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Wound healing is a complex process that is still not fully understood despite extensive research. To address this, we aimed to design and characterize a standardized porcine model for the evaluation of wound healing, dressings, cell therapies, and pharmaceutical agents. Using a standardized approach, we examined the wound healing process in 1.2 mm-deep dermatome wounds at defined positions in 11 female pigs. Unlike previous studies that have only described/analyzed selected punch biopsies, we performed and described histological analyses along the complete wound length using quantitative morphometric methods. All animals remained fully healthy following surgery and showed no signs of infection. Our histopathological evaluation using a predetermined grading score and quantitative manual morphometry demonstrated the impact of different tissue sampling methods, sampling sites, and residual dermis thickness on wound healing. Our study presents a reproducible model for wound healing evaluation and demonstrates the usefulness of porcine models for assessing dermal and epidermal wound healing. The use of histological analyses over the complete wound length provides advantages over previous studies, leading to the possibility of a deeper understanding of the wound healing process. This model could potentially facilitate future research on novel wound dressings and local wound healing therapies.
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Modelos Animais de Doenças , Cicatrização , Animais , Suínos , Feminino , Pele/patologia , Pele/lesões , Derme/patologia , BandagensRESUMO
Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.
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Artrite , Plasma Rico em Plaquetas , Humanos , Polegar/cirurgia , Estudos Prospectivos , Qualidade de Vida , Artrite/terapia , DorRESUMO
Introduction: Platelet-rich plasma (PRP) is gaining popularity and is applied in a variety of clinical settings. This review aims to present and evaluate available evidence regarding the use of PRP in various applications in plastic surgery. Methods: PubMed, Web of Science, Medline, and Embase were searched using predefined MeSH terms to identify studies concerning the application of PRP alone or in combination with fat grafting for plastic surgery. The search was limited to articles in English or German. Animal studies, in vitro studies, case reports, and case series were excluded. Results: Of 50 studies included in this review, eleven studies used PRP for reconstruction or wound treatment, eleven for cosmetic procedures, four for hand surgery, two for burn injuries, five for craniofacial disorders, and 17 as an adjuvant to fat grafting. Individual study characteristics were summarized. Considerable variation in preparation protocols and treatment strategies were observed. Even though several beneficial effects of PRP therapy were described, significance was not always demonstrated, and some studies yielded conflicting results. Efficacy of PRP was not universally proven in every field of application. Conclusion: This study presents an overview of current PRP treatment options and outcomes in plastic surgery. PRP may be beneficial for some indications explored in this review; however, currently available data are insufficient and systematic evaluation is limited due to high heterogeneity in PRP preparation and treatment regimens. Further randomized controlled trials employing standardized protocols are warranted.
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BACKGROUND: Unpredictable outcomes with autologous fat grafting due to reabsorption processes present a major challenge for healthcare providers and patients. A higher number of viable adipocytes is considered to result in a higher volume being retained. Although various adverse factors have been extensively researched, other potential parameters have been less investigated or even neglected. OBJECTIVE: The aim of this study was to investigate the harvesting process of adipose tissue as the primary cause of cell damage and to determine the risk factors associated with low cell survival. METHODS: Thirty-nine male and female subjects undergoing planned elective liposuction or abdominoplasty were enrolled. Forty-seven lipoaspirates harvested by different liposuction techniques were analyzed. RNA isolation and real-time polymerase chain reaction was performed to elucidate differences in the expression of various adipocyte markers. Furthermore, scanning electron microscopy was performed on various samples to determine the cell damage caused by the different techniques. RESULTS: A statistically significant lower expression of peroxisome proliferator-activated receptor γ was detected in subjects with a higher BMI. A trend towards a lower expression of perilipin 1 in lipoaspirates harvested by a super wetâ +â ultrasound technique, compared with dry and super wet techniques, was shown. The lowest level of cell damage determined from scanning electron microscopy images was in lipoaspirates harvested by the super wetâ +â ultrasound technique, and this level was statistically significantly different from those obtained by the 2 other techniques. CONCLUSIONS: Optimization of the outcome in autologous fat grafting may be feasible by targeting and optimizing the harvesting process as a main risk factor for impaired adipocyte viability. Ultrasound-assisted liposuction might be considered a suitable harvesting technique.
