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Rappl T, Wurzer P, May S, Tuca AC, Cambiaso-Daniel J, Parvizi D, Kamolz LP, Lumenta DB. Three-Dimensional Evaluation of Static and Dynamic Effects of Botulinum Toxin A on Glabellar Frown Lines. Aesthetic Plast Surg 2019; 43:206-212. [PMID: 30311033 DOI: 10.1007/s00266-018-1230-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of injectable solutions for aesthetic purposes has increased tremendously, but lacks objective support. We aimed at assessing static and dynamic effects of botulinum toxin A (BoNTA) on glabellar lines by use of an objective three-dimensional methodology. METHODS We prospectively collected three-dimensional stereographic photographs of two different facial expressions (pretreatment, 30 and 90 days posttreatment) in 21 patients, receiving a total of 20 units of BoNTA in both corrugator supercilii muscles. The primary endpoint was the three-dimensional static and dynamic surface irregularity, and secondary endpoints were the glabellar line scale and overall patient satisfaction. Blinded retrospective data analysis and statistical evaluation were performed with p < 0.05 considered statistically significant. RESULTS Static glabellar lines (neutral facial expression) were significantly reduced by - 17% and - 24% on day 30 and 90 posttreatment, respectively (vs. pretreatment; both p < 0.0001). Dynamic glabellar frown lines (firmest possible bilateral eye closure) demonstrated a reduction of surface irregularity by - 26% and - 21% on day 30 and 90 posttreatment, respectively (vs. pretreatment; both p < 0.0001). The subjective dynamic glabellar line scale documented a statistically significant improvement on day 30 posttreatment (mean ± SD: 1.5 ± 0.8; p < 0.05) versus pretreatment (2.8 ± 1.0). Polled patients confirmed a subjective wrinkle improvement 90 days posttreatment. CONCLUSION The presented setup detected even subtle changes of BoNTA treatment for facial wrinkling and is a promising asset for scientific evaluations of clinical studies analyzing the outcome and duration of efficacy of injectable solutions on the face. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Benedikt S, Parvizi D, Feigl G, Koch H. Anatomy of the medial antebrachial cutaneous nerve and its significance in ulnar nerve surgery: An anatomical study. J Plast Reconstr Aesthet Surg 2017; 70:1582-1588. [DOI: 10.1016/j.bjps.2017.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/02/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
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Wurzer P, Guillory A, Parvizi D, Clayton RP, Branski LK, Kamolz LP, Finnerty CC, Herndon DN, Lee JO. Human herpes viruses in burn patients: A systematic review. Burns 2016; 43:25-33. [PMID: 27515422 DOI: 10.1016/j.burns.2016.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 12/22/2015] [Accepted: 02/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The contribution of human herpes viruses, including herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV) to morbidity and mortality after burns remains controversial. This systematic review was undertaken to assess evidence of herpes virus-related morbidity and mortality in burns. MATERIALS AND METHODS PubMed, Ovid, and Web of Science were searched to identify studies of HSV, CMV, or VZV infections in burn patients. Exclusion criteria included: A level of evidence (LoE) of IV or V; nonhuman in vivo studies; and non-English articles. There was no limitation by publication date. RESULTS Fifty articles were subjected to full-text analysis. Of these, 18 had LoE between I-III and were included in the final review (2 LoE I, 16 LoE II-III). Eight had a prospective study design, 9 had a retrospective study design, and 1 included both. CONCLUSIONS No direct evidence linked CMV and HSV infection with increased morbidity and mortality in burns. Following burn, CMV reactivation was more common than a primary CMV infection. Active HSV infection impaired wound healing but was not directly correlated to mortality. Infections with VZV are rare after burns but when they occur, VZV infections were associated with severe complications including mortality. The therapeutic effect of antiviral agents administered after burns warrants investigation via prospective randomized controlled trials.
