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Background and Objectives: Chest wall defect reconstruction is a complex procedure aimed at restoring thoracic structural integrity after trauma, tumor removal, or congenital issues. In this study, postoperative complications were investigated to improve the care of patients with these critical conditions. Materials and Methods: A retrospective study of chest wall reconstructions from 2004 to 2023 was conducted at Klinikum Nürnberg and Evangelisches Waldkrankenhaus Spandau-Berlin. Data included patient demographics, comorbidities, defect etiology, surgery details, and complications using the Clavien-Dindo classification. Results: Among the 30 patients included in the study, a total of 35 complications occurred in 35 thoracic wall defect reconstructions. These complications were classified into 22 major and 13 minor cases. Major complications were more common in patients with cancer-related defects, and considerable variations were observed between free flap and pedicled flap surgeries. Notably, the use of the anterolateral thigh (ALT) flap with vastus lateralis muscle demonstrated promise, exhibiting fewer complications in select cases. The reconstruction of chest wall defects is associated with substantial complications regardless of the etiology of the defect and the particular surgical procedure used. Interestingly, there was a lower complication rate with free flap surgery than with pedicled flaps. Conclusions: The ALT flap with vastus lateralis muscle deserves further research in this field of reconstruction. Multidisciplinary approaches and informed patient discussions are crucial in this complex surgical field, emphasizing the need for ongoing research and technique refinement.
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Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias , Retalhos Cirúrgicos , Parede Torácica , Humanos , Parede Torácica/cirurgia , Parede Torácica/anormalidades , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Adulto , Idoso , Retalhos Cirúrgicos/efeitos adversosRESUMO
OBJECTIVE: Fibroblasts are important for the successful healing of deep wounds. However, the influence exerted by Cuticell, a natural polymer on fibroblasts and by the synthetic polymer, Suprathel, made of poly-L-lactic acid, is not sufficiently characterised. This study compared the survival and growth characteristics of human juvenile and adult dermal fibroblasts as well as murine fibroblast cell line L929, on a natural polymer with those of a synthetic polymer using different culture models. METHOD: Murine, juvenile and adult human fibroblasts were seeded on both the natural and synthetic polymers using statical slide culture or the medium air interface and dynamical rotatory culture. Cell adherence, viability, morphology and actin cytoskeleton architecture were monitored for 1-7 days. Biomaterial permeability was checked with a previously established diffusion chamber. RESULTS: The majority of the murine and adult human fibroblasts survived in slide and rotatory cultures on both wound dressings. The fibroblasts seeded on the synthetic polymer exhibited phenotypically a typical spread shape with multiple cell adhesion sites earlier than those on the natural polymer. The highest survival rates in all tested fibroblast species over the entire observation time were detected in rotatory culture (mean: >70%). Nevertheless, it led to cell-cluster formation on both materials. In the medium air interface culture, few adult fibroblasts adhered and survived until the seventh day of culture on both the natural and synthetic polymers, and no viable juvenile and L929 fibroblasts could be found by day seven. Apart from a significant higher survival rate of L929 in slide culture on the natural polymer compared with the synthetic polymer at the end of the culturing period (p<0.0001), and a higher cell survival of L929 on the natural polymer in medium air interface culture, only minor differences between both materials were evident. This suggested a comparable cytocompatibility of both materials. Permeability testing revealed slightly higher permeance of the natural polymer compared with the synthetic polymer. CONCLUSION: Cell survival rates depended on the culture system and the fibroblast source. Nevertheless, the juvenile skin fibroblasts were the most sensitive. This observation suggests that wound dressings used in treating children should be tested beforehand with juvenile fibroblasts to ensure the dressing does not compromise wound healing. Future experiments should also include the response of compromised fibroblasts, for example, from burn patients.
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Bandagens , Materiais Biocompatíveis , Polímeros , Cicatrização/fisiologia , Adulto , Animais , Criança , Fibroblastos , Humanos , CamundongosRESUMO
This report presents a case of necrotizing fasciitis following a seemingly minor injury sustained from handling a spiny plant. Despite initial primary care by a physician, the patient presented with severe septic shock and necrotizing fasciitis of the hand, necessitating emergency surgical intervention. The use of scoring systems aided in the prompt recognition of the condition. Subsequent surgery was required due to infection progression, leading to significant soft tissue defects and functional impairment. The patient underwent multiple reconstructive procedures, including placement of dermis-replacement material and, ultimately, free flap reconstruction, to restore the hand function. This case report highlights the importance of rapid identification of potential cases of necrotizing fasciitis in cases of hand infections, demonstrates that scoring systems can assist in smaller affected body sites such as the hand, and illustrates the difficulties of defect reconstruction following necrotizing fasciitis.
