51
|
Sacral and Ischial Pressure Ulcer Management With Negative-Pressure Wound Therapy With Instillation and Dwell. Plast Reconstr Surg 2021; 147:61S-67S. [PMID: 33347064 DOI: 10.1097/prs.0000000000007613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The addition of topical fluid instillation, a programmable "dwell" time and a novel foam-wound interface to the established wound healing benefits of negative-pressure wound therapy (NPWT) works synergistically to benefit patients with complex wounds. This engineering breakthrough for wound care has been termed NPWT with instillation and dwell (NPWTi-d), and the new foam dressings are reticulated open cell foam dressings specifically designed for use with NPWTi-d. This combined technology has shown promise in chronic, complex wounds and has potential for the management of sacral and ischial pressure wounds. METHODS A qualitative comprehensive review was performed analyzing articles from PubMed and Medline that reported on the use of NPWTi-d in sacral or ischial pressure ulcers. Case series and case reports were predominant, and results of cases specific to sacral and ischial pressure wounds were extracted from larger studies and summarized for presentation. RESULTS Compared with conventional NPWT alone, NPWTi-d has been shown to help irrigate the wound, remove fibrinous debris, and promote granulation tissue formation. This is associated with a decreased number of operative debridements and decreased hospital length of stay. CONCLUSIONS This technology is rapidly demonstrating expanded utilization in hospitalized patients with chronic sacral and ischial pressure ulcers. When used correctly, NPWTi-d serves as an effective "bridge to defined endpoint": whether that is a flap reconstruction, skin grafting, or discharge home with a stable chronic wound and simplified wound care.
Collapse
|
52
|
Abstract
SUMMARY Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed, thanks to new medical devices based on fluid aspiration capacities and the development of negative pressure wound therapy. Negative-pressure wound therapy was initially designed for a double action, fluid aspiration and mechanical stimulation of wound edges by a foam. Successive technical evolutions of negative pressure wound therapy were declined since 1997 when Argenta and Morykwas first presented their solution. The adjunct of instillation in 2009 was considered as the first interactive dressing, allowing topical wound solutions to sequentially reach the wound, in alternance with negative pressure. Other devices based on the same principle were designed to prevent postoperative infections when placed over a suture after surgery. This long evolution could enhance the armamentarium of possible solutions, considerably reducing the wound healing time.
Collapse
|
53
|
Skochdopole AJ, Wagner RD, Davis MJ, Raj S, Winocour SJ, Ropper AE, Xu DS, Bohl MA, Reece EM. Vascularized Bone Grafts in Spinal Reconstruction: An Overview of Nomenclature and Indications. Semin Plast Surg 2021; 35:50-53. [PMID: 33994879 DOI: 10.1055/s-0041-1726101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Several vascularized bone grafts (VBGs) have been introduced for reconstruction and augmenting fusion of the spine. The expanding use of VBGs in the field of spinoplastic reconstruction, however, has highlighted the need to clarify the nomenclature for bony reconstruction as well as establish the position of VBGs on the bony reconstructive algorithm. In the current literature, the terms "flap" and "graft" are often applied inconsistently when describing vascularized bone transfer. Such inconsistency creates barriers in communication between physicians, confusion in interpreting the existing studies, and difficulty in comparing surgical techniques. VBGs are defined as bone segments transferred on their corresponding muscular attachments without a named major feeding vessel. The bone is directly vascularized by the muscle attachments and unnamed periosteal feeding vessels. VBGs are best positioned as a separate entity in the bony reconstruction algorithm between nonvascularized bone grafts (N-VBGs) and bone flaps. VBGs offer numerous advantages as they supply fully vascularized bone to the recipient site without the microsurgical techniques or pedicle dissection required for raising bone flaps. Multiple VBGs have been introduced in recent years to optimize these benefits for spinoplastic reconstruction.
Collapse
Affiliation(s)
- Anna J Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Ryan D Wagner
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Sarth Raj
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sebastian J Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - David S Xu
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
54
|
Snake Bite Management: A Scoping Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3506. [PMID: 33936914 PMCID: PMC8084039 DOI: 10.1097/gox.0000000000003506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 01/20/2023]
Abstract
Background: Around the world, snake bite envenomation remains an underreported human health hazard. Envenomation can cause local and systemic complications, especially when there is a lack of antivenom availability. Although there are established guidelines regarding snake bite management acute care, there is a paucity of data regarding surgical intervention and the plastic surgeon’s role treating this unique patient population. Methods: A review was conducted identifying relevant published articles involving snake bite management and treatment in PubMed and EMBASE. Results: One hundred ten articles were identified and 77 met inclusion criteria. Snake bite envenomation can result in complications that are dependent upon a variety of variables. The literature has shown the best field treatment to be timely transportation to the nearest medical facility, along with antivenom administration. The cytotoxic, hemotoxic, and neurotoxic effects of venom can cause a variety of local soft tissue and systemic complications. Surgical interventions such as fasciotomies, wound debridements, skin grafts, and tissue flaps may be necessary in these patients to optimize functional and aesthetic outcomes. Disparities in access to care in resource limited settings are discussed. Conclusions: Global health disparities and insufficient antivenom distribution create an inequality of care in snake bite patients. Plastic surgeons have an important role in managing acute and chronic complications of snake bite envenomations that can lead to improved patient outcomes.
Collapse
|
55
|
Fulchignoni C, Rocchi L, Cauteruccio M, Merendi G. Matriderm dermal substitute in the treatment of post traumatic hand's fingertip tissue loss. J Cosmet Dermatol 2021; 21:750-757. [PMID: 33786967 DOI: 10.1111/jocd.14115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Treatment of fingers tissue loss is particularly challenging as it often necessitates advanced reconstructive techniques such as flaps or grafts, with esthetic and functional results that are not always as good as hoped for, with long healing times. Recently, along with tissue engineering development, numerous types of dermal substitute have been commercialized, with promising possibilities of treatment in finger tissue loss. In the author's unit, Matriderm® is the most commonly used dermal substitute. As described by the manufacturer, this scaffold is designed to be covered with a split-thickness skin graft. In using a two-step procedure, the authors realized that in most cases of fingertips injuries, at three weeks follow-up, the wound appeared in an advanced state of healing, which permitted to avoid grafting. MATERIAL AND METHODS Between October 2017 and October 2018, 27 fingers have been included in this study. Patients have been divided in two groups: those treated with Matriderm® alone (15 fingers) and those who had a skin graft three weeks after the first surgery (12 fingers). At the 6-month follow-up, authors evaluated the esthetic results with the Vancouver Scar Scale (VSS), the functional results with Quick Disability of the Arm, Shoulder and Hand (qDASH) score, and sensibility by the mean of two-point discrimination test (2-PD). RESULTS All outcomes were overlapping in patients treated with or without skin graft: mean VSS was 2.3, mean qDASH was 13.3, and mean 2-PD was 7.7 mm. CONCLUSIONS The results obtained allow to consider Matriderm® , used also without skin graft coverage, as a valid solution for treatment of fingertip tissue loss.
Collapse
Affiliation(s)
- Camillo Fulchignoni
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Lorenzo Rocchi
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Michele Cauteruccio
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Gianfranco Merendi
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| |
Collapse
|
56
|
Almeida IR, Coltro PS, Gonçalves HOC, Westin AT, Almeida JB, Lima RVKS, Silva MF, Farina Junior JA. The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience. Wound Repair Regen 2021; 29:486-494. [PMID: 33772964 DOI: 10.1111/wrr.12910] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according to the PRISMA guidelines) on the use of NPWT in the treatment of PG, and we report our personal experience with two patients treated with this device. The result of the review showed that articles on the topic are, in their entirety, of low levels of evidence, such as case series, case reports, and reviews. Improvement in wound healing with the use of NPWT was observed in 85.1% of the patients studied. Besides, a significant association between improvement in wound healing with NPWT and immunosuppressive therapy was observed. Regarding the cases reported here, both showed good outcomes with the use of NPWT and skin graft during the treatment of PG injuries. Due to the rarity of PG, there is a scarcity of studies with robust evidence for standardization and comparison between treatments, which consequently makes it difficult to select therapeutic options. However, based on this systematic review and reported cases, we consider NPWT a safe option for adjuvant treatment of wounds caused by PG if combined with systemic immunosuppression, which plays a key role in greater chances of successful treatment. This approach should be recommended, whenever possible, associated with skin grafting to accelerate wound closure. The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: a systematic review and personal experience.