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Lipectomia , Coleta de Tecidos e Órgãos , Humanos , Masculino , Feminino , Coleta de Tecidos e Órgãos/efeitos adversos , Lipectomia/efeitos adversos , Lipectomia/métodos , Adipócitos/transplante , Tecido Adiposo/transplante , Transplante Autólogo , Sobrevivência CelularRESUMO
BACKGROUND: Autologous fat grafting is an effective tool for soft tissue augmentation in reconstructive breast surgery. Despite the major advantages of this minimally invasive approach, the unpredictability of graft survival presents challenges. OBJECTIVES: No clear consensus on the optimal technique has yet been published and well-defined prospective studies investigating impairing factors are lacking. This aim of this study was to generate valuable fundamental data. METHODS: Ten female patients undergoing elective autologous fat grafting after nipple-sparing mastectomy were enrolled. Punch biopsies and lipoaspirates were collected from the harvest site for histologic, gene expression, and scanning electron microscopic analysis. Noninvasive Lipometer measurements determining the subcutaneous adipose tissue thickness at the graft site were used to calculate the respective take rate. Patient- and surgery-related data were acquired and correlated with the take rate. RESULTS: A statistically relevant correlation between the take rate and the existing mean subcutaneous adipose tissue thickness at the grafted breast prior to surgery was observed. An approximate correlation was identified regarding the number of previous grafting sessions, body weight, and BMI. No statistically significant correlation was demonstrated for age, harvest site, or the mean adipocyte size. A lower level of cell damage was observed in scanning electron microscopic samples of washed lipoaspirates; and a strong indirect correlation with the expression of the adipocyte markers FABP4 and PLIN1 was apparent. CONCLUSIONS: Factors correlating to the take rate were identified. Future studies investigating the clinical relevance of each impairing factor are essential to contribute to the optimization of this valuable method.
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Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Mamoplastia/métodos , Mastectomia , Estudos Prospectivos , Tecido Adiposo/transplante , Transplante Autólogo/métodos , Sobrevivência de EnxertoRESUMO
The anterolateral thigh flap and the tensor fasciae latae flap are supplied by the lateral circumflex femoral artery (LCFA). Different branching patterns of the LCFA have been described, leading to confusion, discrepancies and difficulties in clinical and cadaveric study comparisons. The aim of this study was to evaluate the branching patterns of the LCFA in dissected lower limbs and propose a simplified nomenclature. One hundred and two lower limbs fixed with Thiel's method were investigated. Meticulous dissection was performed, and the branching pattern of the arteries was documented by illustration and photography. These were analysed and allocated to the currently existing terminologies regarding the numbers of the branches (Part 1), and these subgroups were evaluated according to the variability of the trunk formations (Part 2). In Part 1, four subgroups could be classified (A, B, C and D). Group A included a total number of three branches (n = 50), Group B included four (n = 41), Group C included five (n = 5) and Group D included only two branches (n = 6). Part 2 showed in total 11 different trunk variations. Group A had four trunk variations: A1 (n = 38), A2 (n = 5), A3 (n = 2) and A4 (n = 6); Group B also had four variations: B1 (n = 16), B2 (n = 18), B3 (n = 3) and B4 (n = 4); Group C displayed two variations: C1 (n = 1) and C2 (n = 4); and in Group D, there was only one variation observed D1 (n = 6). Branching patterns were highly variable and inconsistent in terms of the number of branches and trunk variations, which resulted in different possible and justified interpretations and classifications. A new terminology should be defined cooperatively among anatomists and clinicians that will be useful for everybody. We propose a terminology oriented to the associated muscles.
