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Legemate CM, Kwa KAA, Goei H, Pijpe A, Middelkoop E, van Zuijlen PPM, Beerthuizen GIJM, Nieuwenhuis MK, van Baar ME, van der Vlies CH. Hydrosurgical and conventional debridement of burns: randomized clinical trial. Br J Surg 2022; 109:332-339. [PMID: 35237788 PMCID: PMC10364696 DOI: 10.1093/bjs/znab470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/06/2021] [Accepted: 12/18/2021] [Indexed: 08/02/2023]
Abstract
BACKGROUND Tangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the hypothesis that enhanced preservation of vital dermal tissue reduces scarring. The aim of this trial was to compare scar quality after hydrosurgical versus conventional debridement before split-skin grafting. METHODS A double-blind randomized within-patient multicentre controlled trial was conducted in patients with burns that required split-skin grafting. One wound area was randomized to hydrosurgical debridement and the other to Weck knife debridement. The primary outcome was scar quality at 12 months, assessed with the observer part of the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included complications, scar quality, colour, pliability, and histological dermal preservation. RESULTS Some 137 patients were randomized. At 12 months, scars of the hydrosurgical debrided wounds had a lower POSAS observer total item score (mean 2.42 (95 per cent c.i. 2.26 to 2.59) versus 2.54 (95 per cent c.i. 2.36 to 2.72; P = 0.023)) and overall opinion score (mean 3.08 (95 per cent c.i. 2.88 to 3.28) versus 3.30 (95 per cent c.i. 3.09-3.51); P = 0.006). Patient-reported scar quality and pliability measurements were significantly better for the hydrosurgically debrided wounds. Complication rates did not differ between both treatments. Histologically, significantly more dermis was preserved with hydrosurgery (P < 0.001). CONCLUSION One year after surgery scar quality and pliability was better for hydrosurgically debrided burns, probably owing to enhanced histological preservation of dermis. REGISTRATION NUMBER Trial NL6085 (NTR6232 (http://www.trialregister.nl)).
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Affiliation(s)
- Catherine M. Legemate
- Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Kelly A. A. Kwa
- Burn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Department of Traumasurgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Harold Goei
- Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Paul P. M. van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Burn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Pediatric Surgical Centre, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, 1105 AZ Amsterdam, The Netherlands
| | | | - Marianne K. Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, 9728 NT Groningen, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, 9747 AS Groningen, The Netherlands
- Department for Human Movement Sciences, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Margriet E. van Baar
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Cornelis H. van der Vlies
- Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
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Legemate CM, van der Vlies CH. Donor site morbidity - Where is the evidence to guide therapeutic decision making? Burns 2021; 47:1456-1457. [PMID: 34344570 DOI: 10.1016/j.burns.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Catherine M Legemate
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands.
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Abstract
Split-thickness skin grafting remains a fundamental treatment for patients with deep burns and other traumatic injuries. Unfortunately, the donor site wound that remains after split skin graft (SSG) harvesting may also cause problems for the patient; they can lead to discomfort and scars with a poor cosmetic outcome. Regrafting of the donor site is one of the methods described to improve donor site healing and scarring. In this report, we describe a case of a 26-year-old woman with a self-inflicted chemical burn (0.5% TBSA) who underwent split skin grafting. During surgery, only part of the donor site was regrafted with split skin graft remnants. This part healed faster and had a better scar quality at 3 months postsurgery. Nevertheless, the appearance and patients' opinion on the regrafted part deteriorated after 12 months. With this case report, we aim to create awareness of the long-term consequences of regrafting, which may differ from short-time results. Patients expected to have poor reepithelialization potential may benefit from regrafting of the SSG on the donor site. But in healthy young individuals, timewise there would be no benefit since it can lead to an aesthetically displeasing result.
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Affiliation(s)
- Catherine M Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Ymke Lucas
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Irma M M H Oen
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands
| | - Cornelis H van der Vlies
- Burn Center, Maasstad Hospital, AC Rotterdam, the Netherlands.,Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit, Rotterdam, The Netherlands
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Legemate CM, Ooms PJ, Trommel N, Middelkoop E, van Baar ME, Goei H, van der Vlies CH. Patient-reported scar quality of donor-sites following split-skin grafting in burn patients: Long-term results of a prospective cohort study. Burns 2020; 47:315-321. [PMID: 33419665 DOI: 10.1016/j.burns.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/02/2020] [Accepted: 12/04/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Skin grafting is the current gold standard for treatment of deeper burns. How patients appraise the donor-site scar is poorly investigated. The aim of this study was to evaluate long-term patient-reported quality of donor-site scars after split skin grafting and identify possible predictors. METHODS A prospective cohort study was conducted. Patients were included in a Dutch burn centre during one year. Patient-reported quality of donor-site scars and their worst burn scar was assessed at 12 months using the Patient and Observer Scar Assessment Scale (POSAS). Mixed model analyses were used to identify predictors of scar quality. RESULTS This study included 115 donor-site scars of 72 patients with a mean TBSA burned of 11.2%. The vast majority of the donor-site scars (84.4%) were rated as having at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and the overall opinion on 80.9% of the donor-site scars was that they deviated from normal skin 12 months after surgery. The overall opinion on the donor-site scar was 3.2 ± 2.1 vs. 5.1 ± 2.4 on the burn scar. A younger age, female gender, a darker skin type, and location on the lower leg were predictors of reduced donor-site scar quality. In addition, time to re-epithelization was associated with scar quality. CONCLUSION This study provided new insights in long-term scar quality of donor-sites. Donor-site scars differed from normal skin in a large part of the population 12 months after surgery. Results of this study can be used to inform patients on the long-term outcomes of their scars and to tailor preventive or therapeutic treatment options.