Collapse
Affiliation(s)
- Ivan R Almeida
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Pedro S Coltro
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Henrique O C Gonçalves
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Andrezza T Westin
- Division of Dermatology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Juliano B Almeida
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Renan V K S Lima
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcelo F Silva
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jayme A Farina Junior
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
57
|
Kushida-Contreras BH, Gaxiola-García MA. Ultrathin free flaps for foot reconstruction: impact on ambulation, functional recovery, and patient satisfaction. J Plast Surg Hand Surg 2021; 55:380-387. [PMID: 33771082 DOI: 10.1080/2000656x.2021.1898974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Plantar reconstruction is a complex procedure due to the paucity of tissue around the foot. Tissues used for reconstruction should provide similar properties, which can be accomplished by using ultra-thin flaps. Validated functional scales may provide essential information regarding patients' evolution. METHODS Information concerning a series of 12 cases of plantar reconstruction using ultra-thin free flaps was gathered retrospectively by the authors. Data from preoperative functional scores in Lower Extremity Functional Scale and American Orthopaedic Foot and Ankle Society scale were obtained from clinical records; these were compared to postoperative scores assigned prospectively during follow-up. Differences were determined using Student's t-test for paired samples. Objective measurements concerning evolution (ulceration, footwear usage, sensation), as well as patient satisfaction, were also explored. RESULTS The mean follow-up duration was 16.5 (range 12 to 24) months. The Lower Extremity Functional Scale scores mean modified from 39.1 to 60.2, p = 0.004; the American Orthopaedic Foot and Ankle Society scale mean modified from 42.2 to 53.4, p = 0.012. No patient showed plantar ulceration. Protective sensation was achieved in 75% of the patients, and 10 out of 12 could use regular footwear. All patients reported satisfaction with the surgical procedure. CONCLUSIONS Ultra-thin flaps for foot reconstruction are related to improvement in functional scales, high rates of patient satisfaction, and use of regular footwear as well as a limited range of complications.
Collapse
Affiliation(s)
| | - Miguel Angel Gaxiola-García
- Plastic and Reconstructive Surgery Department, Mexico's Children's Hospital (Hospital Infantil de México "Federico Gómez"), Mexico City, Mexico
| |
Collapse
|
58
|
Effect of Negative Pressure Wound Therapy in Electrical Burns. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3383. [PMID: 33680645 PMCID: PMC7929684 DOI: 10.1097/gox.0000000000003383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
Electrical burns are capable of damaging cells through both thermal and nonthermal mechanisms. The complexity of these wounds, the deterioration in time, and the conversion during the first days make managing them a challenge. Negative pressure wound therapy (NPWT) is a technology that can be used as a tool to improve outcomes in patients with burns in the acute and reconstructive phases of the treatment. We describe 2 cases in which we apply this technology in electrical injuries. We present 2 cases of patients with electrical burns who underwent NPWT with instillation (NPWTi) with saline solution in the acute phase, to block the conversion of the burn and to improve the granulation tissue and in the reconstructive phase, as a tool to improve the grafts take. Both patients showed early formation of granulation tissue adequate for surgical reconstruction, and neither of them presented loss of skin grafts. In the acute phase, NPWT with instillation when applied in these patients showed fast formation of granulation tissue adequate for early reconstruction, whereas NPWT in the reconstructive phase when applied to bolster grafts showed improvements in grafts take. NPWT is a useful tool to support the surgical management of the electrical injuries during the acute phase to prepare the wound for early reconstruction and after the skin grafts reconstruction to improve the grafts take.
Collapse
|
59
|
Chien YC, Lin YH, Chen CC, Lin HC. Compromised Flap Salvage With Closed Incision Negative Pressure Therapy Under Real-Time Indocyanine Green Fluorescence Assessment. Ann Plast Surg 2021; 86:S96-S101. [PMID: 33438958 DOI: 10.1097/sap.0000000000002653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin flap transfer is a commonly used technique by surgeons; however, compromised blood flow may result in flap ischemia and necrosis. We describe the use of closed incision negative pressure therapy (ciNPT) to help manage skin flap reconstructions with indocyanine green fluorescence angiography (ICG-FA) to assess perfusion of the flaps before and after ciNPT. METHODS Three female and 5 male patients underwent various skin flap reconstructions, including local flaps, pedicled flaps, and propeller flaps, for wound defects related to trauma, infection, or cancer. After flap setting and suturing, ciNPT (-125 mm Hg) was applied to the closed incision for 7 days. Perfusion was assessed using ICG-FA before applying ciNPT and again at 24 hours later. The Shapiro-Wilk test and Wilcoxon signed rank test were used in statistical analysis. RESULTS Initial postoperative survival was observed for all skin flaps; however, 1 flap failed after 2 weeks due to uncontrolled infection. The remaining 7 flaps healed well without any surgical revision. All patients were initially determined to have impaired flap perfusion; however, skin flap perfusion was significantly higher after ciNPT than before ciNPT in each case (P = 0.012). CONCLUSIONS This study showed good healing outcomes for skin flap reconstructions without complications, despite the fact that each flap had compromised flap perfusion to some extent during the surgery. This case series is novel in that it used laser-assisted ICG-FA to provide a real-time assessment of skin flap perfusion before and after ciNPT.
Collapse
Affiliation(s)
- Yi-Chun Chien
- From the Shin-Kong Memorial Hospital, Taipei, Taiwan
| | | | | | | |
Collapse
|
60
|
Kang AS, Kang KS. Expanding the scope of rhomboid flap: Large cutaneous defect reconstruction. Case report. Ann Med Surg (Lond) 2021; 62:369-372. [PMID: 33552496 PMCID: PMC7848721 DOI: 10.1016/j.amsu.2021.01.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance: Large cutaneous defects may result from excision of skin malignancies. Typically, skin grafting is used to manage such defects, but the final result may be compromised by inadequate take and poor cosmesis. Accordingly, transposition flaps may be indicated. Case Presentation and clinical discussion: A 93-year-old female presented with a painful, necrotic 12 cm × 12 cm Squamous Cell Cancer of left upper back. She underwent wide excision followed by a rhomboid transposition fasciocutaneous flap. The flap was easily designed, quickly executed, and did not require any special instruments. The overall result was a good cosmetic outcome with no complications. Conclusion Our case outlines successful use of rhomboid flap instead of a more complicated option to reconstruct a very large cutaneous defect. The flap healed with excellent contour, texture, thickness, and color match. A very large cutaneous defect was caused by excision of a Squamous Cell Cancer in an elderly female. A rhomboid fasciocutaneous flap was easily designed, quickly executed, and inset without any special instruments. The patient healed uneventfully with excellent contour, texture, thickness, and color match. The excision design, flap elevation, rotation, inset, and post-operative photographs are included to educate readers. The case has been presented based on SCARE guidelines.
Collapse
Affiliation(s)
- Ajaipal S Kang
- Department of Surgery and Chief of Plastic Surgery, UPMC Hamot, Erie, PA, 16507, USA
| | - Kevin S Kang
- Geisel Dartmouth Medical School, Hanover, NH, 03755, USA
| |
Collapse
|
61
|
Khoo MJW, Ooi ASH. Management of postreconstructive head and neck salivary fistulae: A review of current practices. J Plast Reconstr Aesthet Surg 2021; 74:2120-2132. [PMID: 33551359 DOI: 10.1016/j.bjps.2020.12.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Salivary fistulas are common complications after reconstructive head and neck surgery with significant morbidity. Yet, there are no established guidelines for their management. METHOD A comprehensive search of PubMed was performed from 01/01/2000 to 06/31/2019 to evaluate all treatment options in postreconstructive head and neck fistulas. RESULTS Nineteen articles with 132 patients were included. Thirty-nine of 132(30%) patients were treated with conventional wound care. All fistulas closed after 51.6±54.0 days with no refistulations. Thirty-eight of 132(29%) patients were treated with negative pressure wound therapy (NPWT). Thirty-eight of 40(95%) fistula closed after 14.7±12.0 days with no refistulations. The reduced healing time was statistically significant as compared to patients on conventional wound care (p < 0.001). Fifty-three of 132(40%) patients received surgical management. Forty-four of 53(83%) patients had complete fistula closure without postoperative complications. A pedicled flap was used in 60% of cases (n = 32). CONCLUSION Most salivary fistulas close with conservative management. NPWT potentially shortens fistula healing time while it achieves similar closure rates as conventional wound care. In the absence of contraindications, NPWT should be trialed on all salivary fistulas. Surgical management should be reserved for large, chronic, high-risk fistulas or those not responding to a trial of conservative treatment. Secondary reconstruction should be kept as simple as possible.
