[Secondary reconstruction in zones V-VII in extensor tendon injuries]. / Sekundäre Rekonstruktionen in den Zonen V­VII bei Strecksehnenverletzungen.

BACKGROUND: Due to various functional impairments after primary extensor tendon repair or lack of treatment, secondary tendon reconstruction is often required. Anatomical considerations, the outcome of the injury and its treatment and the patients' individual demands on the function of the hand affect the choice of the procedure. OBJECTIVE: Description of techniques for secondary reconstruction after extensor tendon injury in zones V-VII. MATERIAL AND METHODS: Overview of surgical treatment concepts for secondary extensor tendon repair in zones V-VII of the extensor tendons of the fingers and thumb. Discussion of alternative surgical techniques for secondary extensor tendon repair. RESULTS: While techniques for reconstruction of sagittal band injuries are predominant in zone V, side-to-side tendon transfers, the use of tendon grafts and end-to-end tendon transfers prevail in zones VI-VII. The reconstruction of the extensor pollicis longus tendon function using transfer of the extensor indicis proprius tendon is the standard procedure. CONCLUSION: For secondary repair of an extensor tendon function, anatomical features and functional interaction of the extrinsic and intrinsic hand musculature need to be considered depending on the zone affected.

Fractional ablative carbon dioxide laser treatment of facial scars: Improvement of patients' quality of life, scar quality, and cosmesis.

BACKGROUND: Disfiguring facial scars can be a massive burden on patients' psychosocial health and severely impact patients' self-esteem. AIMS: The aim of this study was to analyze whether ablative fractional carbon dioxide laser (CO2-AFL) treatment can positively influence facial scarring and quality of life (QoL) while improving the aesthetic appearance. PATIENTES/METHODS: Patients with facial scars who had received CO2-AFL treatment between May 2019 and May 2020 were included in a retrospective study. The post-interventional course and patient and/or observer reported outcomes were inquired before and three months after treatment. Primary outcomes were changes in the Patient and Observer Scar Scale (POSAS) and QoL (Short Form (SF) 36). In addition, two independent examiners evaluated the aesthetic outcome by comparing initial scarring with the post-intervention results using photographs. RESULTS: A total of 16 patients with facial scars were included. Most of the scars were caused by burns (43.8%) or trauma (31.3%). The post-interventional course was uneventful. Overall POSAS scores improved decisively for both observers (n=2) and patients (n=16) (p<0.001 and p<0.001). Also, there was an improvement in QoL with an increase in emotional well-being (p=0.043) and social functioning (p=0.01). Furthermore, the aesthetic outcome was significantly enhanced (p=0.001) after treatment. CONCLUSION: The CO2-AFL offers a safe and effective treatment for disfiguring facial scars. We have shown that improvement of scar appearance and scar quality was meaningful to the patient, with a significant impact on a patient's life quality. Based on these findings we suggest including the CO2-AFL in the facial scar treatment concept.

A novel option in negative pressure wound therapy (NPWT) for chronic and acute wound care.

INTRODUCTION: Negative pressure wound therapy (NPWT) has become a widely accepted technique in treatment of all kinds of wounds. After a long period of clinical application of the V.A.C.™ system (KCI Inc., San Antonio, Texas, USA) a number of options for delivery of NPWT are now commercially available. An urgent need exists for evidence demonstrating clinical efficacy of these new devices to support clinicians regarding their choice of NPWT. METHODS: 42 patients with an acute or chronic wound were randomly assigned to either treatment by V.A.C.™ (group A) or therapy with an alternative newly available polyurethane foam-based NPWT system (RENASYS GO™ - F/P, Smith & Nephew GmbH) (group B). In both groups NPWT was applied after surgical debridement to prepare the wound bed for skin grafting. After skin grafting NPWT was applied additionally to secure skin grafts and improve grafts survival. Primary outcome measures were the time to complete healing (days) and duration of the NPWT application (days). Secondary outcome measures were the number of dressing changes and reported complications. In addition, we evaluated the cost-benefit in the clinical implementation. RESULTS: There were no significant differences comparing the investigated parameters between both groups. Especially average time to complete healing and average time NPWT was applied did not differ (p>0.05). No complications occurred in either group. By an almost identical supply agreement of both providers for our hospital RENASYS™ system appeared to be more cost-effective. CONCLUSION: After a long period of preserving a monopoly market position of the V.A.C.™ system, a new comparable option was successfully tested in this preliminary study. The polyurethane foam-based NPWT system (RENASYS GO™ - F/P, Smith & Nephew GmbH) is an efficient and cost-effective alternative NPWT system, which we effectively implemented in therapeutic management of different kinds of wounds.

A clinical evaluation of Biobrane(®) and Suprathel(®) in acute burns and reconstructive surgery.

BACKGROUND: In the treatment of superficial partial-thickness burns, various skin substitutes and temporary dressings offer potential advantages over traditional treatments. Nonetheless, the search for an ideal temporary skin substitute or biosynthetic wound dressing is still a continuous quest. This research aimed to provide objective data on the long-term outcome of Biobrane(®) and Suprathel(®). METHODS: Eight months after the initial burn treatment of Biobrane(®) and Suprathel(®), skin elasticity was measured objectively using a Cutometer(®) and the scarring process was quantified using the Vancouver Scar Scale (VSS). RESULTS: The median healing time for patients treated with Biobrane(®) was up to 1.8 days shorter then the Suprathel(®) group. Regarding the Vancouver Scar Scale (VSS), neither the single parameter, nor the total score were significantly different in both groups. In comparison, the Biobrane(®) group demonstrated superior Cutometer(®) parameters in regards to maximal extension, elasticity, retraction and pliability. Despite higher levels of Biobrane(®) group, the differences in the viscoelastic analysis of both substitutes did not vary significantly. CONCLUSION: Using both substitutes, we observed satisfying results in superficial partial-thickness burn treatment, without any significant differences. Since the treatment of burned patients is associated with high socioeconomic load, the cost factor should be one of the most important criteria in dermal substitute selection.