Acta Chirurgiae Plasticae

Registrar-to-registrar insights: Essential tips for aspiring microsurgeons on early independent DIEP Flap reconstructions

2024-08-16T19:41:12+00:00

High-voltage electrotrauma: Unmasking the threat of early anaerobic infection

2024-08-03T08:29:12+00:00

This paper highlights a critical issue regarding burn patients, especially those with electric burns at risk of developing anaerobic infections during early hospitalization. A 33-year-old male with polytrauma, including high-voltage electrotrauma, exemplifies the severity of such cases. Following a suicide attempt involving a fall from a power line pole, the patient underwent fasciotomy and necrectomy due to compartment syndrome. Despite early microbiological findings, he faced a significant risk of anaerobic infections. Early amputation of the right forearm was necessitated by Clostridium infections, followed by further amputation of the upper right and left forearms due to progressing necrosis. Skin autografting and gradual rehabilitation of fractures ensued, leading to the healing of amputation stumps and burns after three months of hospitalization. The case underscores the challenges posed by electric burns and the critical need for prompt and effective interventions to address anaerobic infections. Traditional wound care approaches must evolve to include advanced techniques like Quantitative Wound Biopsy (QWB) for accurate diagnosis and monitoring. This comprehensive protocol is essential in managing high-voltage electrotrauma, optimizing patient outcomes, and minimizing complications associated with such severe injuries.

From Pixels to Pain Relief: Virtual Reality's Therapeutic Landscape in Burn Care

2024-09-17T16:27:40+00:00

Managing pain in burn patients is a difficult task. Innovative approaches are necessary to alleviate distress, prevent medication dependence, and improve the therapeutic experience for patients, caregivers, physicians, and the broader healthcare and research and development ecosystem. Virtual Reality (VR) offers an immersive and interactive modality that can help modulate pain perception without medication. Compared to traditional pain management methods, VR has the potential to be highly patient-centered. This is achieved through customizable virtual environments that are tailored to individual needs and preferences. This individualization acknowledges the unique challenges presented by burn injuries, enhancing personalized distraction therapy and contributing to a more empathetic pain management strategy. Empirical evidence shows that integrating VR into burn care protocols leads to a significant reduction in the use of opioid medications. This is supported by consistently reported lower pain scores, decreased opioid requests, and improved patient satisfaction, demonstrating VR's effectiveness in alleviating burn-related pain. In addition to its quantitative impact on pain reduction, VR also enhances the overall patient experience by promoting positive emotional states and reducing anxiety. The potential of virtual reality VR extends beyond acute pain management and can also influence rehabilitation and recovery outcomes. Integrating VR into burn care protocols has the potential to create a scalable paradigm shift in pain management. However, this depends on sufficient investment, digital literacy of healthcare personnel and patients, and regulatory support. As scientific understanding deepens, it is becoming increasingly clear that VR has a wide range of benefits for burn patients. These benefits include neurobiological modulation and individualized therapy, making VR an indispensable tool in the holistic care of burn patients.

Efficacy of Collagen and Elastin matrix in treatment of complex lower extremity wounds.

2024-07-24T20:45:53+00:00

Abstract

Background

Successful engraftment of skin grafts highly depends on the quality of the wound bed. A

good quality of blood vessels near the surface is critical to support the viability of the graft.

Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood

supply. In such situation flap s are to be resorted to. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various serious skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. In this study is done to ascertain the effectiveness of these substitutes in treatment of complex wounds .

Methodology

Between January 2022 to June 2023, 20 patients who had complex wounds which could not be treated with simple skin grafting and who are treated with collagen and elastin matrix and SSG will be retrospectively studied. The percentage of SSG take as per the records will be noted at 10 days post op period. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment will be noted.

Results

20 patients were included in the study. Minimum size of the ulcer was 5 x 4 cm (20 cms²) and maximum size of the ulcer was 15 x 15 CMS (225 cms²). Average take of skin graft was 93.7% at 10^th post op day. Recurrence at 6 months was nil. The scar quality assessed by patient and observer at 3 months and 6 months post op.

Conclusion

The lower-limb ulcers with compromised surrounding tissue are complex. Major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration which helps maximize SSG take and stable long-term scar.

Limberg flap for previously recurrent complex sacrococcygeal pilonidal sinus surgeries

2024-02-16T16:57:03+00:00

Objective: Limberg flap, is a rotational rhomboid flap. A procedure done for people who have either complex or recurrent pilonidal disease. This study has been performed to determine effects of the Limberg flap for sacrococcygeal pilonidal sinus, regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, it’s cosmetic final result and patients’ satisfaction.

Methods: A total of 10 patients were operated from January 2022 to March 2023. Patients were selected according to the disease complexity and recurrence, so that the patients selected were classified as complexes and at least of a second recurrence disease.

Results: patients successfully underwent surgery, with mild to moderate postoperative pain, stayed in hospital for average 3 days, returned to work after 6 weeks, with 5 patients having flap edema, 1 patient had wound infection, no one had having flap necrosis, and no recurrences so far for average follow up time about 3 months. Patients with flap edema took 2–3 weeks to heal with regular dressing only. Patient satisfaction and final cosmetic result were good accepted. Limberg flap for sacrococcygeal pilonidal sinus was found very useful in terms of recurrences.