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This case report presents a rare complication after percutaneous needle fasciotomy for Dupuytren contracture: the development of epidermoid cysts. A 60-year-old man who had previously undergone a needle fasciotomy required a subsequent limited fasciectomy due to disease progression. Unexpectedly, epidermoid cysts were discovered during the procedure. The successful removal of the cysts, together with the removal of the contracture cord, resulted in a good functional outcome. The conducted literature review identified four case reports of epidermoid or dermoid cysts after treatment for Dupuytren contracture. The reported cases in the literature and our case emphasize the need for adaptability in the management of Dupuytren contracture and the potential for unexpected complications. Further investigation is essential to understand the relationship between Dupuytren disease and cyst formation.
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Necrotizing fasciitis is a rare yet severe complication after body contouring surgery. We present a case of a 54-year-old woman with a complex medical history who developed necrotizing fasciitis 9 days after panniculectomy and epigastric hernia repair. Microbiological examination revealed Finegoldia magna as the causative agent, a rare pathogen in necrotizing fasciitis. Patients undergoing body contouring may be at increased risk of developing necrotizing fasciitis; therefore, increased attention should be paid to this differential diagnosis in case of postoperative signs of infection. This case report highlights the pivotal importance of early recognition, prompt surgical intervention, and comprehensive medical treatment to improve patient outcomes in necrotizing fasciitis.
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INTRODUCTION: Necrotizing fasciitis (NF) is a critical disease with high morbidity and mortality rates that poses significant challenges in diagnosis and treatment. Prognostic factors for the clinical course of NF remain unclear and are currently under research. This study aims to identify such factors in a large cohort of patients which represents a major comprehensive investigation of prognostic factors for NF. METHODS: Retrospective analysis was conducted on necrotizing fasciitis cases from 2003 to 2023 at two German hospitals. Data included demographics, comorbidities, laboratory findings, infection site, causative microorganisms and outcomes. Statistical analysis involved t-tests, chi-square tests, and ROC analysis. RESULTS: A total of 209 patients were included, with a mortality rate of 18%. Patients were categorized into survivors (n = 171) and non-survivors (n = 38). Non-survivors were significantly older (68.9 ± 13.9 years vs. 55.9 ± 14.3 years; p < 0.01) and exhibited a higher prevalence of peripheral vascular diseases, cancer, and heart, liver, or renal insufficiency. Laboratory findings and scoring results also varied significantly between the two groups. The ROC curve analysis identified age as a predictor of mortality, with an optimal cut-off value of 68.5 years (sensitivity: 60.5%, specificity: 81.9%). Higher age was associated with increased mortality risk. CONCLUSIONS: The patient's age stands out as the primary predictive element for mortality in necrotizing fasciitis. Additionally, we advocate for employing the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF-score), which holds substantial prognostic significance and is straightforward to calculate. Considering our findings, crafting a clinical algorithm or scoring mechanism to forecast mortality in NF would be a promising target for future research.
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Background: Necrotizing fasciitis (NF) is a life-threatening and rare condition. However, we report and analyze a remarkably high number of NF cases during the coronavirus disease 2019 (COVID-19) pandemic and especially in the first months after the COVID-19 pandemic. Patients and Methods: We conducted a retrospective analysis of 17 cases of NF treated in our clinic between January and May 2023. Data were collected on demographics, comorbidities, risk factors, laboratory findings, and clinical outcomes. For each individual case two risk indicating scores, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF) were calculated. Results: In the pandemic years 2021 and 2022 there were 21 and 30 patients with NF, respectively, treated in our clinic. Of the 17 included NF cases in this study from January until May 2023, 16 cases required intensive care unit (ICU) admission, six cases required limb amputation, and four cases resulted in death. The microbiologic examination revealed seven cases of polymicrobial infections, eight cases of monomicrobial infections primarily caused by Streptococcus pyogenes, and two cases without microbial growth. The LRINEC score showed a sensitivity of 82%, whereas the LARINF score demonstrated a sensitivity of 100% for identifying cases of NF. Conclusions: This study highlights a notable increase in NF during and after the COVID-19 pandemic, predominantly associated with Streptococcus pyogenes-induced infections. These cases demonstrate a highly aggressive nature, leading to limb amputation or death in more than half of the cases.