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Artéria Femoral , Coxa da Perna , Humanos , Extremidade Inferior , Músculos , Retalhos CirúrgicosRESUMO
Striae distensae, also known as stretch marks, particularly associated with female sex, pregnancy, obesity, and/or hormonal change, are linear bands of benign dermal lesions. Although not posing any health risk, aesthetically unpleasing stretch marks can cause significant psychological distress among those affected. In abundance of therapeutic approaches, some literature sources proclaim platelet-rich plasma to be a promising treatment modality for striae distensae. We aimed to shed some light on the current literature evidence of platelet-rich plasma for treating stretch marks and performed an English literature analysis with two independent reviewers in accordance with PRISMA guidelines searching the PubMed and Web of Science databases in June 2019. Of the 12 found studies, 6 matched inclusion criteria. With no control groups in two, just two other reports used intraindividual comparisons, and all but one publication performed histopathological assessments. All studies observed clinical and subjective improvements without using validated scores or patient-reported outcome measures (PROMs). The main findings were that multiple treatments with platelet-rich plasma demonstrated increased epidermal thickness, rete ridges formation, and collagen/elastin formation, while decreasing the inflammatory cell infiltrate. The current literature evidence supporting the use of platelet-rich plasma for striae distensae is poor. We propose in this review an outline for a study protocol with intraindividual control groups, standardised scores, validated PROMs, and participant incentives to enhance the scientific power in future clinical trials.
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Plasma Rico em Plaquetas , Estrias de Distensão , Colágeno , Feminino , Humanos , Obesidade , Gravidez , Pele , Estrias de Distensão/terapiaRESUMO
Patients suffering from pressure ulcers remain to be a challenging task for nursing staff and doctors in the daily clinical management, putting-notably in the case of recurrences-additional strain on the constantly reduced resources in public healthcare. We aimed to assess the risk factors for the recurrence of pressure ulcers at our institution, a tertiary referral center. In this retrospective analysis of patients admitted to our division we identified risk factors for pressure ulcer recurrence. The hospital patient database search included all patients with a diagnosis of pressure ulcers of the torso and lower extremity. One hundred sixty-three patients were diagnosed with pressure ulcers and 55 patients with 63 pressure ulcers met our inclusion criteria. The 17 recurrences (27%) had an average follow-up of 728 days. Most presented with lesions of the ischial tuberosity (n=24). Recurrence was statistically associated with defect size (p = 0.013, Cox regression analysis), and serum albumin levels (p = 0.045, Spearman correlation), but no association was found for body mass index, bacterial profile, comorbidities, localization, previous surgery, or time-to-admission for reconstruction (all p > 0.05). Supported by the recent literature we identified factors like defect size to be associated with pressure ulcer recurrence, but not with time-to admission for reconstruction or number of previous debridements. Whether laboratory values like serum albumin levels were the cause, the result or associated with pressure ulcer recurrence warrants further investigation.
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Antibacterianos/uso terapêutico , Procedimentos de Cirurgia Plástica/métodos , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/fisiopatologia , Albumina Sérica Humana/metabolismo , Adulto , Idoso , Índice de Massa Corporal , Estudos de Coortes , Terapia Combinada , Comorbidade , Desbridamento/métodos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Úlcera por Pressão/tratamento farmacológico , Úlcera por Pressão/cirurgia , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Fatores de Tempo , Cicatrização , Adulto JovemRESUMO
BACKGROUND: For the treatment of carpometacarpal arthritis of the thumb, various therapies are used. Infiltration therapy with autologous substances such as platelet-rich plasma and autologous fat have recently gained increasing attention because of beneficial pain-reducing effects in arthritis and the associated regenerative potential. However, the extent of clinical evidence in this area and how well autologous substances work in terms of pain reduction and improvements in hand function remain unclear. METHODS: A systematic review and meta-analysis were conducted to evaluate the current evidence and to provide more insight into pain reduction and improvement in hand function after infiltration of autologous substances. The authors identified 11 clinical trials, of which we included eight in the meta-analysis. RESULTS: Autologous substances achieved a good and long-lasting pain reduction, which may also be accompanied by corresponding improvement in hand function. Autologous substances appear to be more effective than corticoid infiltrations. The infiltration of autologous fat seems to be particularly promising in more advanced stages of carpometacarpal arthritis of the thumb. Our meta-analysis showed a mean pain reduction of 2.4 to 3 in visual analogue scale score and a reduction of 18 to 19 points in the Disabilities of the Arm, Shoulder, and Hand questionnaire after infiltration with autologous substances. CONCLUSION: Both platelet-rich plasma and autologous fat infiltration offer an efficient and long-lasting, minimally invasive therapy option in the treatment of carpometacarpal arthritis of the thumb.