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Affiliation(s)
- Paul Wurzer
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Ashley Guillory
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
| | - Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert P Clayton
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-P Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
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Wurzer P, Parvizi D, Lumenta DB, Giretzlehner M, Branski LK, Finnerty CC, Herndon DN, Tuca A, Rappl T, Smolle C, Kamolz LP. Smartphone applications in burns. Burns 2015; 41:977-89. [DOI: 10.1016/j.burns.2014.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Wurzer P, Eberl R, Kamolz LP, Parvizi D, Rappl T, Spendel S. Aesthetically and functionally satisfying reconstruction of an Achilles tendon and overlying skin defect in a 15 year old girl: A case report. Burns 2015; 41:e1-3. [DOI: 10.1016/j.burns.2014.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/13/2014] [Indexed: 11/28/2022]
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Kamolz LP, Wurzer P, Giretzlehner M, Parvizi D, Lumenta DB. Burn surface area calculation instead of burn size estimation: Our opinion. Burns 2014; 40:1813-4. [DOI: 10.1016/j.burns.2014.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 11/27/2022]
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Kamolz L, Lumenta D, Parvizi D, Wiedner M, Justich I, Keck M, Pfurtscheller K, Schintler M. Skin graft fixation in severe burns: use of topical negative pressure. Ann Burns Fire Disasters 2014; 27:141-145. [PMID: 26170793 PMCID: PMC4441309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Indexed: 06/04/2023]
Abstract
Over the last 50 years, the evolution of burn care has led to a significant decrease in mortality. The biggest impact on survival has been the change in the approach to burn surgery. Early excision and grafting has become a standard of care for the majority of patients with deep burns; the survival of a given patient suffering from major burns is invariably linked to the take rate and survival of skin grafts. The application of topical negative pressure (TNP) therapy devices has demonstrated improved graft take in comparison to conventional dressing methods alone. The aim of this study was to analyze the impact of TNP therapy on skin graft fixation in large burns. In all patients, we applied TNP dressings covering a %TBSA of >25. The following parameters were recorded and documented using BurnCase 3D: age, gender, %TBSA, burn depth, hospital length-of-stay, Baux score, survival, as well as duration and incidence of TNP dressings. After a burn depth adapted wound debridement, coverage was simultaneously performed using split-thickness skin grafts, which were fixed with staples and covered with fatty gauzes and TNP foam. The TNP foam was again fixed with staples to prevent displacement and finally covered with the supplied transparent adhesive film. A continuous subatmospheric pressure between 75-120 mm Hg was applied (VAC®, KCI, Vienna, Austria). The first dressing change was performed on day 4. Thirty-six out of 37 patients, suffering from full thickness burns, were discharged with complete wound closure; only one patient succumbed to their injuries. The overall skin graft take rate was over 95%. In conclusion, we consider that split thickness skin graft fixation by TNP is an efficient method in major burns, notably in areas with irregular wound surfaces or subject to movement (e.g. joint proximity), and is worth considering for the treatment of aged patients.