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Affiliation(s)
- Catherine M Legemate
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands.
| | - Pauline J Ooms
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands
| | - Nicole Trommel
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands
| | - Esther Middelkoop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
| | - Margriet E van Baar
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands
| | - Harold Goei
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Cornelis H van der Vlies
- Maasstad Hospital, Burn Centre, Rotterdam, The Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Legemate CM, de Rooij FPW, Bouman MB, Pigot GL, van der Sluis WB. Surgical outcomes of testicular prostheses implantation in transgender men with a history of prosthesis extrusion or infection. Int J Transgend Health 2020; 22:330-336. [PMID: 34240075 PMCID: PMC8118234 DOI: 10.1080/26895269.2020.1840476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background: Testicular prostheses implantation may be used for neoscrotal augmentation in transgender men. In current literature, explantation rates range from 0.6% to 30% and most are a result of infection or extrusion. Information on the surgical path of individuals after prosthesis explantation is scarce. Aim: To assess the frequency and success rate of testicular prosthesis implantation after previous explantation due to infection or extrusion. Methods: All transgender men who underwent testicular prosthesis explantation between January 1991 and December 2018 were retrospectively identified from a departmental database. A retrospective chart study was conducted, recording demographics, surgical and prosthesis characteristics, reoperations, and outcomes. Results: A total of 41 transgender men were included who underwent testicular prosthesis explantation in the study time period. Of these, 28 (68%) opted for new prosthesis implantation. Most explanted prosthesis had a volume ≥30cc and were replaced with an equally sized one. The postoperative course was uneventful in 19 out of 28 (68%) individuals. Explantation of one or both prostheses occurred in 7 out of 28 (25%) individuals, because of infection (n = 3, 11%) or extrusion (n = 4, 14%). Patients that experienced complications had more often a history of smoking (p = 0.049). The explantation rate was lower if a smaller or lighter prosthesis was reimplanted (p = 0.020). Discussion: Most patients opt for testicular prosthesis implantation after previous explantation due to extrusion or infection. Explantation rates are higher than after the primary implantation procedure. Results of current study can be used to inform individuals on postoperative outcomes.
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Affiliation(s)
- Catherine M. Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
| | - Freek P. W. de Rooij
- Department of Urology, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Garry L. Pigot
- Department of Urology, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
| | - Wouter B. van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands
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Legemate CM, Ooms PJ, Trommel N, Goei H, Lucas Y, Middelkoop E, Baar ME, Vlies CH. Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers. Wound Repair Regen 2020; 28:696-703. [DOI: 10.1111/wrr.12840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Catherine M. Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | | | - Nicole Trommel
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Harold Goei
- Department of Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
| | - Ymke Lucas
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk the Netherlands
| | - Margriet E. Baar
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Cornelis H. Vlies
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
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Kwa KAA, Legemate CM, Pijpe A, Meij-de Vries A, Middelkoop E, van Baar ME, Breederveld RS, Nieuwenhuis MK. Doxepin cream is not effective in reducing itch in burn scar patients: A multicenter triple-blind randomized clinical crossover trial. Burns 2019; 46:340-346. [PMID: 31839501 DOI: 10.1016/j.burns.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/18/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effect of doxepin hydrochloride 5% cream on reducing pruritus in burn scar patients compared to a placebo cream. METHOD We conducted a multicenter triple-blind randomized clinical placebo-controlled crossover trial in which burn patients ≥18 years with an itch intensity ≥3 on a Visual Analogue Scale (VAS) were randomized between a doxepin-placebo or placebo-doxepin treatment protocol. Patients used each cream during two weeks with a wash-out period of one week in between. Primary outcome was change in itch intensity in two weeks' time using the VAS. Secondary outcome included the impact of itch (Burn Itch Questionnaire). Other parameters were the use of hydrating cream, silicon treatment, pressure garments, and other antipruritic medication. RESULTS Twenty-seven patients were included. The change in itch intensity (VAS) was not different during the doxepin and placebo period (p=0.994); neither the doxepin cream nor placebo cream reduced itch intensity. However, based on the Burn Itch Questionnaire, we observed a statistically significant decrease in itch intensity and improvement in impact scores in both treatment groups, but no difference in the degree of reduction between the groups. CONCLUSION Doxepin cream was not effective in reducing pruritus in our burn patient study population.
