Epidemiological and Clinical Profile of Pediatric Burns in the COVID-19 Era: The Experience of a Reference Center.

Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.

The Impact of Preoperative Negative-Pressure Wound Therapy on Pectoralis Major Muscle Flap Reconstruction for Deep Sternal Wound Infections.

BACKGROUND: Deep sternal wound infection (DSWI) represents a life-threatening complication following open-heart surgery and pectoralis major muscle flap reconstruction has led to a significant reduction in mortality and morbidity. Negative-pressure wound therapy represented a step forward in DSWI treatment, both as a single procedure or as a preparation for reconstructive surgery.In the present study, we report our 13 years' experience with sternal reconstruction in order to evaluate the impact of preoperative vacuum-assisted closure (VAC) therapy on reconstructive outcome. METHODS: Seventy-three patients diagnosed with DSWI undergoing pectoralis major muscle flap reconstruction were divided into 2 subgroups: preoperative VAC treatment group (n = 37) and no preoperative VAC (NVAC n = 36). We collected patients' DSWI and reconstructive surgery clinical data, and we analyzed surgical outcome in terms of complication rate, reoperation rate, defects closure times, and intraoperative/30-day and 1-year mortality. RESULTS: Eighty-three flaps were used, bilateral flaps were used more in the NVAC subgroup (P = 0.005), and operative time was significantly shorter in the VAC subgroup (P < 0.001). Complication rate was 9.6%, with no significant differences between the 2 subgroups (P = 0.723). There was no recurrence of mediastinitis, and all flaps survived. Sternal closure time was significantly lower in the VAC subgroup (P < 0.001). No intraoperative death occurred; 30-day and 1-year mortality were 2.7% and 19.2%, respectively, with no significant difference between the 2 groups (P = 0.596). CONCLUSIONS: Preoperative VAC therapy makes reconstructive surgery easier and faster, even though it has no impact on complication rate and overall success of the reconstruction. Pectoralis major muscle flap represents a reliable solution even if not associated with preoperative VAC.

MRI anatomical preoperative evaluation of distally based peroneus brevis muscle flap in reconstructive surgery of the lower limb.

BACKGROUND: The distally based peroneus brevis muscle flap has proved to be a simple solution for small- to moderate-sized wounds of the lower limb. The length of the muscle belly suitable for coverage is a crucial parameter. In this study, we evaluated the capability of 3D MRI of the lower limb to measure it preoperatively. METHODS: Between 2008 and 2017, 32 patients with lower limb defects underwent preoperative MRI to measure the peroneus brevis muscle length. All patients underwent reconstruction, and the muscle was measured again intraoperatively during surgical dissection. Surgical measurements were then compared to the MRI ones. RESULTS: MRI measures of the peroneus brevis muscle belly ranged from 9 to 21 cm (µ = 14.44 ± 3.43 cm), and intraoperative measures ranged from 9 to 20 cm (µ = 14.2 ± 2.3 cm). Thirty of 32 intraoperative measures corresponded to the MRI ones (variation = ± 1 cm, r = 0.92, p = 0.002). One patient showed an intraoperative muscle length 3 cm shorter than the MRI measure, and another patient had intraoperative muscle length 3 cm longer than the MRI one. All flaps survived, and no secondary local flap coverage was required, with no flap-related complication, limited donor site morbidity, and acceptable patient discomfort. CONCLUSIONS: The reverse peroneus brevis muscle flap is a versatile alternative to free flap reconstruction in small- to moderate-sized defects of the lower limb. Preoperative 3D MRI is accurate to evaluate the anatomy of the muscle when performed by an expert radiologist. In our experience, it should become part of preoperative workup before performing a peroneus brevis flap procedure.

Lipolysis using a new 1540-nm diode laser: a retrospective analysis of 230 consecutive procedures.

BACKGROUND: Although traditional liposuction still remains the most required body sculpting procedure, laser lipolysis systems are becoming increasingly popular. The feasibility and efficacy of a new 1540-nm diode laser for suction-assisted laser lipolysis were evaluated. METHODS: Two hundred-thirty patients underwent a new 1540-nm diode laser lipolysis. Outcomes were determined by case notes, clinical review of side effects, and a questionnaire through which patient satisfaction was assessed. Macroscopic and histologic effects on subcutaneous fat and collagen deposition were evaluated. Moreover thermal effects were studied through thermography. RESULTS: The treated regions were abdomen in 56 cases, thighs in 54, trochanteric area in 27, flanks in 17, neck in 14, arms in 12, breast in 11, hips in 7, knees in 3; 29 cases were revisions of previous lipoplasties. No adverse effect as scarring, infection, burns, hypopigmentation, bruising, or swelling was observed. The required effects of laser lipolysis such as contour reshaping and skin tightening were achieved in almost all patients with high levels of satisfaction after treatment. CONCLUSION: Our investigation highlighted the safety and efficacy of the new 1540-nm diode laser assisted liposuction device for removal of small volumes of fat deposits associated with concurrent subdermal tissue contraction, tolerance and quick recovery time.