Collapse
Affiliation(s)
- Mark Junn Wei Khoo
- Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Adrian Seng Huan Ooi
- Polaris Plastic & Reconstructive Surgery, 3 Mount Elizabeth, #08-05 Mount Elizabeth Medical Centre, Singapore 288510, Singapore.
| |
Collapse
|
62
|
Srivastava A, Maniakas A, Myers J, Chambers MS, Cardoso R. Reconstruction of intraoral oncologic surgical defects with Integra ® bilayer wound matrix. Clin Case Rep 2021; 9:213-219. [PMID: 33489162 PMCID: PMC7813028 DOI: 10.1002/ccr3.3501] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022] Open
Abstract
Utilization of biologic skin substitutes for the management of soft tissue defects as an alternative to autologous skin grafts has expanded over the past 2 decades. The purpose of this case series study was to report our experience with Integra® bilayer wound matrix for reconstruction of intraoral oncologic defects. Case records of 6 patients with intraoral oncologic defects reconstructed with Integra® bilayer wound matrix were retrospectively reviewed. The surgical defect location, size, and time to removal of surgical splint varied. Clinically, normal oral epithelialization was noted for all patients. One patient demonstrated a small area of dehiscence and bone exposure after adjuvant radiation therapy which resolved with minimal intervention. Integra bilayer wound matrix is a viable and versatile option for reconstruction of intraoral oncologic surgical defects. Further exploration of wound healing with Integra® matrix, surgical techniques, and cost-effectiveness is advocated.
Collapse
Affiliation(s)
- Akanksha Srivastava
- Department of Restorative Dentistry and ProsthodonticsThe University of Texas School of DentistryHoustonTXUSA
| | - Anastasios Maniakas
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Jeffrey Myers
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Mark S. Chambers
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Richard Cardoso
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| |
Collapse
|
63
|
The New Reconstructive Ladder: Modifications to the Traditional Model: Correction. Plast Reconstr Surg 2020; 146:1212. [DOI: 10.1097/prs.0000000000007512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
64
|
Saeg F, Chiccarelli EN, Hilaire HS, Lau FH. Regenerative Limb Salvage: A Novel Technique for Soft Tissue Reconstruction of Pediatric Extremities. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2020. [DOI: 10.1055/s-0040-1718420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background In complex extremity wounds, free flap-based limb salvage (fLS) is the standard of care. However, fLS is resource- and cost-intensive, and the limited availability of pediatric microsurgical expertise exacerbates these challenges. Regenerative LS (rLS) addresses these barriers to care. The aim of this study was to quantify the efficacy, safety, and cost-effectiveness of rLS in complex pediatric extremity wounds.
Methods We conducted a retrospective cohort study of pediatric LS at a single hospital. Subjects were treated with fLS or rLS based on surgeon preference. Primary outcome measures were: definitive wound closure rates and time, rates of return to ambulation, number and length of procedures to achieve definitive closure, and rates of perioperative complications. Statistical analyses were performed utilizing the Wilcoxon Mann–Whitney U test with statistical significance set at p < 0.05.
Results Over a 2-year period, nine consecutive patients presented with complex extremity wounds requiring fLS (n = 4) or rLS (n = 5). Demographics and wound characteristics were similar between groups. Compared with fLS, the rLS group achieved definitive wound closure 85.8% more quickly (13.8 vs. 97.5 days, p < 0.02), required 64.5% less operative time (132.6 vs. 373.0 minutes, p < 0.02), had fewer perioperative complications (0 vs. 5), and required fewer intensive care unit stays (0 vs. 1.3 days).
Conclusion These data indicate that rLS is a safe and efficacious option in pediatric patients requiring soft tissue reconstruction for LS. Use of this novel technique can restore the reconstructive ladder, thereby expand patient access to pediatric LS while minimizing morbidity and reducing LS-related resource utilization.
Collapse
Affiliation(s)
- Fouad Saeg
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Elvira N. Chiccarelli
- Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Hugo St. Hilaire
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Frank H. Lau
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| |
Collapse
|
65
|
Henning JA, Liette MD, Laklouk M, Fadel M, Masadeh S. The Role of Dermal Regenerative Templates in Complex Lower Extremity Wounds. Clin Podiatr Med Surg 2020; 37:803-820. [PMID: 32919606 DOI: 10.1016/j.cpm.2020.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Dermal regenerative templates (DRTs) provide an option for management of complex lower extremity wounds. DRTs may be used to achieve definitive wound closure by serving as a scaffold for local tissue infiltration. Healing with a DRT interface leads to histologic and structural properties similar to native skin. DRTs can be applied over deep wounds with exposed critical structures that may have required a local or free flap. DRTs are a valuable option for lower extremity limb reconstruction.
Collapse
Affiliation(s)
- Jordan A Henning
- University of Cincinnati Medical Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Michael D Liette
- University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA
| | - Mohamed Laklouk
- Faculty of Medicine, Minia University, Doctors Building Minia University Second Floor, 10th Ramadan Street, Minia, Egypt
| | - Mohamed Fadel
- Orthopedic and Trauma Surgery, Minia University Hospital, Minia, Egypt
| | - Suhail Masadeh
- University of Cincinnati Medical Center, Cincinnati Veteran Affairs Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA.
| |
Collapse
|
66
|
Ciudad P, Vargas MI, Castillo-Soto A, Sanchez JR, Manrique OJ, Bustos SS, Forte AJ, Huayllani MT, Soto Z, Grández-Urbina JA. Manejo de heridas traumáticas de difícil cicatrización con colgajos microvasculares. J Wound Care 2020; 29:27-34. [PMID: 33054617 DOI: 10.12968/jowc.2020.29.latam_sup_2.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Present different flap alternatives when performing microvascular free-flap reconstruction in acute hard-to-heal wounds. METHOD A retrospective review of patients whose acute hard-to-heal wounds were treated with microvascular free-flap reconstruction. Data on demographics, wound aetiology, diagnostic, previous treatment, free-flap type, free-flap size, complications and follow up were analysed. RESULTS A total of 20 patients received microvascular free-flap reconstruction. The median age was 39.5 years. Twenty free-flap reconstructions were performed. These included: 3 cross-leg free flap, 1 cross-leg vascular cable bridge flap, 2 fibula osteocutaneous flap, 6 anterolateral thigh (ALT) flap, 3 thoracodorsal artery perforator (TDAP) flap, 3 fasciomyocutaneous flap, and 2 femoral artery fasciocutaneous flap. A patient required microvascular anastomosis due to hematoma; the rest did not present complications during their postoperative. Previous treatment included negative pressure wound therapy (12 patients) and surgical debridement with silver hydrogel dressings (8 patients). CONCLUSION Hard-to-heal wounds can be unresponsive to traditional wound healing practices or local flaps. They often require free-flap reconstruction, using tissues similar to those compromised. Microvascular techniques can be an effective alternative.
Collapse
Affiliation(s)
- Pedro Ciudad
- Departmento de Cirugía Plástica, Reconstructiva y Quemaduras, Hospital Nacional Arzobispo Loayza, Lima, Perú.,División de Cirujía Plástica, China Medical University Hospital, Taichung, Taiwan
| | - Maria I Vargas
- Departmento de Cirugía Plástica, Reconstructiva y Quemaduras, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Ana Castillo-Soto
- Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | | | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, Estados Unidos
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, Estados Unidos
| | - Antonio J Forte
- División de Cirugía Plástica y Reconstructiva, Mayo Clinic, Jacksonville, Florida, Estados Unidos
| | - Maria T Huayllani
- División de Cirugía Plástica y Reconstructiva, Mayo Clinic, Jacksonville, Florida, Estados Unidos
| | | | | |
Collapse
|
67
|
Fahim RX, AbdelFattah SR. Peroneal Artery Adipofascial Flaps for Coverage of Distal Leg and Rearfoot. Clin Podiatr Med Surg 2020; 37:681-697. [PMID: 32919598 DOI: 10.1016/j.cpm.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic wounds of the lower extremity can pose several obstacles for the treating physician as well as the patient. Peroneal artery adipofascial flaps have been shown to be a reliable and durable option for reconstruction of these defects for many reasons, including ease of dissection, minimized donor site mobility, reliability of take to underlying surfaces, and cosmetically more pleasing outcome. This article discusses the current literature regarding the use of peroneal artery adipofascial flaps and our surgical technique for harvest, transfer, and postoperative course for this versatile flap.
Collapse
Affiliation(s)
- Ramy X Fahim
- Foot and Ankle Surgery, Mercy Health, Youngstown, OH, USA; Northern Ohio Medical Specialties (NOMS) Healthcare, Sandusky, OH, USA.
| | - Sharif R AbdelFattah
- East Liverpool City Hospital, East Liverpool, OH, USA; Sullivan County Community Hospital, 2200 North Section Street, Sullivan, IN 47882, USA
| |
Collapse
|
68
|
Abstract
Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different bacteria and is often due to assumed minor trauma. Clinically, only relatively insignificant skin changes are initially present, such as blistering or erythema. They are often accompanied by excessive pain. In the further course, the massive systemic reaction becomes predominant. The diagnosis of necrotizing fasciitis is primarily clinical, which can be supported by laboratory parameters (LRINEC score) and computed tomography imaging. Decisive for the prognosis is the immediate initiation of surgical treatment by radical debridement. Additionally, the calculated administration of a combination of different antibiotics should be initiated. As part of the further complex intensive care treatment, a regular reevaluation of the wounds is carried out. Multiple débridements are always necessary until plastic surgery for defect coverage can be carried out.