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Affiliation(s)
- L.P. Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - D.B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - D. Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Wiedner
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - I. Justich
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Keck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - K. Pfurtscheller
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - M. Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Wurzer P, Spendel S, Kamolz LP, Parvizi D, Tuca A, Rappl T. [Is there a psychological and physiological difference between DIEP- and free TRAM-flap? A retrospective patient survey]. HANDCHIR MIKROCHIR P 2014; 46:256-62. [PMID: 25162244 DOI: 10.1055/s-0034-1384578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The DIEP- (Deep Inferior Epigastric Perforator) flap and the free TRAM- (Transverser Rectus Abdominis Musculocutaneous) flap are common procedures for breast reconstruction. The aim of the study was to identify a difference in the psychological and physiological patient satisfaction between DIEP- and free TRAM-flap. MATERIAL AND METHODS To provide a homogenous group, with a stable result of the reconstruction, the collective for questioning was picked out of the years 2009 and 2010. All patients included underwent a breast reconstruction with a DIEP-flap or free TRAM-flap at our division. For evaluation we formed 2 groups: DIEP-flap group (DLG) and TRAM-flap group (TLG). After preparing the questionnaire a telephone survey was performed. For the null hypothesis we postulated that there is no difference between DLG and TLG in the patient satisfaction. RESULTS We contacted 44 patients, 30 of them took part in our survey (15 from the DLG and 15 from the TLG). The mean BMI in the questionnaire group was 26.9 kg/m² and the mean age was 48.3 years. 2 questions (lifting heavy loads (p=0.005) and performing sit-up's (p=0.001)) show a significant difference between DLG and TLG, a benefit of the DLG could be seen. Both questions had the physiology of the rectus abdominis muscle as background. The complication rate for partial flap loss or partial necrosis was one third lower (p=0.299) in the TLG than compared to the DLG. CONCLUSION Up to now, physicians think that the DIEP-flap seems to be the best possible procedure for breast reconstruction with belly flaps. However, numerous studies disprove the superiority in the donor site morbidity. In the literature, an advantage of the TRAM-flap is clearly visible by comparing the complication rates. Our oral interviewing also states that there is no -difference in the psychological and physiological satisfaction of the patients. We can recommend a precise patient selection if a DIEP-flap for breast reconstruction should be performed. In case of comorbidities the possibility of the safer free TRAM-flap should be considered. In the future, a comparative analysis between the DIEP-flap, free TRAM-flap and pedicled TRAM-flap should be performed, by keeping the patients satisfaction, the complication rate and the cost effectiveness in mind.
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Affiliation(s)
- P Wurzer
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
| | - S Spendel
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
| | - L P Kamolz
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
| | - D Parvizi
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
| | - A Tuca
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
| | - T Rappl
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
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Kamolz LP, Koller H, Parvizi D, Lumenta DB. Skin substitutes: Which one do we know, which one do we use? Burns 2014; 40:1053-4. [DOI: 10.1016/j.burns.2014.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 02/06/2014] [Indexed: 11/28/2022]
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Parvizi D, Haas F, Peintinger F, Hubmer M, Rappl T, Koch H, Schintler M, Spendel S, Kamolz LP, Wurzer P, Tuca A, Fuchsjaeger M, Weinke R. First Experience Using Contrast-enhanced Ultrasound to Evaluate Vascularisation of Acellular Dermal Matrices after Implant-Based Breast Reconstruction. Breast J 2014; 20:461-7. [DOI: 10.1111/tbj.12301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Franz Haas
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Florentia Peintinger
- Department of Senology; Breast Center of University Hospital Salzburg; LKH Leoben; Leoben Austria
| | - Martin Hubmer
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Thomas Rappl
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Horst Koch
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Michael Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Alexandru Tuca
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | | | - Roland Weinke
- Department of Radiology; Medical University of Graz; Graz Austria
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Parvizi D, Giretzlehner M, Dirnberger J, Owen R, Haller H, Schintler M, Wurzer P, Lumenta D, Kamolz L. The use of telemedicine in burn care: development of a mobile system for TBSA documentation and remote assessment. Ann Burns Fire Disasters 2014; 27:94-100. [PMID: 26170783 PMCID: PMC4396802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Indexed: 06/04/2023]
Abstract
The requirements for accurate documentation within the process of burn assessment have increased dramatically over the years. TBSA (total body surface area) and burn depth are commonly determined by visual inspection, especially in the emergency or acute care setting. However, inexperience often results in incorrect estimation of these factors. In 2001, BurnCase 3D was initiated in order to develop a tool for objective burn assessment and documentation on mobile devices (Apple iPhoneTM). The centerpiece is a 3D model representing the actual patient. At two international burn meetings, a survey containing three pictures of patients was conducted and this data was collected. A patient-specific 3D model adapted to the height and weight of the real patient was created and the digital picture was superimposed in the computer system. The burns were transferred to the model and the TBSA in % was calculated by the software BurnCase 3D. The preferred methods of the 80 respondents for burn extent estimation were: the Rule of Nines (38%), the Rule of Palm (37%) and the Lund-Browder chart (18%). Analysis showed very high deviations of TBSA within the participants, even among the group of experts. In comparison to a computer-aided method we found massive overestimation of up to 230%. The use of BurnCase 3D could have a true impact on the quality of treatment in burns. In the acute care setting for burn injuries, telemedicine has great potential to help guide decisions regarding triage and transfer based on TBSA, burn depth, patient age and injury mechanism.