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COVID-19 , Fasciite Necrosante , Infecções Estreptocócicas , Humanos , Fasciite Necrosante/microbiologia , Pandemias , Estudos Retrospectivos , COVID-19/epidemiologia , Infecções Estreptocócicas/epidemiologia , Fatores de RiscoRESUMO
Background: Necrotizing fasciitis (NF) is a potentially fatal soft tissue infection. Four types of pathogens can be distinguished in the pathogen spectrum, although there are strong regional differences with regard to the most common pathogens. Patients and Methods: All cases of NF between 2003 and 2021 with an identified causative agent were analyzed retrospectively. The cases were divided into three groups: polymicrobial, gram-positive and gram-negative. Demographic factors, localization of infection, inflammatory parameters, and clinical outcome were compared between the three groups. Results: A total of 95 cases were analyzed, 41% of which were caused by multiple pathogens. A gram-positive pathogen was reported in 40% of cases and a gram-negative pathogen in 19%. There were significant differences between the three groups with respect to age (with patients in the gram-negative group being on average the oldest) and intensive care unit admissions (which was most frequent in the polymicrobial group). Conclusions: The pathogen spectrum of NF has rarely been studied in a large patient population. Gram-positive pathogens account for the majority of monomicrobial infections in our study. Nevertheless, we recommend calculated broad-spectrum antibiotic therapy given the high number of polymicrobial infections and gram-negative infections. Gram-negative infections may be associated with increased mortality, elevated procalcitonin levels, and are relatively frequent in NF of the lower extremities.
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Fasciite Necrosante , Infecções dos Tecidos Moles , Humanos , Fasciite Necrosante/epidemiologia , Estudos Retrospectivos , Infecções dos Tecidos Moles/terapia , Infecções dos Tecidos Moles/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
Radial polydactyly or thumb duplication is a relatively common congenital malformation of the hand, whereby the surgical techniques can be broadly divided into simple excisions, reconstructions and a Bilhaut-Cloquet procedure. The aim of this study was to identify the appropriate surgical procedures and to present the clinical outcomes that can be achieved. We performed a multicenter analysis of cases of radial polydactyly surgically treated with reconstruction or a Bilhaut-Cloquet procedure between 2015 and 2022. The clinical outcome was assessed using a modification of the Tada score. A total of 28 cases of 27 patients with radial polydactyly were included in the study. The most common Wassel type was type IV (13 cases), and the most common surgical procedure was reconstruction (24 cases). Our study validates an algorithm from the literature as a helpful tool for decision making in selecting a surgical technique for radial polydactyly, although individual surgical experience should also be considered.
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BACKGROUND: Necrotising fasciitis (NF) represents a rare but often life-threatening condition. Early diagnosis and surgical treatment are of vital importance. The LRINEC score was developed to distinguish necrotising fasciitis from other soft tissue infections (STI) at initial evaluation using six laboratory values. In this retrospective study, we attempted to determine the diagnostic and prognostic value of the LRINEC score. METHODS: A total of 125 patients, hospitalised in our clinic between 2003 and 2021 with a histologically confirmed diagnosis of necrotising fasciitis (NF group) and 319 patients with surgically treated soft tissue infections (STI group) were included in this study. Individual LRINEC scores were calculated and analysed retrospectively. RESULTS: The sensitivity of the LRINEC score at the cut-off point of ≥ 6 was 59%, whereas the specificity was 82%. The positive and negative predictive values were 57% and 84%, respectively. The mean LRINEC score was significantly higher in the NF group than in the STI group (6.0 compared to 2.4, respectively). All clinical outcome parameters such as amputation and mortality rates (15% vs 1%) were found to be significantly higher in the NF group (p<0.001). Within the NF group, there was no statistically significant association between the LRINEC score and clinical outcomes except for the necessary number of operations. CONCLUSION: In isolation, we found the LRINEC score not to be a reliable enough diagnostic tool for the differentiation between NF and other soft tissue infections, because of its low sensitivity. Although we cannot recommend it as a prognostic tool either, we do believe it can be a useful adjunct to the clinical suspicion of NF.
