Effectiveness of Autologous Fat Transfer in the Treatment of Scar-Related Conditions: A Systematic Review and Meta-analysis

BACKGROUND AND AIM

Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions.

METHODS

PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model.

RESULTS

9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036).

CONCLUSION

Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required.

LEVEL OF EVIDENCE III

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Successful Elbow Flexion Reconstruction Using Latissimus Dorsi Muscle Transfer Following a Road Traffic Accident and Upper Limb Trauma

BACKGROUND Several surgical procedures to restore elbow flexion have been reported in the literature. Multiple factors direct the selection of appropriate procedures for each patient, including hand dominance, neurovascular injury, and comorbidities. Traumatic damage to the anterior compartment of the arm is an indication for latissimus dorsi transfer, which can restore elbow flexion. Bipolar pedicled latissimus dorsi (LD) flap is a design used very rarely to simultaneously reconstruct biceps brachii soft-tissue defects and regain complete flexion function. We report the case of a 30-year-old man who underwent successful elbow flexion reconstruction using latissimus dorsi muscle transfer following a road traffic accident and upper limb trauma. CASE REPORT A 30-year-old man presented with acute compartment syndrome caused by a road traffic accident and impact trauma to the left arm. The surgical evaluation revealed proximal biceps tendons rapture; therefore, immediate repair and therapeutic fasciotomy were done. Subsequently, unsuccessful repair resulted in total necrosis of the biceps muscle, which necessitated debridement of the biceps muscle. Delayed reconstruction with an LD flap was successfully done after stabilization of the patient's condition. The flap was harvested as free-pedicled, then modified into a tube-like shape to resemble the biceps muscle. CONCLUSIONS This report has shown that the surgical procedure of latissimus dorsi muscle transfer can successfully restore elbow function following upper limb trauma; however, preoperative planning and postoperative follow-up are crucial for functional reconstruction of the upper extremity. In addition, carefully selecting reconstructive surgery considering patient factors, degree of injury, and the institution's capacity are essential factors in achieving optimal function restoration with minimal complications.

"Is there a doctor on board?": willingness and confidence of physicians in the Kingdom of Saudi Arabia in assisting with in-flight medical emergencies

Background

In-flight medical emergencies (IMEs) are common, and for a traveling physician, it is very likely to encounter such a condition. Data discussing this issue are limited. Thus, this study aimed to evaluate the willingness and confidence of physicians in the Kingdom of Saudi Arabia (KSA) in responding to IMEs. As well as, to assess the associated sociodemographic, occupational, and travel-related factors, and their previous experience with such events.

Methods

This cross-sectional, online-based, study was conducted among all physicians in KSA during January 2021. The self-administered questionnaire included questions on sociodemographic, occupational, travel profiles, willingness and confidence towards IMEs. Chi-Squared or Fisher’s Exact test were used for bivariate analysis followed by the multivariable binary logistic regression analysis.

Results

A total of 4558 physicians participated in the study. About one-third of participants reported one or more IME incidents, and the vast majority of them provided assistance. Cardiovascular diseases were the most common IMEs. About half of the participating physicians are concerned about the medico-legal consequences of providing assistance with such a condition. Among all specialties, emergency physicians reported the highest willingness and confidence toward IMEs. Predictors for a physician’s willingness to assist in IMEs were being male, having been involved in a previous IME situation, attended life support and IME courses, frequent traveling, and practicing medicine in the Central region of Saudi Arabia.

Conclusion

Findings from the current study stressed the need for establishing standardized guidelines about the roles of healthcare workers and the legal consequences of providing medical assessment in IMEs. Moreover, training programs on IMEs to all physicians, especially those who deal with a variety of cases during their practice such as internal medicine and family medicine are also suggested.

Acute Kidney Injury as a Risk Factor for Cerebrovascular Disease Outcome among Patients Presenting with Stroke in King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A Retrospective Cohort Study

Patients suffering from stroke may develop different complications including acute kidney injury (AKI). AKI affects mortality among the stroke patients. The association between stroke and AKI despite extensive research has been not completely understood. The study aimed to determine an AKI as an independent poor risk factor of cerebrovascular disease outcome among the stroke patients. Our objectives were to estimate AKI incidence among stroke patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between 2013 and 2017 and assess the major risk factors related to AKI among stroke patients. The research population was sourced from the publicly available KAUH records from 2013 to 2017. The total number of stroke cases was 717 with a mean age of 63.94 ± 15.70 years. As many as 83.5% of cases had no AKI and 16.5% were suffered from AKI among total stroke patients studied. Furthermore, 74.1% of stroke patients were alive compared to 25.9% reported dead. The study concluded that AKI incidence is higher in stroke patients after admission immediately or during hospitalization. As such, the renal function file could be used as an early indicator upon stroke patients' admission to health-care facilities. Prevention and control of AKI seem to be very important among patients with stroke.