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Artralgia , Articulações Carpometacarpais , Osteoartrite , Plasma Rico em Plaquetas , Humanos , Osteoartrite/terapia , Polegar , Artralgia/terapiaRESUMO
Objective: In contrast to the rising amount of financial investments for research and development in medical technology worldwide is the lack of usability and clinical readiness of the produced systems. We evaluated an augmented reality (AR) setup under development for preoperative perforator vessel mapping for elective autologous breast reconstruction. Methods: In this grant-supported research pilot, we used magnetic resonance angiography data (MR-A) of the trunk to superimpose the scans on the corresponding patients with hands-free AR goggles to identify regions-of-interest for surgical planning. Perforator location was assessed using MR-A imaging (MR-A projection) and Doppler ultrasound data (3D distance) and confirmed intraoperatively in all cases. We evaluated usability (System Usability Scale, SUS), data transfer load and documented personnel hours for software development, correlation of image data, as well as processing duration to clinical readiness (time from MR-A to AR projections per scan). Results: All perforator locations were confirmed intraoperatively, and we found a strong correlation between MR-A projection and 3D distance measurements (Spearman r = 0.894). The overall usability (SUS) was 67 ± 10 (=moderate to good). The presented setup for AR projections took 173 min to clinical readiness (=availability on AR device per patient). Conclusion: In this pilot, we calculated development investments based on project-approved grant-funded personnel hours with a moderate to good usability outcome resulting from some limitations: assessment was based on one-time testing with no previous training, a time lag of AR visualizations on the body and difficulties in spatial AR orientation. The use of AR systems can provide new opportunities for future surgical planning, but has more potential for educational (e.g., patient information) or training purposes of medical under- and postgraduates (spatial recognition of imaging data associated with anatomical structures and operative planning). We expect future usability improvements with refined user interfaces, faster AR hardware and artificial intelligence-enhanced visualization techniques.