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Fasciite Necrosante , Infecções dos Tecidos Moles , Humanos , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/cirurgia , Infecções dos Tecidos Moles/diagnóstico , Estudos Retrospectivos , Prognóstico , Fatores de RiscoRESUMO
BACKGROUND: From 1991-2014, all major burn centers of the German-speaking countries participated in a multicenter study in which essentially demographic data were collected. Individual patient data was located at the particular burn centers and only cumulated data were summarized annually for presentation. Retrospective statistical analysis of the entire data collection and identification of subgroups was not possible. In 2015 the German Burn Registry was established for prospective collection of individual patient data as a tool for quality management (QM) and for scientific analyses. METHODS: A working group was formed to ensure the development and administration of the registry. From the official start of the German Burn Registry at the beginning of the year 2015 prospective data collection was realized with an individualized, web-based data collection software in a pseudonymized way. Selected data analysis was performed for the first 5 years of data collection. Severely burned adults and all hospitalized children with burn injuries were documented in the registry. RESULTS: The German Burn Registry was successfully established. 64 burn divisions have already been registered. 18,891 patients were documented over 5 years, of which 58% where children (<16 years). Mean ABSI Score was 4 (children: 3, adults: 6) with a mortality rate of 3.8.0% (children: 0.2%, adults: 9.3%). Children were hospitalized for an average of 7 days, whereas adults were discharged after 18 days. CONCLUSION: A registry is mandatory for quality assurance in burn medicine, since realization of randomized studies is difficult due to the heterogeneity of burn injuries. The German Burn Registry already is one of the biggest burn registries in Europe. Several scientific projects, based on the registry database, are in working process or have already been published.
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Queimaduras , Adulto , Criança , Humanos , Queimaduras/epidemiologia , Coleta de Dados , Alemanha/epidemiologia , Sistema de Registros , Estudos RetrospectivosRESUMO
BACKGROUND: Suicide attempted by self-inflicted burns are associated with lower survival rates compared to accident related burns. OBJECTIVE: We investigate the relation between self-inflicted burns (SIB) and survival rates and how this relation is moderated by variables used to predict survival rates in the ABSI score, a widely used measure. Additionally, we compare the predicted survival rates by the ABSI score to the actual rates in our sample for SIB and accident patients. METHODS: In this prospective multicenter study data from the German Burn Registry are statistically analyzed using two sided t-test and multivariate linear regression models. RESULTS: 5330 patients (214 with SIB) met our inclusion criteria. We find a 6.8 percentage points lower survival rate for patients with SIB when we control for patient condition with the five ABSI components as covariates. These higher mortality rates can be explained by the higher rate of therapy restrictions for patients with self-inflicted burns. Additionally, different ABSI modifications can improve the predictive power of the score. CONCLUSION: Patients with SIB have lower survival rates compared to accident patients. Recently proposed modifications of the ABSI score can improve the accuracy of survival rate prediction for SIB.
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Queimaduras , Comportamento Autodestrutivo , Humanos , Queimaduras/terapia , Comportamento Autodestrutivo/terapia , Estudos Prospectivos , Estudos Retrospectivos , Sistema de RegistrosRESUMO
The accurate assessment of burn wounds is challenging but crucial for correct diagnosis and following therapy. The most frequent technique to evaluate burn wounds remains the clinical assessment, often subjective depending on the experience of the physician. Hyperspectral imaging (HIS) is intended to improve on this subjective diagnosis by accurate and objective analyses of perfusion parameters. The purpose of this study was to analyze the ability of technical burn depth assessment and to investigate a link between a certain value to burn depth versus the value of healthy skin references. One hundred and eighteen HSI analyses were included in this study between July 2017 and July 2019. We analyzed 74 recordings with dorsal hand burns and 44 recordings of healthy skin on the dorsal hand as control group. HSI recordings' investigation was performed with special interest to wound center, intermediate zone, and wound margin. The results indicate that a differentiation between burned tissue and healthy skin was feasible and also significant in almost all HSI analysis parameters (P < .05). No significant distinction between superficial and deep partial thickness burns could be determined. However, in the wound center, we recorded smaller values with a more pronounced tissue damage. Our preliminary results demonstrate that HSI can distinguish between normal and burned hands. However, as currently used, HSI could not accurately determine the depth of indeterminate burns.