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Affiliation(s)
- K A A Kwa
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - C M Legemate
- Burn Center Maasstad Hospital, Rotterdam, The Netherlands; Amsterdam UMC, Free University Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Association of Dutch Burn Centers, The Netherlands.
| | - A Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.
| | - A Meij-de Vries
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.
| | - E Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Amsterdam UMC, Free University Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Association of Dutch Burn Centers, The Netherlands.
| | - M E van Baar
- Burn Center Maasstad Hospital, Rotterdam, The Netherlands; Association of Dutch Burn Centers, The Netherlands; Department of Public Health Erasmus MC, Rotterdam, The Netherlands.
| | - R S Breederveld
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - M K Nieuwenhuis
- Association of Dutch Burn Centers, The Netherlands; Burn Center, Martini Hospital, Groningen, The Netherlands.
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Legemate CM, Goei H, Gostelie OFE, Nijhuis THJ, van Baar ME, van der Vlies CH. Application of hydrosurgery for burn wound debridement: An 8-year cohort analysis. Burns 2018; 45:88-96. [PMID: 30322740 DOI: 10.1016/j.burns.2018.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/21/2018] [Accepted: 08/07/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION During the last decade, the Versajet™ hydrosurgery system has become popular as a tool for tangential excision in burn surgery. Although hydrosurgery is thought to be a more precise and controlled manner for burn debridement prior to skin grafting, burn specialists decide individually whether hydrosurgery should be applied in a specific patient or not. The aim of this study was to gain insight in which patients hydrosurgery is used in specialized burn care in the Netherlands. METHODS A retrospective study was conducted in all patients admitted to a Dutch burn centre between 2009 and 2016. All patients with burns that underwent surgical debridement were included. Data were collected using the national Dutch Burn Repository R3. RESULTS Data of 2113 eligible patients were assessed. These patients were treated with hydrosurgical debridement (23.9%), conventional debridement (47.7%) or a combination of these techniques (28.3%). Independent predictors for the use of hydrosurgery were a younger age, scalds, a larger percentage of total body surface area (TBSA) burned, head and neck burns and arm burns. Differences in surgical management and clinical outcome were found between the three groups. CONCLUSION The use of hydrosurgery for burn wound debridement prior to skin grafting is substantial. Independent predictors for the use of hydrosurgery were mainly burn related and consisted of a younger age, scalds, a larger TBSA burned, and burns on irregularly contoured body areas. Randomized studies addressing scar quality are needed to open new perspectives on the potential benefits of hydrosurgical burn wound debridement.
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Affiliation(s)
- C M Legemate
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, The Netherlands.
| | - H Goei
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, The Netherlands.
| | - O F E Gostelie
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.
| | - T H J Nijhuis
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - M E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.
| | - C H van der Vlies
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
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Legemate CM, Middelkoop E, van Baar ME, van der Vlies CH. Is the time right to put down the knife? A call for evidence-based decision making. Burns 2018; 44:1859-1860. [PMID: 30077490 DOI: 10.1016/j.burns.2018.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Affiliation(s)
- C M Legemate
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, The Netherlands.
| | - E Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, The Netherlands; Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands.
| | - M E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.