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Affiliation(s)
- D. Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Giretzlehner
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria
| | - J. Dirnberger
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria
| | - R. Owen
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria
| | | | - M.V. Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - P. Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - D.B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - L.P. Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Kamolz L, Lumenta D, Parvizi D, Dirnberger J, Owen R, Höller J, Giretzlehner M. Smartphones and burn size estimation: "Rapid Burn Assessor". Ann Burns Fire Disasters 2014; 27:101-104. [PMID: 26170784 PMCID: PMC4396790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Indexed: 06/04/2023]
Abstract
Estimation of the total body surface area burned (%TBSA) following a burn injury is used in determining whether to transfer the patient to a burn center and the required fluid resuscitation volumes. Unfortunately, the commonly applied methods of estimation have revealed inaccuracies, which are mostly related to human error. To calculate the %TBSA (quotient), it is necessary to divide the burned surface area (Burned BSA) (numerator in cm2) by the total body surface area (Total BSA) (denominator in cm2). By using everyday objects (eg. credit cards, smartphones) with well-defined surface areas as reference for estimations of Burned BSA on the one hand and established formulas for Total BSA calculation on the other (eg. Mosteller), we propose an approximation method to assess %TBSA more accurately than the established methods. To facilitate distribution, and respective user feedback, we have developed a smartphone app integrating all of the above parameters, available on popular mobile device platforms. This method represents a simple and ready-to-use clinical decision support system which addresses common errors associated with estimations of Burned BSA (=numerator). Following validation and respective user feedback, it could be deployed for testing in future clinical trials. This study has a level of evidence of IV and is a brief report based on clinical observation, which points to further study.
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Affiliation(s)
- L.P. Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
| | - D.B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
| | - D. Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
| | - J. Dirnberger
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria
| | - R. Owen
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria
| | - J. Höller
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging, Graz, Austria
| | - M. Giretzlehner
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria
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Kamolz LP, Parvizi D, Giretzlehner M, Lumenta DB. Burn surface area calculation: What do we need in future. Burns 2014; 40:171-2. [DOI: 10.1016/j.burns.2013.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 11/25/2022]
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Lars PKL, Giretzlehner M, Trop M, Parvizi D, Spendel S, Schintler M, Justich I, Wiedner M, Laback C, Lumenta D. The properties of the "ideal" donor site dressing: results of a worldwide online survey. Ann Burns Fire Disasters 2013; 26:136-141. [PMID: 24563639 PMCID: PMC3917148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Indexed: 06/03/2023]
Abstract
Split skin grafting is a widely used technique for reconstructing skin defects. Although a vast number of different coverage options for donor sites have become available in daily clinical practice, no optimum dressing material has been found to date. For this reason, we conducted a globally-distributed online survey to poll for the properties of such an "ideal" donor site dressing, possibly leading to an improved clinically-driven direction of future wound dressing developments. A total of 69 respondents from 34 countries took part in the questionnaire, resulting in a response rate of 13.8% (69/500) over a 1-month period. The majority of respondents rated the characteristics of an "ideal" donor site dressing to be either "essential" or "desirable" as follows: lack of adhesion to the wound bed ("essential": 31/69, 44.9%; "desirable": 30/69, 43.5%); pain-free dressing changes ("essential": 38/69, 55.1%; "desirable": 30/69, 43.5%); absorbency ("essential": 27/69, 39.1%; "desirable": 33/69, 47.8%); ease of removal ("essential": 37/69, 53.6%; "desirable": 27/69, 39.13%). With regard to the desired frequency of dressing changes, respondents preferred "no dressing change until the donor site has healed" (51/69, 73.9%) in the majority of cases, followed by "twice weekly" (10/69, 14.5%), "alternate days" (5/69, 7.2%) and "daily" (3/69, 4.3%). With regard to the design of the dressing material, the majority of participants preferred a one-piece (composite) dressing product (44/69, 63.8%). The majority of respondents also denied the current availability of an "ideal" donor site dressing (49/69, 71%). The strength of this study was the remarkable geographic distribution of responses; all parts of the world were included and participated. We believe that this globally conducted online survey has polled for the properties of the "ideal" donor site dressing and possibly will lead to an improved clinically-driven direction of future wound dressing development.