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Queimaduras/diagnóstico por imagem , Traumatismos da Mão/diagnóstico por imagem , Imageamento Hiperespectral , Adulto , Queimaduras/patologia , Feminino , Traumatismos da Mão/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The most common burn wound assessment continues to be the clinical inspection and the tactile examination, which are subjective and remain challenging even for experienced burn surgeons. Recently, hyperspectral imaging camera systems have been increasingly used to support the evaluation of burn wounds. The aim of our study was to determine if hyperspectral imaging analysis differentiates and objectifies the assessment of burn wounds in burns of the upper extremities. We included 97 superficial partial, deep partial dermal burns, and full thickness burns. Hyperspectral imaging analysis was performed for all burns using proprietary software. The software recorded parameters for tissue oxygenation (StO2), tissue hemoglobin index, and near-infrared perfusion. These values were compared with the recordings for healthy, non-burned skin. We found that hyperspectral imaging analysis effectively differentiates burn wounds and shows the ability to distinguish even superficial partial burns from deep partial burns in the near-infrared perfusion analysis feature. Although, it was not possible to differentiate burn wounds in all features. Currently, it is important to optimize the respective reference values of the individual burn degrees for an objectified assessment.
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Queimaduras , Lesões dos Tecidos Moles , Queimaduras/diagnóstico por imagem , Humanos , Imageamento Hiperespectral , Exame Físico , Pele/diagnóstico por imagem , Extremidade Superior/diagnóstico por imagemRESUMO
BACKGROUND: The three-dimensional [3D] wound dressings Biobrane® and Epicite are used in the wound management. Fibroblasts are important for successful deep wound healing. The direct effect of Biobrane® and Epicite on human fibroblasts, particularly of juvenile individuals, remains unclear. Therefore, this study compared the survival and growth characteristics of juvenile and adult dermal fibroblasts on Biobrane® and Epicite using different culture models. METHOD: Murine (L929), primary juvenile and adult human fibroblasts were seeded on both materials using two dimensional (2D, slide culture) or 3D culture at the medium-air interface and dynamical rotatory culture. Cell adherence, viability, morphology, actin cytoskeleton architecture and DNA content were monitored. Scanning electron microscopy (SEM) analyses could be only performed from Biobrane®. Permeability of both materials were tested. RESULTS: The majority of all tested fibroblasts species survived on both dressings with no significant differences between 1 and 14 days. Juvenile and adult fibroblasts exerted typical fibroblast morphology with spindle-shaped cell bodies on the materials. SEM visualized morphological differences between murine and human fibroblasts on Biobrane®. Juvenile and adult fibroblasts colonized Biobrane® in rotatory culture after 7 days the most. The Biobrane® rotatory culture of L929 and juvenile fibroblasts showed after 7 days the significantly highest DNA amount. No major gender differences could be observed. Biobrane® had a higher permeability than Epicite. CONCLUSION: Both wound dressing can be colonized by fibroblasts suggesting their high cytocompatibility. Fibroblast survival and morphology on Biobrane® and Epicite depended on the culture system and the fibroblast source.
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Bandagens , Curativos Oclusivos , Adulto , Humanos , Camundongos , Animais , Fibroblastos , BiopolímerosRESUMO
Background: Necrotizing fasciitis is a potentially fatal soft tissue infection in which the timing of surgical intervention significantly affects clinical outcome. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, the Site other than the lower limb, Immunosuppression, Age <60 years, Renal impairment (creatinine >141), and Inflammatory markers (CRP ≥150, WCC >25) (SIARI) score, and procalcitonin levels are intended to aid in the decision-making process to differentiate between necrotizing fasciitis and soft tissue infections. Methods: A retrospective analysis of cases of necrotizing fasciitis and soft tissue infections treated at Klinikum Nürnberg was performed. The two scores as well as procalcitonin levels were tested for their diagnostic value and a new score, the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF), was created based on the results. Results: Procalcitonin, LRINEC score, and SIARI score showed insufficient discriminatory ability in our study. The newly created LARINF score combined laboratory parameters of the LRINEC score (hemoglobin and C-reactive protein) with procalcitonin and three comorbidities, resulting in a sensitivity of 84% and a specificity of 75% and the highest area under the receiver operating characteristic (ROC) curve of 0.83. Conclusions: The LARINF score is a novel decision-supporting tool. The decision, in which cases surgical exploration should be initiated, remains a clinical one. However, the score seems to provide an improved basis for identifying a rare clinical picture.