| | - C H van der Vlies
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands; Department of Trauma Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Legemate CM, Goei H, Middelkoop E, Oen IMMH, Nijhuis THJ, Kwa KAA, van Zuijlen PPM, Beerthuizen GIJM, Nieuwenhuis MK, van Baar ME, van der Vlies CH. Long-term scar quality after hydrosurgical versus conventional debridement of deep dermal burns (HyCon trial): study protocol for a randomized controlled trial. Trials 2018; 19:239. [PMID: 29673408 PMCID: PMC5909227 DOI: 10.1186/s13063-018-2599-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 03/19/2018] [Indexed: 12/01/2022] Open
Abstract
Background Deep dermal burns require tangential excision of non-viable tissue and skin grafting to improve wound healing and burn-scar quality. Tangential excision is conventionally performed with a knife, but during the last decade hydrosurgery has become popular as a new tool for tangential excision. Hydrosurgery is generally thought to be a more precise and controlled manner of burn debridement leading to preservation of viable tissue and, therefore, better scar quality. Although scar quality is considered to be one of the most important outcomes in burn surgery today, no randomized controlled study has compared the effect of these two common treatment modalities with scar quality as a primary outcome. The aim of this study is, therefore, to compare long-term scar quality after hydrosurgical versus conventional tangential excision in deep dermal burns. Methods/design A multicenter, randomized, intra-patient, controlled trial will be conducted in the Dutch burn centers of Rotterdam, Beverwijk, and Groningen. All patients with deep dermal burns that require excision and grafting are eligible. Exclusion criteria are: a burn wound < 50 cm2, total body surface area (TBSA) burned > 30%, full-thickness burns, chemical or electrical burns, infected wounds (clinical symptoms in combination with positive wound swabs), insufficient knowledge of the Dutch or English language, patients that are unlikely to comply with requirements of the study protocol and follow-up, and patients who are (temporarily) incompetent because of sedation and/or intubation. A total of 137 patients will be included. Comparable wound areas A and B will be appointed, randomized and either excised conventionally with a knife or with the hydrosurgery system. The primary outcome is scar quality measured by the observer score of the Patient and Observer Scar Assessment Scale (POSAS); a subjective scar-assessment instrument, consisting of two separate six-item scales (observer and patient) that are both scored on a 10-point rating scale. Discussion This study will contribute to the optimal surgical treatment of patients with deep dermal burn wounds. Trial registration Dutch Trial Register, NTR6232. Registered on 23 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2599-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine M Legemate
- Association of Dutch Burn Centers, Maasstad Hospital, Rotterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Harold Goei
- Association of Dutch Burn Centers, Maasstad Hospital, Rotterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands.,Association of Dutch Burn Centers, Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | - Irma M M H Oen
- Burn Center, Maasstad Hospital, Rotterdam, the Netherlands
| | - Tim H J Nijhuis
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kelly A A Kwa
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands.,Burn Center, Red Cross Hospital, Beverwijk, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | | | | | - Margriet E van Baar
- Association of Dutch Burn Centers, Maasstad Hospital, Rotterdam, the Netherlands
| | - Cornelis H van der Vlies
- Burn Center, Maasstad Hospital, Rotterdam, the Netherlands. .,Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. .,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Legemate CM, van der Kwaak M, Gobets D, Huikeshoven M, van Zuijlen PPM. The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: Technique and long-term outcome of a cohort study. J Plast Reconstr Aesthet Surg 2018; 71:889-894. [PMID: 29428586 DOI: 10.1016/j.bjps.2018.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/07/2017] [Accepted: 01/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold. METHODS A retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017. The skin flap was designed along the gluteal fold. The skin perforators of the pudendal artery were marked with a Doppler probe in the medial region of the gluteal fold. Surgery was performed in the jackknife position, and flaps were elevated in the suprafascial plane. Patients were assessed for minor (requiring no additional surgery) and major complications (requiring additional surgery). RESULTS Twenty-seven patients (34 flaps) were identified. The median follow-up period was 38 months (IQR 37). Primary closure of the donor-site was achieved in all procedures, only one flap required muscle flap transposition in order to fill the dead space. The mean operating time was 60 ± 21 minutes. In six flaps (9%) wound healing problems were noted that did not require an additional operative procedure. Among the nine flaps (27%) that required a second procedure, 3 (9%) were necessary due to recurrent ulcers. CONCLUSIONS The PIPAP flap is a safe and reliable alternative for ischial pressure sore reconstruction, certainly when compared to available techniques. Moreover, it has significant advantages over other techniques including minimal donor-site morbidity, preservation of posterior thigh skin, buttock-line integrity and reliable vascularity.
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Affiliation(s)
- Catherine M Legemate
- Red Cross Hospital, Department of Plastic, Reconstructive and Hand Surgery, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | - David Gobets
- Rehabilitation Centre, Heliomare, Relweg 51, 1949 EC, Wijk aan Zee, The Netherlands
| | - Menno Huikeshoven
- Red Cross Hospital, Department of Plastic, Reconstructive and Hand Surgery, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
| | - Paul P M van Zuijlen
- Red Cross Hospital, Department of Plastic, Reconstructive and Hand Surgery, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Legemate CM, Hop MJ, Nieuwenhuis MK, Middelkoop E, van Baar ME, van der Vlies CH. [Determining depth of burns using laser Doppler imaging]. Ned Tijdschr Geneeskd 2018; 162:D2374. [PMID: 29629853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Early accurate assessment of burn depth is important to determine the optimal treatment of burns (conservative versus surgery). Laser Doppler imaging (LDI) is a technique that allows accurate measurement of burn depth by measuring dermal perfusion. Although it has been demonstrated that LDI led to faster decisions as to whether or not to operate, this has not lead to shorter wound healing time or cost savings in Dutch burn care. LDI is used in all Dutch burn centres. In case of doubt about the depth of a burn in primary or secondary care, referral to a burn centre is advisable.
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Affiliation(s)
- C M Legemate
- *Namens de Vereniging Samenwerkende Brandwondencentra (VSBN)
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