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Affiliation(s)
- P. Kamolz L.P. Lars
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Giretzlehner
- Research Unit for Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Austria
| | - M. Trop
- Pediatric Intensive Care Unit and Children’s Burns Unit, Department of Pediatrics, Medical University of Graz, Austria
| | - D. Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - S. Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - I. Justich
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - M. Wiedner
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - C. Laback
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - D.B.. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Rappl T, Parvizi D, Friedl H, Wiedner M, May S, Kranzelbinder B, Wurzer P, Hellbom B. Onset and duration of effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA in the treatment of glabellar frown lines: a randomized, double-blind study. Clin Cosmet Investig Dermatol 2013; 6:211-9. [PMID: 24098087 PMCID: PMC3789632 DOI: 10.2147/ccid.s41537] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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] [Indexed: 11/23/2022]
Abstract
Background Three botulinum neurotoxin type A preparations (incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA) are widely approved in Europe and in the US for the treatment of glabellar frown lines. The purpose of this study was to determine and compare the time to onset and duration of treatment effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA for the treatment of glabellar frown lines. Subjects and methods Subjects aged 20–60 years with moderate to severe glabellar frown lines received one treatment of either 21 units (U) incobotulinumtoxinA, 21 U onabotulinumtoxinA, or 63 U abobotulinumtoxinA. Assessments were made over a period of 180 days. Onset of treatment effect was defined as the day that the observer noted a decrease in glabellar muscle activity compared with baseline photographs and videos. Duration of treatment effect was defined as the time until glabellar muscle action returned to the baseline level. Analyses were performed using a Weibull log(T) regression model. Results The study enrolled 180 subjects; 60 per group. For all three products, onset of treatment effect occurred earlier in female subjects compared to male subjects. For both sexes, a significantly earlier time to onset of treatment effect was seen for incobotulinumtoxinA compared to onabotulinumtoxinA and abobotulinumtoxinA; in female subjects these times were 3.02 days, 5.29 days, and 5.32 days, respectively. The duration of treatment effect was longer for incobotulinumtoxinA compared to onabotulinumtoxinA and abobotulinumtoxinA; for all products, treatment effect duration was longer in females than in males. Time to onset was not a predictor of treatment duration. Conclusion IncobotulinumtoxinA demonstrated a more rapid onset and a longer duration of treatment effect than onabotulinumtoxinA (1:1 dose ratio) and abobotulinumtoxinA (1:3 dose ratio). Onset of effect was faster and duration of effect was longer in female subjects compared to male subjects.
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Affiliation(s)
- Thomas Rappl
- Department of Plastic and Reconstructive Surgery, Medical University Graz, Graz, Austria
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Parvizi D, Kamolz LP, Giretzlehner M, Haller HL, Trop M, Selig H, Nagele P, Lumenta DB. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind. Burns 2013; 40:241-5. [PMID: 24050977 DOI: 10.1016/j.burns.2013.06.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 12/03/2012] [Revised: 06/15/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Accurate estimation of burn size is of critical importance, as it is incorporated in every resuscitation formula. The aim of this study was to investigate total burn surface area (TBSA) accuracy among burn specialists, evaluate the potential impact of incorrect evaluation on variations of resultant fluid resuscitation volumes and to discuss future possibilities to estimate or measure TBSA more precisely. METHODS In a poll during two international burn meetings in 2010 and 2011 demonstrating three pictures of patients with different burn wound patterns and sizes we asked participants to estimate the total surface area burned in percentages. We then calculated resultant fluid volume differences based on established resuscitation formulas. RESULTS In the polled 80 participants, the estimations for three patients demonstrated the following differences (DIF=MAX-MIN): for patient 1, 2 and 3 they were 22.5 (25-2.5), 16.5 (20-3.5) and 31.5 (40-8.5) %TBSA, respectively. Based on these differences we calculated the volume differences for patients 1,2 and 3, which were 1080ml (Cincinnati Formula), 5280ml (Parkland Formula) and 2016ml (Cincinnati Formula), respectively. CONCLUSIONS The analysis showed high deviations of total body surface area among participants, also resulting in large variations of initial fluid resuscitation volumes. One option to address estimation variances is to perform more accurate assessments; also incorporating new technologies aiding to improve the quality of body surface estimations and related decisions.