Collapse
Affiliation(s)
- V M Hösl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - A Kehrer
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - L Prantl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| |
Collapse
|
69
|
Elbatawy A, Elgammal M, Zayid T, Hamdy A, Ouf MO, Ismail H, Sholkamy K, Malik M, Zidan SM, Ayad W. Pediatric Microsurgery in the Reconstruction of Complex Posttraumatic Foot and Ankle Defects: A Long-Term Follow-Up with a Comprehensive Review of the Literature. J Reconstr Microsurg 2020; 37:193-200. [PMID: 32842159 DOI: 10.1055/s-0040-1714429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lower limb reconstruction is a well-recognized challenge to the trauma or plastic surgeon. Although techniques and outcomes in the adult population are well documented, they are less so in the pediatric population. Here, we present our experience in the management of posttraumatic foot and ankle defects with free tissue transfer in children. METHODS We performed a retrospective analysis of 40 pediatric patients between the ages of 3 and 16 from 2008 to 2016 who underwent foot and ankle soft tissue reconstruction. Any patient who underwent reconstruction for any reason other than trauma was excluded. Data were collected on operative time, free tissue transfer type, use of vein grafts, length of hospital stay, and postoperative morbidity. Also, a comprehensive systematic literature review was completed according to the PRISMA protocol for all previous reports of foot and ankle reconstruction in the young age group with free tissue transfer. RESULTS Of our 40 patients, 23 were males and 12 females, free tissue transfer was used to reconstruct primarily the dorsum (71%), heel (11%), medial (9%), and lateral (3%) aspect of the foot. The anterior tibial artery was the predominant recipient vessel for anastomosis (77%). Mean inpatient stay was 9 days and our complication rate was 20%, primarily of superficial infection treated with antibiotic therapy. The review of the literature articles is completely analyzed in detail. CONCLUSION The need for durable coverage of exposed joints, tendons, fractures, or hardware makes the free flap particularly well suited to trauma reconstruction of the foot and ankle. The lack of underlying vascular disease in this patient group allows for low complication rates. Our study evidences the safety and positive long-term outcomes of free tissue transfer for the reconstruction of huge sized-soft tissue defects of the foot and ankle in children.
Collapse
Affiliation(s)
- Amr Elbatawy
- Plastic Surgery Department, Al Azhar University, Cairo, Egypt
| | | | - Tarek Zayid
- Plastic Surgery Department, Al Azhar University, Cairo, Egypt
| | | | | | - Hany Ismail
- Plastic Surgery Department, Al Azhar University, Cairo, Egypt
| | | | - Mohammad Malik
- Welsh Center for Plastic and Burn Surgery, Swansea Bay University NHS Trust, Swansea, United Kingdom
| | - Serag M Zidan
- Plastic Surgery Department, Al Azhar University, Cairo, Egypt
| | - Wael Ayad
- Plastic Surgery Department, Al Azhar University, Cairo, Egypt
| |
Collapse
|
70
|
Faenza M, Ferraro GA, Fonzone Caccese FP, Verolino P, Papale S, Di Costanzo P, Pieretti G, Izzo S, Fonzone Caccese A. Combined approach with negative pressure wound therapy and dermal substitute for extravasation injury: Why can't they be friends? JPRAS Open 2020; 25:62-67. [PMID: 32743039 PMCID: PMC7387737 DOI: 10.1016/j.jpra.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- M Faenza
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - G A Ferraro
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - F P Fonzone Caccese
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - P Verolino
- Azienda Ospedaliera Universitaria Policlinico, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - S Papale
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - P Di Costanzo
- Università degli Studi della Campania Luigi Vanvitelli, Ph.D. Training Program in Medical, Clinical and Experimental Sciences.- Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - G Pieretti
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - S Izzo
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - A Fonzone Caccese
- Ospedale dei Pellegrini, Hand and Peripheral Nerves Surgery Unit, Via Portamedina alla Pignasecca, 41, 80134 Naples, Italy
| |
Collapse
|
71
|
Abstract
Coverage of soft tissue defects in the upper extremity caused by infection and debridement of infected tissue is a challenging problem. Treatment starts with prompt identification and eradication of infection, including antibiotics and extensive debridement. Optimizing the patient's medical and nutritional status can facilitate eradication of infection and wound healing. Coverage of soft tissue defects caused by infection and debridement demands consideration of many factors. Options include healing by primary or secondary intention, skin grafts, local flaps, and distant flaps. Negative pressure wound therapy and acellular dermal matrices can also aid in coverage.
Collapse
Affiliation(s)
- Vanessa Prokuski
- Philadelphia Hand to Shoulder Center/Jefferson, Philadelphia, PA, USA; Orthopedic Care Physicians Network, 675 Paramount Drive, Suite 205, Raynham, MA 02767, USA
| | - Adam Strohl
- Plastic and Reconstructive Surgery, Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G-114, Philadelphia, PA 19107, USA.
| |
Collapse
|
72
|
Wang A, Lv G, Cheng X, Ma X, Wang W, Gui J, Hu J, Lu M, Chu G, Chen J, Zhang H, Jiang Y, Chen Y, Yang W, Jiang L, Geng H, Zheng R, Li Y, Feng W, Johnson B, Wang W, Zhu D, Hu Y. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition). BURNS & TRAUMA 2020; 8:tkaa017. [PMID: 32685563 PMCID: PMC7336185 DOI: 10.1093/burnst/tkaa017] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/21/2020] [Indexed: 02/07/2023]
Abstract
In recent years, as living standards have continued to improve, the number of diabetes patients in China, along with the incidence of complications associated with the disease, has been increasing. Among these complications, diabetic foot disease is one of the main causes of disability and death in diabetic patients. Due to the differences in economy, culture, religion and level of medical care available across different regions, preventive and treatment methods and curative results for diabetic foot vary greatly. In multidisciplinary models built around diabetic foot, the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology. In 2019, under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society, the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition) was established with the participation of scholars from the specialist areas of endocrinology, burn injury, vascular surgery, orthopedics, foot and ankle surgery and cardiology. Drawing lessons from diabetic foot guidelines from other countries, this guide analyses clinical practices for diabetic foot, queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China. This paper begins with assessments and diagnoses of diabetic foot, then describes treatments for diabetic foot in detail, and ends with protections for high-risk feet and the prevention of ulcers. This manuscript covers the disciplines of internal medicine, surgical, nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot. Registry number: IPGRP-2020cn124
Collapse
Affiliation(s)
- Aiping Wang
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Guozhong Lv
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Xingbo Cheng
- Department of endocrinology, the First Affiliated Hospital of Suzhou University, Suzhou, 215006, China
| | - Xianghua Ma
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China.,Department of endocrinology, Xuzhou Central Hospital, Xuzhou, 221009,China
| | - Wei Wang
- Vascular Surgery, Gulou Hospital, Nanjing, 210008, China
| | - Jianchao Gui
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Ji Hu
- Department of endocrinology, The Second Affiliated Hospital of Suzhou University, Suzhou, 215004, China
| | - Meng Lu
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Guoping Chu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Jin'an Chen
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Hao Zhang
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yiqiu Jiang
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Yuedong Chen
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Wengbo Yang
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Lin Jiang
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Houfa Geng
- Department of endocrinology, Xuzhou Central Hospital, Xuzhou, 221009,China
| | - Rendong Zheng
- Department of endocrinology, Jiangsu Province Hospital on Traditional of Chinese and Western Medicine, 210028, China
| | - Yihui Li
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Wei Feng
- Operating department, Jiangsu Medical Association, Nanjing, 210008, China
| | - Boey Johnson
- Diabetic Foot Centre, The National University Hospital, 119077, Singapore
| | - Wenjuan Wang
- Department of Chronic Non-Communicable Diseases, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Dalong Zhu
- Vascular Surgery, Gulou Hospital, Nanjing, 210008, China
| | - Yin Hu
- Operating department, Jiangsu Medical Association, Nanjing, 210008, China
| |
Collapse
|
73
|
Abstract
Resection of large cutaneous malignancies may result in substantial skin defects. Often, skin grafting is a first-line option for reconstruction of such defects but may be limited by poor cosmetic outcomes and incomplete graft acceptance. Accordingly, skin flaps, tissue rearrangement techniques, and more complex procedures may be needed. This case report presents the successful use of a rhomboid flap for reconstruction of a 20 × 19 cm2-sized trunk skin defect left after a squamous cell cancer resection. The flap was quickly and easily fashioned, did not require any special instruments, and resulted in a good cosmetic outcome. There were no major wound complications despite postoperative radiation therapy. At 1-year follow-up, the flap healed completely with excellent contour, texture, thickness, color match, and complete patient satisfaction. In the past, rhomboid flaps have been used for small defects. This case is a unique example of a versatile and successful rhomboid flap reconstruction of an extremely large defect, instead of a more complicated reconstructive option.