Conclusion: Better patients’ acceptance and satisfaction despite the increased risk in postoperative pain, infection rates, and longer return to work in comparison to the open procedures.

Stakeholder and Patient Experiences with Virtual Reality in Burn Treatment: A Study of the Cold River Application in a Clinical Setting

2024-10-03T19:30:00+00:00

The use of virtual reality (VR) in medicine is rapidly expanding, particularly in areas like pain management, surgical training, and mental health therapy. This study examines the implementation and effects of the Cold River VR application, a fully immersive tool designed to help manage pain and anxiety during dressing changes for burn trauma patients in a Czech hospital. The Cold River application immerses patients in a peaceful, interactive virtual environment, utilizing eye-tracking technology to engage them without the need for physical controllers, which could interfere with wound care. The study included 67 participants and found that Cold River effectively distracted patients, making the often painful and anxiety-provoking dressing changes more bearable. While stakeholder interviews indicated that the VR application was generally well-received and seen as a valuable tool in reducing patient discomfort, challenges such as lengthy calibration and occasional issues with nausea and headset discomfort were noted. Importantly, the Cold River application increased patient engagement and reduced the psychological burden associated with burn care, though it also highlighted the need for customization based on individual patient preferences and conditions. Overall, the experience with Cold River suggests that immersive VR holds significant potential for improving patient care during burn treatment, particularly when tailored to specific patient needs and contexts.

Delayed two stage breast reconstruction with acellular dermal matrix

2024-02-22T07:13:27+00:00

OBJECTIVE: The aim of this study was to assess the long-term impact and potential effectiveness of our specialized acellular dermal matrix (ADM) in a two-stage breast reconstruction process.

INTRODUCTION: Opinions regarding the use of ADMs are currently divided. While their positive contribution to reconstructive breast surgery is evident, the results of studies vary depending on specific procedures, patient selection, and techniques employed.

MATERIALS AND METHODS: In a retrospective study conducted between January 2015 and October 2023, it was examined a cohort of patients who underwent delayed two-stage breast reconstruction with the addition of ADM prepared by Central Tissue Bank (CTB) the Burn and Reconstructive Surgery Department University hospital Ružinov. Our primary focus was on the occurrence of significant postoperative complications during both the initial and subsequent reconstruction periods, taking into account patients' medical history, comorbidities, and adjuvant therapy.

RESULTS: We examined a total of 46 patients (49 breasts) who underwent two-stage breast reconstruction. The average age of the patients was 46 and the average BMI was 23,1. The average length of outpatient follow-up for female patients was 32 months. We observed a total of 4 cases of capsular contracture, ranging from grade I to grade III, with 2 cases requiring surgical revision through capsulotomy and implant exchange. Postoperative complications, such as infection and dehiscence leading to expander/implant loss, occurred in one case. The occurrence of seroma was noted in 3 cases. Complications were more frequently observed in the group of patients with post-radiation chest changes and comorbidities such as diabetes or hypertension, and in patients with a lower BMI than the group's average (23,1). In the group of patients who were smokers, we did not observe an increased rate of complications, with the exception of wound dehiscence in cases where there was no expander exposure.

CONCLUSION: ADM prepared by CTB, used in delayed two-stage breast reconstruction, can, in experienced hands, be beneficial as an adjunct to prosthetic breast reconstruction while also reducing costs.

Treatment of exposed tibial bone by old school burr holes: a case report

2024-07-19T04:50:58+00:00

Background. We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone.

Most clinics would promote flap surgery to cover wounds with bone exposure however in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases.

Case. We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis (LCV) and sarcoidosis which is medicated by immunosuppressive medication.

The patient's wounds were initially treated with mechanical debridement, split-thickness skin grafts (STSG), however his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow up. The wound was ultimately treated by placing burr holes in the underlying cortical bone.

Conclusion. Treatment of chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemical disease, it is mandatory to stay away from invasive flap surgery. With this case we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

Pedicled myocutaneous trapezius flap for chronic osteomyelitis of the spinous processes – case report

2024-07-24T18:29:17+00:00

Complex injuries to the posterior trunk can still pose a significant challenge to the reconstructive surgeon. Due to the lack of skin laxity, dependent anatomical location and the importance of the deeper structures a systematic approach tailored to the individual defect should be considered for these types of reconstructions. In our case report, we present a reconstructive solution of a chronic defect of the back caused by resection of an ulceration. What was previously considered to be a relapse of a malignant melanoma turned out to be a chronic osteomyelitis of the spinous processes of the thoracic vertebrae. The defect after the resection of the ulceration and infected spinous procceses of the thoracic vertebrae with exposed dorsal lamina was covered with pedicled myocutaneous flap. Reconstruction yielded well-vascularized tissue that provided sufficient volume and tissue quality. Even in the light of modern perforator flaps, local or locoregional muscle and myocutaneous flaps remain the first choice for the treatment of deep back defects. Considering all the factors in the given case, plastic surgeons are able to tailor the reconstructive technique to every individual case to match the desired reconstruction goal.