Surgical correction of rhinophyma: comparison of two methods in a 15-year-long experience.

PURPOSE: Rhinophyma is characterized by slowly progressive tumour-like enlargement of the nasal skin that will not resolve spontaneously. Though its treatment consists of surgical removal of the hyperplastic alterations, in the literature there is not general agreement about the best method. We presented our experience with two different treatment modalities such as decortication by scalpel and CO2 laser treatment. METHODS: The authors reviewed the long-term results of 67 patients affected by rhinophyma treated with two different methods between 1996 and 2011. Outcomes were determined by case notes, clinical review and patient satisfaction questionnaire. RESULTS: Forty-five cases were treated with tangential excision and 22 with a CO2 laser. Minor complications, including scarring and hypopigmentation, were seen in 6 patients. All patients were satisfied with their outcomes at the follow-up visit, and no major complications were detected during follow-up. CONCLUSION: Both tangential excision and carbon dioxide laser are well-established, reliable procedures for rhinophymaplasty that preserve the underlying sebaceous gland fundi allowing spontaneous re-epithelialization without scarring with similar outcomes and high patient satisfaction. The original nose shape and nearly normal skin surface texture are preserved by quickly removal of the hypertrophic tissue sparing the pilosebaceous tissue. The CO2 laser is more capital intensive and results in higher fees compared with the simpler cold blade tangential excision. In our experience the ease of use, accuracy and precision of the lasers offer is not justified by the increased costs.

The contribution of Aulus Cornelius Celsus (25 B.C.-50 A.D.) to eyelid surgery.

An accurate study of ancient medicine reveals that our forebears developed a large number of surgical ideas and techniques considered to be quite modern. Although the contribution of Aulus Cornelius Celsus to the development of several branches of surgery has already been celebrated, scant attention has been focused on his description of eyelid surgery in the seventh book of his encyclopedia, De Medicina octo libri. Although the practice was quite advanced by that time, the first century A.D., Celsus was the first among the Greco-Roman authors to deal systematically with ophthalmology and oculoplastic surgery. He was a compiler, and many of his "innovations" were in fact done in principle by others. Yet it is almost certain that the surgical procedures presented were introduced more than 15 centuries before the time of Celsus by Egyptians, Indian surgeons, and Greek and Alexandrian doctors. The burning of the Ancient Library of Alexandria as well as the perishing of many writings of pioneer physicians resulted in a tragic loss of ancient knowledge for posterity. Celsus, whose work has been preserved in our time, helped to publicize this ancient knowledge, and perhaps because of the loss of so much early medical literature, became one of the most influential experts on ancient medicine. An analysis of how previous authors have influenced Celsus' description of eyelid surgery and reflections on how modern his ideas (or those of his time) were are presented in the paper.

Blindness following cosmetic injections of the face.

BACKGROUND: Complications following facial cosmetic injections have recently heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence for the prevention and treatment of this serious eye injury. METHODS: The authors included in the study only the cases in which blindness was a direct consequence of a cosmetic injection procedure of the face. RESULTS: Twenty-nine articles describing 32 patients were identified. In 15 patients, blindness occurred after injections of adipose tissue; in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate, hyaluronic acid, and calcium hydroxyapatite. CONCLUSIONS: Some precautions may minimize the risk of embolization of filler into the ophthalmic artery following facial cosmetic injections. Intravascular placement of the needle or cannula should be demonstrated by aspiration before injection and should be further prevented by application of local vasoconstrictor. Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas when possible. Low-pressure injections with the release of the least amount of substance possible should be considered safer than bolus injections. The total volume of filler injected during the entire treatment session should be limited, and injections into pretraumatized tissues should be avoided. Actually, no safe, feasible, and reliable treatment exists for iatrogenic retinal embolism. Nonetheless, therapy should theoretically be directed to lowering intraocular pressure to dislodge the embolus into more peripheral vessels of the retinal circulation, increasing retinal perfusion and oxygen delivery to hypoxic tissues. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, V.