Collapse
|
74
|
Solanki NS, York B, Gao Y, Baker P, Wong She RB. A consecutive case series of defects reconstructed using NovoSorb Ⓡ Biodegradable Temporising Matrix: Initial experience and early results. J Plast Reconstr Aesthet Surg 2020; 73:1845-1853. [PMID: 32563668 DOI: 10.1016/j.bjps.2020.05.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 02/01/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND NovoSorbⓇ Biodegradable Temporising Matrix (BTM) is a synthetic dermal template recently approved for treatment of full thickness defects of the skin. It requires a two-stage reconstruction where it is initially placed into a defect to generate a neodermis, which is later covered by a split skin graft. It has previously been described for the treatment of acute full thickness burn injury, necrotising fasciitis and free flap donor site reconstruction. METHODS A consecutive case series review of patients treated with BTM at Middlemore Hospital was performed. Patient demographics, defect aetiology, indications for dermal matrix use, surgical details, and complications were recorded using information gathered from the medical records. RESULTS This case series included 25 patients with a range of defects resulting from acute full thickness burn injury, burn scar revision, necrotising soft-tissue infection, tumour excision and traumatic loss. In these patients, 72% of wounds were identified as complex defects with exposed bone or tendon. Complications encountered included infection, non-adherence and incomplete vascularisation. CONCLUSION BTM provided a good reconstructive option for a wide range of defects, many of which were not amenable to immediate skin grafting. Once vascularised and ready for the second stage, it developed a red-pink colour and demonstrated capillary refill. Similar to other dermal matrices, infection was a commonly encountered problem. However, BTM proved more tolerant to this and was able to be salvaged in most cases, allowing the second stage to proceed as normal.
Collapse
Affiliation(s)
- Nicholas S Solanki
- Department of Plastic and Reconstructive Surgery and The National Burn Centre, Middlemore Hospital, 100 Hospital Road Otahuhu, Auckland 2025, New Zealand.
| | - Blair York
- Department of Plastic and Reconstructive Surgery and The National Burn Centre, Middlemore Hospital, 100 Hospital Road Otahuhu, Auckland 2025, New Zealand
| | - Yang Gao
- Department of Plastic and Reconstructive Surgery and The National Burn Centre, Middlemore Hospital, 100 Hospital Road Otahuhu, Auckland 2025, New Zealand
| | - Paul Baker
- Department of Plastic and Reconstructive Surgery and The National Burn Centre, Middlemore Hospital, 100 Hospital Road Otahuhu, Auckland 2025, New Zealand
| | - Richard B Wong She
- Department of Plastic and Reconstructive Surgery and The National Burn Centre, Middlemore Hospital, 100 Hospital Road Otahuhu, Auckland 2025, New Zealand
| |
Collapse
|
75
|
Leypold T, Schäfer B, Boos AM, Beier JP. Plastic Surgery Reconstruction of Chronic/Non-Healing Wounds. Surg Technol Int 2020; 38:65-71. [PMID: 33370841 DOI: 10.52198/21.sti.38.wh1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In western countries, approximately 1 % of individuals are affected by chronic wounds during their lifetime. Due to changing demographics, this incidence will likely increase in the future. Additionally, the high prevalence is accompanied by substantial treatment expenditures. Therefore, it is of global interest to find effective treatment algorithms. In this article, we present up-to-date solutions for treating chronic / difficult to heal and complex wounds by means of plastic and reconstructive surgery. We outline the principles of chronic wounds and how to perform an appropriate diagnosis. Close cooperation and interdisciplinary exchange are important for optimizing treatment. We report the principles of wound debridement and the role of negative pressure wound therapy. Moreover, we discuss the state of the art of defect reconstruction by means of skin grafting, with or without acellular dermal matrices, local tissue transfers and free tissue transfers. In very complex cases, the local macrovascular blood flow is greatly reduced and there are few, if any, recipient vessels for free flap reconstruction. We discuss the role of arteriovenous loops to overcome this problem.
Collapse
Affiliation(s)
- Tim Leypold
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Benedikt Schäfer
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Anja M Boos
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Justus P Beier
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
76
|
Ferreira N, Tanwar YS. Systematic Approach to the Management of Post-traumatic Segmental Diaphyseal Long Bone Defects: Treatment Algorithm and Comprehensive Classification System. Strategies Trauma Limb Reconstr 2020; 15:106-116. [PMID: 36466309 PMCID: PMC9679593 DOI: 10.5005/jp-journals-10080-1466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Bone defects remain challenging to manage. The wide array of treatment options is a testament no single strategy works in every patient. This is more complex if consideration is given to the status of the host and the soft tissues. The choice of treatment should be based on specific patient requirements after taking all variables into account. MATERIALS AND METHODS We present a comprehensive classification system and treatment algorithm to assist with decision-making in management. All potential treatment modalities including amputation are discussed with their relevant pearls and pitfalls. CONCLUSION The proposed classification system may potentially assists with communication, enable patient stratification for assigning the most appropriate treatment modality and guide reporting of treatment outcomes. HOW TO CITE THIS ARTICLE Ferreira N, Tanwar YS. Systematic Approach to the Management of Post-traumatic Segmental Diaphyseal Long Bone Defects: Treatment Algorithm and Comprehensive Classification System. Strategies Trauma Limb Reconstr 2020;15(2):106-116.
Collapse
Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yashwant S Tanwar
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
77
|
Curfman KR, Dumire R, Shayesteh K. Complex Wound Closure Following Mysterious and Vicious Animal Attack. Cureus 2020; 12:e7758. [PMID: 32455075 PMCID: PMC7243086 DOI: 10.7759/cureus.7758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Animal attacks are a worrisome and dangerous entity that occur at high volumes and are evaluated frequently by ER physicians, primary care physicians, trauma teams, acute care surgeons, and plastic surgeons. The severity of animal attacks can range from a small insect sting to mauling by large animal, and even death. With animal attacks of high intensity, there is often significant scratching, tearing, shearing, with destruction of the skin, subcutaneous tissues, muscles, and bone. Serious attacks frequently lead to infection, sepsis, pain, loss of sensation or mobility, operative interventions, and amputations of affected limbs. We report herein the traumatic mauling of a woman by a reported unknown animal. Though the entity of animal attacks has been reported in the past, this case dictates presentation given the suspicious circumstances surrounding the attack, the involvement of her care requiring a multidisciplinary surgical approach via trauma surgery and plastic surgery, multiple extensive interventions, and the excellent take of the split thickness skin graft (STSG) after the use of a dermal regeneration template (DRT).
Collapse
Affiliation(s)
| | - Russell Dumire
- Surgery, Conemaugh Memorial Medical Center, Johnstown , USA
| | | |
Collapse
|
78
|
Abstract
Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different bacteria and is often due to assumed minor trauma. Clinically, only relatively insignificant skin changes are initially present, such as blistering or erythema. They are often accompanied by excessive pain. In the further course, the massive systemic reaction becomes predominant. The diagnosis of necrotizing fasciitis is primarily clinical, which can be supported by laboratory parameters (LRINEC score) and computed tomography imaging. Decisive for the prognosis is the immediate initiation of surgical treatment by radical debridement. Additionally, the calculated administration of a combination of different antibiotics should be initiated. As part of the further complex intensive care treatment, a regular reevaluation of the wounds is carried out. Multiple débridements are always necessary until plastic surgery for defect coverage can be carried out.
Collapse
Affiliation(s)
- V M Hösl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - A Kehrer
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - L Prantl
- Hochschulzentrum für Plastische‑, Ästhetische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| |
Collapse
|
79
|
Attia A, Elmenoufy T, Atta T, Harfoush A, Tarek S. Combination of negative pressure wound therapy (NPWT) and integra dermal regeneration template (IDRT) in the lower extremity wound; Our experience with 4 cases. JPRAS Open 2020; 24:32-39. [PMID: 32322648 PMCID: PMC7170806 DOI: 10.1016/j.jpra.2020.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
The treatment of de-gloving injuries in the lower limb with exposed tendons, bone, and/or nerve is a challenging reconstruction problem. The standard management of de-gloving injuries involve either direct closure if the skin is viable or immediate grafting with the avulsed skin or full- or split-thickness graft when the skin flap is not viable. Alternative methods are flap coverage especially when the underlying structures are not suitable for grafting such as extensive loss of paratenon and/or exposed bone or open joints The use of negative pressure wound therapy (NPWT) followed by use of Integra dermal regeneration template (IDRT) and subsequent split-thickness skin grafting (STSG) as an alternative to the previously mentioned surgical options has been described. In this series we describe the successful management of four patients with exposed tendons, bones, and joints of the distal lower extremity following road traffic accidents (RTA) using NPWT, Integra and thin split-thickness skin grafts.