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BACKGROUND: Surgical therapy for widespread first carpometacarpal (CMC1) arthritis permanently alters the physiologic anatomy of the hand. The injection of autologous substances into the thumb saddle joint could achieve temporary pain relief and delay surgical indications. This trial aimed to compare the pain-reducing effects of autologous fat and/or platelet-rich plasma (PRP) with saline 0.9% in the infiltration therapy of carpometacarpal arthritis of the thumb (CMC1 arthritis). METHODS: A blinded, randomized controlled trial was conducted. Ninety-five patients with CMC1 arthritis were included in the study. The mean follow-up period was 2 years. Participants were injected with 1.5 mL of autologous fat, PRP, autologous fat and PRP, or 0.9% saline solution into the CMC1 joint, depending on the group allocation. The primary outcome of this study was the evaluation of pain reduction in each treatment group. RESULTS: The combination of fat and PRP was the only treatment that resulted in a significantly greater reduction in pain compared with 0.9% saline ( P = 0.003). Similarly, fat and PRP in combination was the only therapy group to achieve clinically relevant Quick Disabilities of Arm, Shoulder, and Hand score reduction, and the only group that showed a significantly better Medical Outcomes Study 36-Item Short-Form Health Survey score than 0.9% saline ( P = 0.016). No major complications were noted. CONCLUSIONS: In addition to pain reduction, the combination of autologous fat and PRP yields a relevant improvement in hand function and a corresponding improvement in quality of life. This treatment seems to be a viable and safe alternative to short-acting glucocorticoids. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
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Osteoartrite , Plasma Rico em Plaquetas , Humanos , Qualidade de Vida , Solução Salina , Osteoartrite/cirurgia , Glucocorticoides , Dor , Resultado do TratamentoRESUMO
Burn wounds are a common challenge for medical professionals. Current burn wound models hold several limitations, including a lack of comparability due to the heterogeneity of wounds and differences in individual wound healing. Hence, there is a need for reproducible in vivo models. In this study, we established a new burn wound model using the chorioallantoic membrane assay (CAM) as a surrogate model for animal experiments. The new experimental setup was tested by investigating the effects of the auspicious biophysical therapy, photobiomodulation (PBM), on the wound healing of an induced CAM burn wound with a metal stamp. PBM has been shown to positively influence wound healing through vascular proliferative effects and the increased secretion of chemotactic substances. The easily accessible burn wounds can be treated with various therapies. The model enables the analysis of ingrowing blood vessels (angiogenesis) and diameter and area of the wounds. The established model was used to test the effects of PBM on burn wound healing. PBM promoted angiogenesis in burn wounds on day 4 (p = 0.005). Furthermore, there was a not significant trend toward a higher number of vessels for day 6 (p = 0.065) in the irradiated group. Changes in diameter (p = 0.129) and the burn area (p = 0.131) were not significant. Our results suggest that CAM can be a suitable model for studying burn wounds. The novel experimental design enables reproducible and comparable studies on burn wound treatment.
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Queimaduras , Terapia com Luz de Baixa Intensidade , Animais , Membrana Corioalantoide , Angiogênese , Cicatrização , Queimaduras/radioterapiaRESUMO
Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the "SIMline", a simulation training program explicitly designed for coaching medical students in burn management. Methods: A total of 43 students participated in the "SIMline" course, which took place at the training facility at the Medical University of Graz, between 2018 and 2019. The course provided theoretical classes, practical exercises, and a full-scale care process simulation training. The learning progress of the students was monitored via a formative integrated test. Results: Students showed great progress throughout the course of the "SIMline" program, as their test scores improved by an average of 88%. The passing rate was 0% at the first exam (prior to course) as compared to 87% at the final exam, taken after the training. Conclusions: Comprehensive practical training programs in burn care are underrepresented in medical education. The "SIMline" course presents a novel and effective approach in training medical students in burn management. However, follow-up evaluation is necessary to confirm long-term educational benefits.
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After body contouring surgery of the lower trunk (CSLT), the definition, rate (4%-70%), and documentation of complications vary. Objectives: We analyzed the effect of risk factors on the outcome based on the Clavien-Dindo classification (CDC) after CSLT surgery and polled postoperative satisfaction among patients. Methods: All patients undergoing CSLT from 2001 to 2016 were included and were classified according to the CDC for postoperative events. Statistical analysis included proportional odds logistic regression analysis. We polled patients to grade their satisfaction with the postoperative result and whether they would have the operation performed again. Results: A total of 265 patients were included: 60 (22.6%), 25 (9.4%), 28 (10.6%), and 21 (7.9%) were in CDC grades I, II, IIIa, and IIIb, respectively. A high preoperative body mass index significantly increased the odds for a postoperative event requiring revision surgery under general anesthesia (CDC grade IIIb, odds ratio 0.93, 95% confidence interval 0.89-0.97, P = 0.001). One-hundred twenty-eight patients (48.3%) participated in the poll: 101 (78.9%) were either happy or content with the postoperative results, and 117 (91.4%) would have the procedure performed again, including all nine patients with CDC grade IIIb. Conclusions: Our results confirm that a high body mass index is a statistically significant risk factor for requiring major revision surgery after CSLT. Despite being a complication prone intervention, postoperative satisfaction after CSLT was ranked favorably in our sample. We recommend that the CDC be used in all surgical specialties to evaluate complications and permit future comparability of pooled data.