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Affiliation(s)
- Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Michael Giretzlehner
- Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria.
| | | | - Maria Trop
- Pediatric Burn Unit, Department of Pediatrics, Medical University of Graz, Graz, Austria.
| | - Harald Selig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria; Department of Hand, Plastic and Reconstructive Surgery with Burn Unit, Eberhard-Karls-University of Tuebingen, BG Trauma Center, Tuebingen, Germany.
| | - Peter Nagele
- Department of Anaesthesiology, Washington University School of Medicine, St. Louis, USA
| | - David B Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria.
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Kamolz LP, Parvizi D, Schintler M. Tissue expansion: things we should keep in mind. Burns 2013; 39:1024-5. [PMID: 23590968 DOI: 10.1016/j.burns.2013.01.022] [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: 01/06/2013] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Michael Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Kamolz L, Schintler M, Parvizi D, Selig H, Lumenta D. The real expansion rate of meshers and micrografts: things we should keep in mind. Ann Burns Fire Disasters 2013; 26:26-29. [PMID: 23966895 PMCID: PMC3741003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Indexed: 06/02/2023]
Abstract
Skin graft expansion techniques (mesh and micrograft) are widely used, but there is ample evidence that skin graft meshers do not provide their claimed expansion rates. Although this finding might not be new for the majority of surgeons, less is known about surgeons' actual knowledge of expansion rates. The aim of this study was to evaluate the true expansion rates of commonly used expansion techniques with regard to claimed, achieved, and polled results. In the first part of the study, 54 surgeons were polled during an annual burns meeting regarding the most commonly used expansion techniques and expansion ratios; in the second step the true (achievable) expansion rates of the most widely used meshers and micrografts were analysed; and in third step, a poll involving 40 surgeons was conducted to estimate the true expansion rates of the most frequently used skin expansion techniques. The skin meshers (1:1.5 / 1:3) did not achieve their claimed values: (1:1.5) 84.7% of the claimed expansion (mean ± SD: 1:1.27 ± 0.15) and (1:3) 53.1% of the 1:3 (1:1.59 ± 0.15) mesher. The use of the micrografting technique resulted in 99.8% of the 1:3 (1:2.99 ± 0.09), 93.6% of the 1:4 (1:3.74 ± 0.12) and 93.8% of the 1:6 (1:5.63 ± 0.12) claimed expansion rates, respectively. In general the surgeons overestimated the achievable expansion rates. In general the achieved expansion rate was lower than the estimated and claimed expansion rates. The micrografting technique provided reliable and valid expansion rates compared to the skin meshers. We recommend using the micrograft technique when large expansion ratios are required, for example in severe extensive burns.
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Affiliation(s)
- L.P. Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
| | - M. Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
| | - D. Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
| | - H. Selig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
- Department of Hand Surgery, Rhön Klinikum Bad Neustadt, Bad Neustadt, Germany
| | - D.B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria
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Wiedner M, Justich I, Vasilyeva A, Parvizi D, Spendel S, Kamolz LP, Scharnagl E. Complications in body-contouring procedures with special regard to massive weight loss patients: personal observations. Eur Surg 2013. [DOI: 10.1007/s10353-012-0185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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