Collapse
Affiliation(s)
- Attia Attia
- Plastic Surgery Department, El Helmeya Military Hospital for Bones and overlay in Egypt, Cairo, Egypt
| | - Tarek Elmenoufy
- Plastic Surgery Department, El Helmeya Military Hospital for Bones and overlay in Egypt, Cairo, Egypt
| | - Tarek Atta
- Plastic Surgery Department, El Helmeya Military Hospital for Bones and overlay in Egypt, Cairo, Egypt
| | - Ahmed Harfoush
- Plastic Surgery Department, El Helmeya Military Hospital for Bones and overlay in Egypt, Cairo, Egypt
| | - Sayed Tarek
- Plastic Surgery Department, El Helmeya Military Hospital for Bones and overlay in Egypt, Cairo, Egypt
| |
Collapse
|
80
|
Miller MQ, Hadlock TA. Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy. Facial Plast Surg Aesthet Med 2020; 22:65-70. [DOI: 10.1089/fpsam.2020.0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew Q. Miller
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Tessa A. Hadlock
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
81
|
Pehde CE, Bennett J, Kingston M. Orthoplastic Approach for Surgical Treatment of Diabetic Foot Ulcers. Clin Podiatr Med Surg 2020; 37:215-230. [PMID: 32146979 DOI: 10.1016/j.cpm.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Diabetic foot ulcers remain a challenge to practitioners and costly to health care systems. They range from simple to complex and many treatment options are available. By following standard wound care protocols to ensure adequate blood supply, infection control, debridement, wound management, and offloading many diabetic foot ulcers heal in a timely fashion. For those that do not, an underlying foot and ankle musculoskeletal abnormality must be suspected and treated concomitantly with soft tissue treatment. This article presents a systematic orthoplastics approach for surgical treatment of diabetic foot ulcers using the soft tissue reconstructive ladder and the musculoskeletal reconstructive matrix.
Collapse
Affiliation(s)
- Collin E Pehde
- College of Podiatric Medicine and Surgery, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA.
| | - John Bennett
- College of Podiatric Medicine and Surgery, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Megan Kingston
- College of Podiatric Medicine and Surgery, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA
| |
Collapse
|
82
|
Prem B, Liu DT, Parschalk B, Erovic BM, Mueller CA. Surgical management of severe facial trauma after dog bite: A case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2020. [DOI: 10.1080/23772484.2019.1708746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Bernhard Prem
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - David Tianxiang Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Parschalk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Christian A. Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
83
|
Abstract
Severe infections frequently cause large soft tissue defects which require early defect coverage by plastic surgeons. A number of reconstructive treatment options are available, ranging from local flaps to microvascular free flap reconstructions. In this respect it is important that the selection of the optimal reconstructive technique is made based on individual patient characteristics and in a timely manner. Weeks of inpatient treatment with vacuum dressings often delay defect coverage and should be avoided as they burden both the patient and the healthcare system. Therefore, it is in the best interest of patients to receive early treatment by plastic surgeons. This manuscript presents the essential reconstructive treatment approaches based on highly informative case reports of patients from the plastic surgical practice at a university hospital.
Collapse
|
84
|
|
85
|
Lin FY, Huang PY, Cheng HT. Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: Outcomes and complications. Int Wound J 2019; 17:251-258. [PMID: 31696637 DOI: 10.1111/iwj.13264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022] Open
Abstract
Fistula formation in head and neck wounds is considered one of the most challenging complications that a head and neck reconstructive surgeon may encounter. The current mainstay of treatment is aggressive surgical debridement followed by vascularised soft tissue coverage. Negative pressure wound therapy (NPWT) has been successfully used for the closure of complicated wounds for decades. This study analysed the outcomes and complications of NPWT in the management of head and neck wounds with fistulas. A systematic search of studies published between January 1966 and September 2019 was conducted using the PubMed, MEDLINE, EMBASE, and SCOPUS databases and using the following key words: "negative pressure wound therapy," "head and neck," and "fistula." We included human studies with abstract and full text available. Analysed endpoints were rate of fistula closure, follow-up duration, and complications if present. Nine retrospective case series (Level IV evidence) that collectively included 122 head and neck wounds with orocutaneous fistulas, pharyngocutaneous fistulas, and salivary contamination were examined. The number of patients included in each study ranged from 5 to 64. The mode of NPWT varied among the included studies, with most adopting a continuous pressure of -125 mm Hg. Mean durations of NPWT ranged from 3.7 to 23 days, and the reported fistula closure rate ranged from 78% to 100%. To achieve complete wound healing, six studies used additional procedures after stopping NPWT, including conventional wound dressings and vascularised tissue transfer. Information regarding follow up was provided in only three of the nine studies, where patients were followed for 5, 10, and 18 months. No serious adverse events were reported. NPWT for head and neck wounds with fistulas may be considered a safe treatment method that yields beneficial outcomes with a low risk of complications. The current data originated mainly from studies with low levels of evidence characterised by heterogeneity. Therefore, definitive recommendations based on these data cannot be offered. Additional high-quality trials are warranted to corroborate the findings of this systematic review.
Collapse
Affiliation(s)
- Fu-Yu Lin
- Department of Medical Education, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan
| | - Pin-Yi Huang
- Department of Medical Education, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsu-Tang Cheng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan
| |
Collapse
|
86
|
Chowdhry SA. Use of oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressings to help manage skin graft donor site wounds. JPRAS Open 2019; 22:33-40. [PMID: 32158895 PMCID: PMC7061655 DOI: 10.1016/j.jpra.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022] Open
Abstract
Harvesting donor site explants for split-thickness skin grafting creates an iatrogenic wound that presents additional challenges to clinicians due to morbidities such as persistent bleeding, pain, infection, and delayed epithelialization. Although there have been several randomized controlled trials to compare wound dressing effectiveness, there is still a lack of standardization for donor site wound dressings. A retrospective comparison of 59 patients that underwent split-thickness skin graft reconstructions between January 2017 and September 2018 was performed. Donor sites of Group 1 patients (n = 29) were treated with a transparent film dressing and transitioned to petrolatum gauze dressings if exudate management became problematic; Group 2 patients (n = 30) were treated with oxidized regenerated cellulose/collagen/silver-oxidized regenerated cellulose (ORC/C/Ag-ORC) dressings. Evaluations of time to epithelialization, number of dressings required, signs of inflammation, and objective pain were compared between groups. Group 1 was comprised of 18 female and 11 male patients, whereas Group 2 was comprised of 14 females and 16 males. There were no significant differences between groups when comparing age, sex, comorbidities, or donor site size (area or depth). Patients in Group 2 had a significantly shorter time to complete re-epithelialization (P < .0001), fewer dressing changes (P < .0001), and less objective pain as measured by the need for opioid pain mediation (P < .0001) when compared to Group 1. The percentage of patients with signs of inflammation was also lower for Group 2, although this difference was not statistically significant (P = .0797). Although prospective, controlled studies are still needed, data from this study suggest that ORC/C/Ag-ORC dressings could become a more effective alternative for the management of donor site wounds, especially in patients with known risk factors for wound healing.
Collapse
Affiliation(s)
- Saeed A Chowdhry
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, 4400W 95th St, Suite 102, Oak Lawn, Chicago, IL 60453, United States
| |
Collapse
|
87
|
Hifny MA, Tohamy AMA, Rabie O, Ali AAA. Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities. ANN CHIR PLAST ESTH 2019; 65:54-60. [PMID: 31477322 DOI: 10.1016/j.anplas.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The middle and distal leg coverage is demanding procedure for reconstructive surgeon until evolution of local perforator flaps which becomes as valuable options in lower limb reconstruction. The goal of our study was to assess the results, reliability, safety, and possible complications of the local propeller perforator flaps in lower extremity reconstruction. PATIENTS AND METHODS We demonstrate a case series of 11 patients in whom we cover small-to-medium soft-tissue defects of the middle and distal leg by application of local propeller perforator flaps. RESULTS The site of soft tissue defects were in the distal third in 9 cases (81.8%) and 2 cases (18.1%) in the middle third. Flap dimensions ranged from 48 to 192cm2, with an average size of 88.9 cm2. The flap rotation was 180 degrees in (63.6%) of cases. The flaps were based on a single perforator of the posterior tibial artery in 8 (72.7%) cases and peroneal artery perforator in 3 (27.2%) cases. Complications were present in 18% of the perforator flaps which were based on peroneal artery perforator, one partial necrosis and one flap with a superfacial epidermolysis. The donor area is covered by split thickness skin graft in 63.6% of our cases and primary closure of in 36.3% of cases. CONCLUSION The perforator propeller flaps are safe, relatively simple procedure and consider as an ideal option in reconstructing small-medium defects of the middle and distal third of the leg which provide similar skin texture with low donor site morbidity.