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Fasciite Necrosante , Infecções dos Tecidos Moles , Proteína C-Reativa , Creatinina , Fáscia , Fasciite Necrosante/diagnóstico , Humanos , Pessoa de Meia-Idade , Pró-Calcitonina , Estudos Retrospectivos , Fatores de Risco , Infecções dos Tecidos Moles/diagnósticoRESUMO
(1) Background: Microsurgical reconstruction of foot defects with free flaps is rare as it is a challenging task for a surgeon. For extensive defects, advanced surgical procedures, such as free flap transfer with microsurgical anastomosis, may be the last chance to avoid major amputation. The aim of the study was to examine the opportunities and risks posed by free flap reconstruction of foot defects and to illustrate in which situations reconstruction is useful on the basis of case characteristics. (2) Methods: In this study, we retrospectively analyzed data of cases with free flap reconstruction of the foot from 2007 to 2022. Therefore, demographic data, comorbidities, information about the defect situation, data on the operational procedure, and complications were evaluated. (3) Results: A total of 27 cases with free flap coverage of foot defects could be included. In 24 of these cases (89%), defect coverage was successful. In 18 patients, some form of complication occurred in the postoperative stage. The most frequently used flap was the latissimus dorsi flap, with 13 procedures. (4) Conclusions: Foot reconstruction using free flaps is a proven procedure for the treatment of larger foot defects and can offer a predominantly good functional outcome. The lengthy process and possible complications should be thoroughly discussed in advance so as to provide criteria, suitably adjusted to the individual prerequisites of the patients, for deciding whether limb salvage using advanced surgical procedures should be attempted.
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BACKGROUND: Treatment outcomes of Dupuytren's disease depend largely on degree of contracture and biological severity. Longitudinal assessment of each is crucial for effective care and long-term outcome assessment. Ideally, each Dupuytren's patient should have ongoing interval evaluations. Because of the large number of Dupuytren's patients, it would be impractical and costly for health care professionals to examine every patient in person on a regular basis. Patient-based evaluations might provide a useful and cost-effective alternative to office-based examination. METHODS: Finger goniometry is the standard metric for office-based evaluation of Dupuytren's disease. This study's goal was to develop a new patient-reported goniometric system. The authors developed a completely Web-based goniometric software for patients to use without supervision and without undue effort or cost. They then evaluated the validity and precision of the core measurement system and the reliability of its patient-based application. RESULTS: With a correlation of 0.992 (p < 0.01), a mean deviation of -0.25 degree, and a standard deviation of 2.74 degrees in patient-based application, the authors found their goniometric software to be comparable to practitioner-based, conventional goniometry. The authors believe patient-based goniometry to be a sufficiently accurate, valid, and reliable approach for longitudinal clinical assessment of Dupuytren's disease. CONCLUSIONS: Patient-based goniometric approaches have great potential for inexpensive, accurate, and accessible longitudinal assessment of the large population of Dupuytren's patients. Such approaches could help to substantially improve overall care of Dupuytren's disease through early diagnosis and timely treatment. In addition, being able to collect reliable patient data on a regular basis and on a larger scale could help improve understanding of the natural history of Dupuytren's disease. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, I.
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Artrometria Articular/instrumentação , Dedos/fisiopatologia , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/fisiopatologia , Desenho de Equipamento , Humanos , Reprodutibilidade dos Testes , SoftwareRESUMO
The depth assessment of thermal wounds is subject to many variables. Therefore, technical systems are increasingly being used to determine severity. Particularly hand burns can have clinically relevant consequences in terms of function and aesthetic appearance. Hence, a secure assessment for an adequate treatment is necessary.Technical analyzes such as Hyperspectral Imaging, Laser-Doppler-Imaging or Laser-Speckle-Imaging are intended to simplify and objectify the examination by helping to determine the necessary depth of necrectomy and thus to define the skin transplantation area. Furthermore, the diverse technical devices are to improve the functional result, reduce the severity of scarring and cosmetic complaints, and facilitate the evaluation of inexperienced personnel in the field of burn medicine.Therefore, various technical approaches have been pursued, which are largely based on optical principles. The respective devices are not yet used in the standard diagnosis of burn wounds.In future studies it will be necessary to determine an algorithm for the measurement intervals based on the wound dynamics and to evaluate which methodology is superior to the specificity and sensitivity.
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Queimaduras , Queimaduras/diagnóstico por imagem , Queimaduras/patologia , Queimaduras/cirurgia , Cicatriz , Humanos , Fluxometria por Laser-Doppler , Pele/diagnóstico por imagem , Transplante de PeleRESUMO
Hands are often affected from burns, due to their unprotected exposure to thermal injuries. Burn injuries also pose a major threat for hands as there is a high risk of severe functional and aesthetical disabilities. Bromelain-based enzymatic debridement is a novel treatment alternative for early surgical excision of burn eschar. This case study describes three patients who were treated with enzymatic debridement in deep thermal burns of the hand.