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BACKGROUND: Painful habitual instability of the thumb basal joint (PHIT) is a rarely diagnosed condition that can severely impair hand function. Furthermore, it can increase the risk of developing carpometacarpal arthritis of the thumb (CMAOT). Clinical examination and radiographic imaging provide the foundation for a correct diagnosis, but early detection is still challenging. We investigated two objective, radiographically obtainable parameters as potential risk factors for PHIT. METHODS: Clinical data and radiographic images of 33 patients suffering from PHIT were collected and compared to those of 35 people serving as the control group. The two main objectives, the slope angle and the bony offset of the thumb joint, were gathered from the X-rays and statistically analyzed. RESULTS: The analysis showed no differences between the study and the control group concerning the slope angle. Gender and the bony offset, on the other hand, had a significant influence. Female sex and higher offset values were associated with an increased risk of PHIT. CONCLUSIONS: The results of this study prove a connection between a high bony offset and PHIT. We believe this information can be valuable in early detection and will allow more efficient treatment of this condition in the future.
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BACKGROUND: Peripheral nerve injuries affect over 2% of trauma patients and can lead to severe functional impairment and permanent disability. Autologous nerve transplantation is still the gold standard in the reconstruction of nerve defects. For small defects, conduits can be considered for bridging. Lately, the combined use of conduits and electrical stimulation has gained attention in the treatment of peripheral nerve injury. This review aimed to present the currently available data on this topic. METHODS: PubMed, Embase, Medline and the Cochrane Library were searched for studies on electrical stimulation through nerve conduits for nerve defects in in vivo studies. RESULTS: Fifteen studies fit the inclusion criteria. All of them reported on the application of nerve conduits combined with stimulation for sciatic nerve gaps in rats. Functional, electrophysiological and histological evaluations showed improved nerve regeneration after electrical stimulation. High variation was observed in the treatment protocols. CONCLUSION: Electrically stimulated conduits could improve peripheral nerve regeneration in rat models. The combined application of nerve guidance conduits and electrical stimulation shows promising results and should be further evaluated under standardized conditions.
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This invited editorial paper is intended to provide a brief overview of the use of alginate-based wound dressings in the treatment of chronic wounds, focusing particularly on the review by Andreea Barbu et al [...].
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The postsurgical Clavien-Dindo classification in minor surgery can improve perception and communication (Investigation on Blepharoplasty). Background: Minor surgery lacks a standardized postoperative complication classification. This leads to the presentation of inaccurate postsurgical complication rates and makes comparisons challenging, especially for patients seeking information. This study aims to evaluate a standardized five-step complication grading system (Clavien-Dindo Classification, CDC) on the example of blepharoplasty, which is the most performed minor aesthetic surgery worldwide. Methods: A retrospective observational exploratory study of patients (N = 344) who received a bilateral upper eyelid blepharoplasty under local anesthesia from the same surgical staff was performed. Data were retrieved from the electronic patient record: the CDC grading and the surgeon-reported complications (N = 128) at the first follow-up on day 7. In addition, a telephone survey with patients (N = 261) after 6 months was performed, which consisted of 7 complication-related yes/no questions. Results: Based on the CDC, 41.6% of patients were classified as having no complications, and 58.4% had one. Furthermore, 1 patient (0.3%) received a revision under general anesthesia (CDC IIIb), 18 patients (5.2%) were re-operated under local anesthesia (CDC IIIa), 23 patients (6.7%) required pharmacological intervention (CDC II), and 159 patients (46.2%) had a complication from the normal postoperative course and received supportive treatment (CDC I). Moreover, 90.5% of the mentioned complications accounted for Grade I and II; 94% of the patients subjectively experienced no complications; 51% of patients were pleased with the surgery even though a complication occurred according to the CDC; 34% of complications escaped the awareness of the surgeon. Conclusions: Grade I and II complications occurred frequently. Complications escaped the perception of the patients and surgeons. The classification identifies a wide variety of postsurgical complications and allows a standardized comparison in minor surgery objectively. Potential: The CDC in minor procedures can improve the (institutional) preoperative communication with patients regarding potential postoperative expectations. Furthermore, the classification can be a useful tool to detect complication-related costs, identify insurance-related requests, and support evidence in medicolegal disputes. The example of blepharoplasty can be translated to various other and even less invasive procedures.
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Background: Split-thickness skin grafting (STSG) is a frequently used reconstructive technique, and its donor site represents a standardized clinical model to evaluate wound dressings. We compared hydroactive nanocellulose-based, silver-impregnated and ibuprofen-containing foam wound dressings. Methods: A total of 46 patients scheduled for elective surgery were evaluated on the STSG donor site for wound healing (time-to-healing, Hollander Wound Evaluation Scale), pain level (Visual Analogue Scale), and handling (ease of use), as well as scar quality (Patient Scar Assessment Scale, Vancouver Scar Scale) after 3, 6 and 12 months. Results: Almost all dressings compared equally well. We observed statistically relevant differences for pain level favoring the ibuprofen-containing dressing (p = 0.002, ΔAIC = 8.1), and user friendliness in favor of nanocellulose (dressing removal: p = 0.037, ΔAIC = 2.59; application on patient: p = 0.042, ΔAIC = 2.33; wound adhesion: p = 0.017, ΔAIC = 4.16; sensation on skin: p = 0.027, ΔAIC = 3.21). We did not observe any differences for wound healing across all groups. Treatment with hydroactive nanocellulose and the ibuprofen-containing foam revealed statistically relevant better scar appearances as compared to the silver wound dressing (p < 0.001, ΔAIC = 14.77). Conclusion: All wound dressings performed equally well, with the detected statistical differences hinting future directions of clinical relevance. These include the reserved use of silver containing dressings for contaminated or close to contaminated wounds, and the facilitated clinical application of the nanocellulose dressing, which was the only suitable candidate in this series to be impregnated with a range of additional therapeutic agents (e.g., disinfectants and pain-modulating drugs). Personalized donor site management with the tested dressings can meet individual clinical requirements after STSG and improve management strategies and ultimately patient outcomes.
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BACKGROUND: Impaired perfusion of the remaining skin flap after subcutaneous mastectomy can cause wound-healing disorders and consecutive necrosis. Personalized intraoperative imaging, possibly performed via the FLIR ONE thermal-imaging device, may assist in flap assessment and detect areas at risk for postoperative complications. METHODS: Fifteen female patients undergoing elective subcutaneous mastectomy and immediate breast reconstruction with implants were enrolled. Pre-, intra- and postoperative thermal imaging was performed via FLIR ONE. Potential patient-, surgery- and environment-related risk factors were acquired and correlated with the occurrence of postoperative complications. RESULTS: Wound-healing disorders and mastectomy-skin-flap necrosis occurred in 26.7%, whereby areas expressing intraoperative temperatures less than 26 °C were mainly affected. These complications were associated with a statistically significantly higher BMI, longer surgery duration, lower body and room temperature and a trend towards larger implant sizes. CONCLUSION: Impaired skin-flap perfusion may be multifactorially conditioned. Preoperative screening for risk factors and intraoperative skin-perfusion assessment via FLIR ONE thermal-imaging device is recommendable to reduce postoperative complications. Intraoperative detectable areas with a temperature of lower than 26 °C are highly likely to develop mastectomy-skin-flap necrosis and early detection allows individual treatment concept adaption, ultimately improving the patient's outcome.