Collapse
Affiliation(s)
- M A Hifny
- Plastic surgery Department, faculty of medicine, Qena university hospital, South Valley University, Qena, Egypt.
| | - A M A Tohamy
- Plastic surgery Department, faculty of medicine, Assiut university hospital, Assiut, Egypt.
| | - O Rabie
- Plastic surgery Department, faculty of medicine, Qena university hospital, South Valley University, Qena, Egypt.
| | - A A A Ali
- Plastic surgery Department, faculty of medicine, Qena university hospital, South Valley University, Qena, Egypt.
| |
Collapse
|
88
|
Azoury SC, Stranix JT, Kovach SJ, Levin LS. Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important? J Reconstr Microsurg 2019; 37:42-50. [PMID: 31454835 DOI: 10.1055/s-0039-1695753] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Regardless of the antecedent etiology, lower extremity salvage and reconstruction attempts to avoid amputation, restore limb function, and improve quality of life outcomes. This goal requires a treatment team well versed in neurovascular pathology, skeletal and soft tissue reconstruction, and physical rehabilitation. METHODS A review was performed of historical milestones that lead to the development of orthoplastic extremity reconstruction, principles of current management and the evidence that supports an orthoplastic approach. Based on available evidence and expert opinion, the authors further sought to provide insight into the future of the field centered around the importance of a multidisciplinary management protocol. RESULTS Historically, orthopaedic and plastic surgeons worked separately when faced with challenging reconstructive cases involving lower extremity skeletal and soft tissue reconstruction. With time, many embraced that their seemingly separate skill-sets and knowledge could be unified in a collaborative orthoplastic approach in order to offer patients the best possible chance for success. First coined by the senior author (LSL) in the early 1990s, the collaborative orthoplastic approach between orthopaedic and plastic surgeons in limb salvage for the past several decades has resulted in a unique field of reconstructive surgery. Benefits of the orthoplastic approach include decreased time to definitive skeletal stabilization/soft tissue coverage, length of hospital stay, post-operative complications, need for revision procedures and improved functional outcomes. CONCLUSION The orthoplastic approach to lower extremity reconstruction is a collaborative model of orthopaedic and plastic surgeons working together to expedite and optimize care of patients in need of lower extremity reconstruction. The implementation of protocols, systems, and centers that foster this approach leads to improve outcomes for these patients. We encourage centers to embrace the orthoplastic approach when considering limb salvage, as the decision to amputate is irreversible.
Collapse
Affiliation(s)
- Saïd C Azoury
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania
| | - John T Stranix
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Stephen J Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania.,Department of Orthopaedic Surgery, Penn Medicine University City, Philadelphia, Pennsylvania
| | - L Scott Levin
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania.,Department of Orthopaedic Surgery, Penn Medicine University City, Philadelphia, Pennsylvania
| |
Collapse
|
89
|
Nicoletti G, Tresoldi MM, Malovini A, Visaggio M, Faga A, Scevola S. Versatile use of dermal substitutes: A retrospective survey of 127 consecutive cases. Indian J Plast Surg 2019; 51:46-53. [PMID: 29928079 PMCID: PMC5992948 DOI: 10.4103/ijps.ijps_217_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Dermal substitutes are currently largely used for the treatment of huge skin loss in patients in critical general health conditions, for the treatment of severe burns and to promote the healing process in chronic wounds. Aims: The authors performed a retrospective assessment of their experience with bioengineered skin to possibly identify the most appropriate clinical indication and management for each substitute. Materials and Methods: The study involved 109 patients with 127 skin defects repaired with dermal substitutes over a 9 years period, from 2007 to 2016. Hyalomatrix® was used in 63 defects, whereas Integra® and Nevelia® were used in 56 and 8 defects, respectively. Results: The statistical analysis failed to reveal a correlation between the choice of a specific dermal substitute and any possible clinical variable except in the soft-tissue defects of the scalp where Hyalomatrix® was electively used. Conclusions: In the authors' experience, the scalp defects followed a radical excision of skin tumours that included the periosteum. Here, the preliminary cover with a hyaluronan three-dimensional scaffold constantly allowed for the regeneration of a derma-like layer with a rich vascular network fit for supporting a split-thickness skin graft. Nevertheless, the authors still prefer Integra® when the goal is a better cosmetic outcome and Hyalomatrix® when a faster wound healing is required, especially in the management of deep wounds where the priority is a fast obliteration with a newly formed tissue with a rich blood supply. However, these clinical indications still are anecdotally based.
Collapse
Affiliation(s)
- Giovanni Nicoletti
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, Plastic and Reconstructive Surgery Unit, University of Pavia, Italy.,Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Pavia, Italy
| | - Marco Mario Tresoldi
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, Plastic and Reconstructive Surgery Unit, University of Pavia, Italy.,Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Pavia, Italy
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Maugeri Clinical Scientific Institutes, Pavia, Italy
| | - Marco Visaggio
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, Plastic and Reconstructive Surgery Unit, University of Pavia, Italy
| | - Angela Faga
- Plastic and Reconstructive Surgery Unit, Maugeri Clinical Scientific Institutes, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Silvia Scevola
- Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Pavia, Italy
| |
Collapse
|
90
|
Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjö M, Piaggesi A, Probst A, Vowden P. EWMA Document: Negative Pressure Wound Therapy. J Wound Care 2019; 26:S1-S154. [PMID: 28345371 DOI: 10.12968/jowc.2017.26.sup3.s1] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4-6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12-14 The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents15-19 with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
Collapse
Affiliation(s)
- Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, 205 02 Malmö, Sweden and Division for Clinical Sciences, University of Lund, 221 00 Lund, Sweden
| | - Christian Willy
- Department of Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Bundeswehr Hospital Berlin, Research and Treatment Center for Complex Combat Injuries, Federal Armed Forces of Germany, 10115 Berlin, Germany
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, and Wound Centre, Södersjukhuset AB, SE-118 83 Stockholm, Sweden
| | - Marco Fraccalvieri
- Plastic Surgery Unit, ASO Città della Salute e della Scienza of Turin, University of Turin, 10100 Turin, Italy
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, Pisa University Hospital, 56125 Pisa, Italy
| | - Astrid Probst
- Kreiskliniken Reutlingen GmbH, 72764 Reutlingen, Germany
| | - Peter Vowden
- Faculty of Life Sciences, University of Bradford, and Honorary Consultant Vascular Surgeon, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
| |
Collapse
|
91
|
Hasenstein TA, Greene T, Van JC, Meyr AJ. Soft Tissue Reconstruction with Diabetic Foot Tissue Loss. Clin Podiatr Med Surg 2019; 36:425-440. [PMID: 31079608 DOI: 10.1016/j.cpm.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although substantial advances have been made in treatment of diabetic foot disease with respect to patient education, preventative measures, early intervention, and prophylactic procedures, most surgical interventions for this condition are reactionary. Patients still primarily present to emergency departments with acute infections and tissue necrosis. The surgical intervention for this results in soft tissue deficit, often with partial foot amputation, through excisional debridement of pathologic tissue. Minimizing this initial soft tissue loss, with subsequent reconstruction of the defect, forms the focus of this article with a detailed anatomic assessment of structures at risk in the forefoot, midfoot and rearfoot.
Collapse
Affiliation(s)
- Todd A Hasenstein
- Temple University Hospital Podiatric Surgical Residency Program, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Timothy Greene
- Temple University Hospital Podiatric Surgical Residency Program, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Jennifer C Van
- Department of Surgery, Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Andrew J Meyr
- Department of Surgery, Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA.
| |
Collapse
|
92
|
Suh HP, Hong JP. The role of reconstructive microsurgery in treating lower-extremity chronic wounds. Int Wound J 2019; 16:951-959. [PMID: 31148396 DOI: 10.1111/iwj.13127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 01/22/2023] Open
Abstract
Frequently considered chronic wounds for reconstruction are wounds lacking healing progress despite good wound care. And those needing microsurgical reconstruction are chronic wounds that are unable to close by local flap or skin grafts, wounds with exposed vital structure such as tendon and bones, and wounds that have prolonged infections such as osteomyelitis and skin necrosis. The reconstruction for soft tissue defects not only aims to provide coverage but to restore function and acceptable form as well. Wound preparation prior to microsurgical reconstruction consists of improving or restoring vascular supply, stabilising skeletal structures, and obtaining clinically clean wounds. Microsurgery is a surgical discipline that combines magnification with a advanced microscope, specialised precision tools, and various operating techniques. Thus microsurgery allows flap to be transferred far from the donor site restoring form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. Microsurgery has expanded reconstructive surgery's elements and strategies and is still evolving. Along with the multidisciplinary approach and good principle of wound care, the repair and restoration strategies using microsurgery have widened the possibilities for limb salvage from complex chronic wounds.
