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11 pages, 1827 KiB

Open AccessArticle

Comparative Evaluation of Tissue Adhesives and Sutures in the Management of Facial Laceration Wounds in Children

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J. Pers. Med. 2023, 13(9), 1350; https://doi.org/10.3390/jpm13091350 - 31 Aug 2023

Viewed by 813

Abstract

Background: This study evaluated tissue adhesives in comparison to sutures for treating facial lacerations in children. Methods: We retrospectively analyzed data from September 2017 to August 2022 involving pediatric facial lacerations managed with either tissue adhesives or sutures. Results: Among 50 children, 20 [...] Read more.

Background: This study evaluated tissue adhesives in comparison to sutures for treating facial lacerations in children. Methods: We retrospectively analyzed data from September 2017 to August 2022 involving pediatric facial lacerations managed with either tissue adhesives or sutures. