONCLUSION: FSG represents an innovative and sustainable solution for paediatric wound care that results in shorter surgery time and reduced hospital stays, with accelerated wound healing times.

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study.

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy.

The Versatility of the Free Vastus Lateralis Muscle Flap: Orbital Reconstruction After Removal of Complex Vascular Malformation in a Pediatric Patient.

Introduction: Vascular orbital lesions in pediatric population represent a demanding therapeutic challenge which requires a multidisciplinary team. In severe cases, orbital enucleation can be considered. Surgical management of enucleated orbital region in children, differently from the adults, represents a challenging procedure owing to the intrinsic relation between volume replacement and normal orbital growth. Many reconstructive options have been proposed, and many donor sites have been utilized for this purpose but each one have demonstrated potential disadvantages. Despite its well-known versatility, no report of the vastus lateralis free flap in children requiring orbital reconstruction exists in literature. Herein, we propose this surgical strategy as a valid option for the reconstruction of an extended orbital defect in a pediatric patient suffering from a mixed type of vascular malformation. Material and Methods: A patient was referred from a foreign country with an unclear medical history, presenting exorbitism and exophthalmos, proptosis of the eyeball, visus 4/10, and limited ocular motility. We made clinical-instrumental investigations with a diagnosis of complex vascular malformation. It expanded in intraorbital and retrorbital space with bulb anterior dislocation and optic nerve involvement. We performed an emptying of the orbital content via transconjunctival and via coronal incision with eyelid preservation. A free vastus lateralis muscle flap was used for reconstruction, filling the orbital cavity. We anastomosed the flap on the superficial temporal artery. An ocular conformator was then positioned. Results: We report the result at 12 months, showing a good orbital rehabilitation with an adequate prosthetic cavity, a good recovery of volume and facial symmetry, guaranteeing balanced orbital and periorbital growth. There were no major or minor complications associated with the procedure. Discussion: The reconstruction of the orbit remains a "surgical challenge" both in adults, whose goal is the restoration of volume, adequate symmetry and facial esthetics, and children, in which correcting the asymmetry has the additional objective to balance orbital growth. Many reconstructive techniques have been proposed, including the use of free flaps. The versatility of the free vastus lateralis muscle flap is well-known. It offers adequate amount of tissue with minimal morbidity to the donor site, provides a long pedicle, gives the possibility of simultaneous work in a double team, and has a constant anatomy and a safe and rapid dissection. There are no descriptions of its use for pediatric orbital reconstructions. Conclusions: In our opinion, the free vastus lateralis flap should be included as one of the best option for orbital pediatric reconstruction after enucleation.

Minor salivary gland neoplasm in children.

In this article, we present a review of the literature, and we focus on 2 particular cases of cancer of the salivary glands accessory in pediatric patients The accessory parotid is the site of congenital and acquired lesions. In adults, the acquired lesions are often neoplastic and are usually similar to those seen in the main parotid gland. The disorders in children are less well defined, as only a few cases have been reported.The accessory parotid gland, or accessory parotid, is a nodule of normal salivary tissue separated from the main parotid gland, located on the masseter muscle, to which it is bound by an extension of the masseteric fascia and connected to the Stensen duct at that level. In contrast to the extensive literature on acquired lesions of the accessory parotid in adults, very few cases of malignant or benign lesions of the accessory parotid in children could be found in the literature. A review of several articles reporting lesions of the accessory parotid in adult patients, reporting 3 or more cases each for a total of 71 patients, showed 24 malignant neoplasms, 39 benign neoplasms, and 8 nonneoplastic lesions. Lesions of the accessory parotid are quite rare in children but should be considered when facing mass located in the cheek.

Occipital condyle fracture: an unusual airbag injury.

The installation of airbags in motor vehicles, in association with the use of seat belts, has reduced the incidence of head injuries, as well as significantly decreasing morbidity and mortality in motor vehicle accidents. Nevertheless, the literature on the subject increasingly refers to lesions related to airbag deployment. These are usually minor, but in certain circumstances, severe and fatal injuries can result. This is a case report of serious injury due to airbag deployment, involving a restrained driver who suffered occipital condylar injury when his airbag deployed in a frontal collision. The range of airbag associated injuries is reported and predisposing factors, such as the probable proximity to the airbag housing, is discussed.