Collapse
Affiliation(s)
- Hyunsuk Peter Suh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
93
|
Adibfar A, Retrouvey H, Padeanu S, Jeschke MG, Shahrokhi S. Current State of Selected Wound Regeneration Templates and Temporary Covers. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-00165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
94
|
Complex Lower Extremity Wound in the Complex Host: Results From a Multicenter Registry. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2129. [PMID: 31321165 PMCID: PMC6554184 DOI: 10.1097/gox.0000000000002129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/12/2018] [Indexed: 01/12/2023]
Abstract
Background: The complex diabetic lower extremity wound has not been well studied. There are a variety of new technologies now being applied with a paucity of evidence in evaluating their outcomes. The aim of this study is to describe clinical outcomes in the complex lower extremity wound in the comorbid host. We hypothesized that treatment choice would have minimal impact on healing outcomes in this compromised population. Methods: A multicenter retrospective registry of patients with diabetes and lower extremity wounds was created to compare treatment modalities of collagen–glycosaminoglycan scaffold, negative-pressure wound therapy, local tissue flap, and free tissue transfer. Statistical analyses included descriptive, proportional comparisons and Cox regression. Results: There were no statistical differences in age, hemoglobin A1c, or body mass index between groups. Study patients had a history of amputation (40.5%), peripheral vascular disease (54.6%), peripheral neuropathy (64.8%), end-stage renal disease (13.9%), renal/hepatic disease (40.4%), and hypertension (85%). The most common wound etiologies were surgical dehiscence (69%), diabetic neuropathic wounds (39%), and ischemic wounds (28%), most commonly located on the foot or at a prior amputation site (30%). Mean wound area was 57.9 cm2 and almost half with exposed bone. There were no statistical differences between treatment groups in proportion or time to healing, recurrence, or time to return to baseline function. Conclusions: Commonly used treatment modalities employed for this population of patients resulted in similar outcomes. This is the first study to describe the complex diabetic lower extremity wound in a complex host.
Collapse
|
95
|
Ehrl D, Brueggemann A, Broer PN, Koban K, Giunta R, Thon N. Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm. J Neurol Surg B Skull Base 2019; 81:149-157. [PMID: 32206533 DOI: 10.1055/s-0039-1683371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm 2 , whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm 2 . The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.
Collapse
Affiliation(s)
- Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexandra Brueggemann
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Konstantin Koban
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Riccardo Giunta
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
96
|
Revisiting the reconstructive surgery framework: The reconstruction supermarket. J Plast Reconstr Aesthet Surg 2019; 72:529-531. [PMID: 30808601 DOI: 10.1016/j.bjps.2019.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/18/2019] [Indexed: 11/24/2022]
|
97
|
Simman R, Hermans MHE. Managing Wounds with Exposed Bone and Tendon with an Esterified Hyaluronic Acid Matrix (eHAM): A Literature Review and Personal Experience. J Am Coll Clin Wound Spec 2018; 9:1-9. [PMID: 30591894 DOI: 10.1016/j.jccw.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The loss of extracellular matrix in combination with the exposure of structures such as bone and tendon pose a major challenge; the development of granulation tissue and subsequent reepithelialization over these structures is extremely slow and often may not happen at all. Replacement of the matrix has been shown to significantly increase the chances of healing since, with revascularization of the matrix, a wound bed is created that may either heal by secondary intention or via the application of a skin graft. A literature search on an esterified hyaluronic acid-based matrix (eHAM) returned five articles on the treatment of wounds with tendon and bone loss in which the eHAM was used. The etiologies of the wounds described varied among the articles, as did treatment modalities. However, all of them received proper debridement of necrosis with subsequent (although not always immediately) application of the eHAM. A very high percentage of all wounds reached the different primary endpoints in the studies, which were complete reepithelialization, complete coverage with granulation tissue and/or 10% coverage of the original wound size with epithelium, the latter being a strong indicator of the wound continuing to heal. The individual authors concluded that the esterified hyaluronic acid matrix (eHAM) is a valuable tool to assist in the complete healing of difficult to heal wounds.
Collapse
Affiliation(s)
- Richard Simman
- Dermatology, Wright State University School of Medicine, Dayton, OH, United States.,Clinical Professor of Surgery, University of Toledo College of Medicine, United States
| | | |
Collapse
|
98
|
Poh Yuen Wen A, Halim AS, Mat Saad AZ, Mohd Nor F, Wan Sulaiman WA. A prospective study evaluating wound healing with sea cucumber gel compared with hydrogel in treatment of skin graft donor sites. Complement Ther Med 2018; 41:261-266. [DOI: 10.1016/j.ctim.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/13/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
|
99
|
Brown JE, Holloway SL. An evidence-based review of split-thickness skin graft donor site dressings. Int Wound J 2018; 15:1000-1009. [PMID: 30117716 PMCID: PMC7949554 DOI: 10.1111/iwj.12967] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022] Open
Abstract
This evidence-based review aimed to identify and evaluate current existing evidence relating to the efficacy of dressing materials for spit-thickness skin graft donor site wounds in relation to promoting rapid healing and reducing patient pain. A comprehensive systematic search of the literature between 2006 and 2016 identified 35 publications that were included in the review. Based on the results of the review, it was found that moist wound-healing products have a clear advantage over non-moist products in the reduction of pain and increased healing rates. This review concluded that moist wound-healing products are more effective than non-moist wound-healing products in reducing pain and promoting healing in split-thickness skin graft donor site wounds. A recommendation based on this review is that further research examine the role of secondary dressing usage in donor site wound management, and the consideration of using more than one primary dressing product during the donor site wound-healing process should be undertaken.
Collapse
Affiliation(s)
- Julie E Brown
- Tissue Viability ServiceOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Samantha L Holloway
- Centre for Medical Education, School of Medicine, College of Biomedical and Life SciencesCardiff UniversityWalesUK
| |
Collapse
|
100
|
Rose LF, Wolf EJ, Brindle T, Cernich A, Dean WK, Dearth CL, Grimm M, Kusiak A, Nitkin R, Potter K, Randolph BJ, Wang F, Yamaguchi D. The convergence of regenerative medicine and rehabilitation: federal perspectives. NPJ Regen Med 2018; 3:19. [PMID: 30323950 PMCID: PMC6180133 DOI: 10.1038/s41536-018-0056-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 08/06/2018] [Accepted: 08/29/2018] [Indexed: 01/13/2023] Open
Abstract
Regenerative rehabilitation is the synergistic integration of principles and approaches from the regenerative medicine and rehabilitation fields, with the goal of optimizing form and function as well as patient independence. Regenerative medicine approaches for repairing or replacing damaged tissue or whole organs vary from utilizing cells (e.g., stem cells), to biologics (e.g., growth factors), to approaches using biomaterials and scaffolds, to any combination of these. While regenerative medicine offers tremendous clinical promise, regenerative rehabilitation offers the opportunity to positively influence regenerative medicine by inclusion of principles from rehabilitation sciences. Regenerative medicine by itself may not be sufficient to ensure successful translation into improving the function of those in the most need. Conversely, with a better understanding of regenerative medicine principals, rehabilitation researchers can better tailor rehabilitation efforts to accommodate and maximize the potential of regenerative approaches. Regenerative rehabilitative strategies can include activity-mediated plasticity, exercise dosing, electrical stimulation, and nutritional enhancers. Critical barriers in translating regenerative medicine techniques into humans may be difficult to overcome if preclinical studies do not consider outcomes that typically fall in the rehabilitation research domain, such as function, range of motion, sensation, and pain. The authors believe that encouraging clinicians and researchers from multiple disciplines to work collaboratively and synergistically will maximize restoration of function and quality of life for disabled and/or injured patients, including U.S. Veterans and Military Service Members (MSMs). Federal Government agencies have been investing in research and clinical care efforts focused on regenerative medicine (NIH, NSF, VA, and DoD), rehabilitation sciences (VA, NIH, NSF, DoD) and, more recently, regenerative rehabilitation (NIH and VA). As science advances and technology matures, researchers need to consider the integrative approach of regenerative rehabilitation to maximize the outcome to fully restore the function of patients.
Collapse
Affiliation(s)
- L F Rose
- 1Clinical and Rehabilitative Medicine Research Program, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD USA
| | - E J Wolf
- 1Clinical and Rehabilitative Medicine Research Program, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD USA
| | - T Brindle
- Department of Veterans Affairs, Office of Research and Development, Washington DC, USA
| | - A Cernich
- 3National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD USA
| | - W K Dean
- 4Tissue Injury and Regenerative Medicine Project Management Office, U.S. Army Materiel Development Authority, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD USA
| | - C L Dearth
- 5Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center & Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - M Grimm
- 6Disability & Rehabilitation Engineering and Engineering of Biomedical Systems Programs, National Science Foundation, Alexandria, VA USA
| | - A Kusiak
- Department of Veterans Affairs, Office of Research and Development, Washington DC, USA
| | - R Nitkin
- 3National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD USA
| | - K Potter
- Department of Veterans Affairs, Office of Research and Development, Washington DC, USA
| | - B J Randolph
- 5Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center & Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - F Wang
- 7National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - D Yamaguchi
- Veteran's Administration, Greater Los Angeles Healthcare System, Los Angeles, CA USA
| |
Collapse
|