Malignancies within rhinophyma: report of three new cases and review of the literature.

BACKGROUND: Rhinophyma, which represents the end stage of rosacea, is characterized by sebaceous hyperplasia, fibrosis follicular plugging, and telangiectasia. Although it is commonly labeled as an aesthetic problem, it may also determine airway obstruction and because of its nature to hide the growth of tumors. Due to the increasing number of reports of nonmelanoma skin types of cancer within rhinophyma, further concern about a higher incidence of malignancies in rhinophyma than in the skin of normal noses is reasonable. METHODS: We describe three male patients who developed malignancies (2 basal and 1 squamous cell carcinoma) associated with rhinophyma disease. The tumors developed over a mean of 23.3 years after primary diagnosis of rhinophyma. One case had a previous history of facial skin tumor. Surgical excision with clear margins allowed resolution in all three patients with a mean follow-up of 34.8 months. CONCLUSIONS: These three new cases and the review of 43 cases reported in the literature call attention to the clinical features of carcinomas arising in the context of rhinophyma, raising further concerns about the possible association between these two entities. The need for histologic examination of all surgically removed tissue in patients with rhinophyma is highlighted. Several macroscopic changes, including ulceration, drainage, and a rapid growth pattern, should alarm the physician and should be considered as suspicious of a malignant degeneration. Unexpected clinical modifications of a preexisting long-lasting silent rhinophyma could indicate the possibility of hidden malignancy rather than a rhinophyma itself. Although evidence of an association between the two entities remains inconclusive, half of the malignancies reported in our review were incidental findings associated with rhinophyma. Thus, since rhinophyma should not be considered solely a cosmetic problem, we recommend that all specimens be reviewed by a pathologist and if malignancy is diagnosed, re-excision with clear margins should be achieved when necessary with periodic follow-up.

ALK-1-negative anaplastic large cell lymphoma associated with breast implants: a new clinical entity.

Concerns have been raised recently regarding the increasing number of reports of non-Hodgkin lymphoma (NHL) that developed in close proximity to silicone or saline breast implants. In particular, an increased risk of anaplastic large cell lymphoma (ALCL) in patients with breast prostheses has been proposed. We reviewed clinical and pathologic findings in 40 women who received a diagnosis of breast NHL arising in association with breast implants and of 27 patients who had a diagnosis of ALCL with breast involvement reported in the published literature. Among the 40 reported cases of prosthesis-associated breast lymphomas, 28 were anaplastic lymphoma kinase-1-negative (ALK-1(-)) ALCLs, whereas of 27 ALCLs in patients without implants found in the literature, only 10 were ALK-1(-). The finding of 28 cases of breast ALK-1(-) ALCL occurring in patients with implants compared with 10 cases in women without implants is in favor of an association between silicone breast prostheses and ALK-1(-) ALCL. Although the incidence of this type of lymphoma remains remarkably low given that breast prostheses have been widely used for decades, clinical and pathologic evidence for a causative role is becoming dramatically strong. The histologic, phenomenologic, and clinical similarities of the majority of implant-related ALK-1(-) ALCLs suggest a common mechanism, especially when compared with the counterpart of patients without implants in which very few and highly dishomogeneous cases of the same malignancy were detected. There is convincing evidence that primary implant-related ALK-1(-) ALCL represents a distinct clinicopathologic entity that has been inappropriately fitted into the category of systemic ALK-1(-) ALCL. Thus it should be recognized as a separate category and classified on its own.

Malignant melanoma of the nasal septum.

Primary malignant melanoma involving the nasal and paranasal sinus mucosa is a rare neoplasm, accounting for less than 1% of all melanomas. Being more aggressive than its cutaneous counterpart, it carries a poor prognosis. We report a case arising from the nasal septum mucosae in a 78-year-old man. We describe clinical features, diagnosis, and treatment of this rare disease along with a review of the pertinent literature. Endoscopic resection of the neoplasm was performed, enabling diagnosis of sinonasal mucosal melanoma involving the frontal sinus floor. Because the patient was too compromised to achieve radical surgical approach (craniofacial resection), he underwent radiation therapy. Through this article, we wish to emphasize that early diagnosis with a high index of suspicion is critical because this type of tumor is extremely aggressive. Its location and relatively nonspecific features frequently delay diagnosis, and its rarity avoids an optimal treatment guideline setting.