Use of plastic adhesive drapes during surgery for preventing surgical site infection

BACKGROUND

Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach but no systematic review has been conducted to date to guide clinical practice.

OBJECTIVES

To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity.

SEARCH STRATEGY

We searched the Cochrane Wounds Group Specialised Register (last searched 24/4/07), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2007), Ovid MEDLINE (1950 to April Week 2, 2007), Ovid EMBASE (1980 to 2007 Week 16), and Ovid CINAHL (1982 to 1980 to April Week 2 2007).

SELECTION CRITERIA

Randomised controlled trials comparing any plastic adhesive drape with no adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes in patients undergoing any type of surgery.

DATA COLLECTION AND ANALYSIS

Two authors independently selected and assessed studies for trial quality and both independently extracted data. Study authors were contacted for additional information.

MAIN RESULTS

This review includes five studies involving 3,082 participants comparing adhesive drapes with no drape and two studies involving 1,113 participants comparing iodine-impregnated adhesive drapes with no drape. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drape. (Relative Risk (RR) 1.23, 95% Confidence Intervals (CI) 1.02 to 1.48, p=0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.064 to 1.66, p=0.89). Length of hospital stay was similar in adhesive drape and non-adhesive drape groups.

AUTHORS' CONCLUSIONS

There was no evidence from the seven trials that plastic adhesive drapes reduces surgical site infection rate and some evidence that they increase infection rates. Further trials may be justified using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection based on different wound classifications.

Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery: a systematic review

BACKGROUND AND OBJECTIVE

Identifying factors that can predict adults at high risk of receiving red blood cell transfusion during coronary artery bypass graft (CABG) surgery may aid in more efficient blood banking practices and may tailor blood conservation strategies for these adult patients. The objective was to identify clinical factors associated with increased red cell transfusion in adults undergoing CABG surgery.

METHODS

A systematic review of the MEDLINE and HealthSTAR databases from 1966 to December 2005 was conducted. Citations containing the medical subject heading or textwords 'coronary artery bypass graft', 'CABG' and 'cardiovascular surgery' were combined with the medical subject headings or textwords 'transfusion' and 'blood transfusion'.

RESULTS

A total of 2461 abstracts were retrieved. Twenty-one studies met the inclusion/exclusion criteria. Transfusion rates ranged from 7 to 97%. Several variables were identified that were associated with increased red cell transfusion rates including older age, female sex, low haemoglobin concentration or haematocrit value, renal insufficiency and urgent/emergent surgery. The strongest risk factor was the urgency of surgery (urgent or emergent surgery), which was associated with a 4x to 8x increase in transfusion rates compared to elective surgery. Increasing age and female sex increased the likelihood of transfusion by 1x to 3x and 2x, respectively.

CONCLUSIONS

Increasing patient age, female sex, lower preoperative haemoglobin levels, as well as the urgency of the CABG surgery were associated with higher transfusion rates. Identifying risk factors for transfusion may allow for targeted use of blood conservation strategies, improved efficiency in blood utilization and informing adults at risk of transfusion.

A high-resolution anthropomorphic voxel-based tomographic phantom for proton therapy of the eye

Proton therapy is increasingly used in medical treatments for cancer patients due to the sharp dose conformity offered by the characteristic Bragg peak. Proton beam interactions with the eye will be simulated using the MCNPX Monte Carlo code and available nuclear cross-section data to calculate the dose distribution in the eye gel and surrounding organs. A high-resolution eye model will be employed using a 3D geometrical voxel-based anthropomorphic head phantom obtained from the Visible Human Project (female data). Manual segmentation of the eye, carried out by the Medical Physics group at the University of Surrey resulted in 15 identified structures. This work emphasizes the use of a realistic phantom for accurately predicting dose deposition by protons.

Neutron-fluence-to-dose conversion coefficients in an anthropomorphic phantom

A set of fluence-to-effective-dose conversion coefficients has been calculated for neutrons with energies <20 MeV using a high-resolution anthropomorphic phantom (Zubal model) and the MCNPX code. The calculation used 13 monodirectional monoenergetic neutron beams in the energy range 10(-9) to 20 MeV, under three different source irradiation configurations: anterior-posterior, posterior-anterior and left lateral. Dose calculations were performed for 18 selected organs of the body, for which the International Commission on Radiological Protection and the International Commission on Radiological Units and Measurements have set tissue weighting factors for the determination of the effective dose. Another set of neutron-fluence-to-effective-dose conversion coefficients was also calculated with the proposed modification wR from ICRP Publication 92. From comparison between the dose results calculated and the data reported for the MIRD and VIPMAN models, it can be concluded that, although some discrepancies exist between the Zubal model and the two other models, there is good agreement in the left lateral irradiation geometry.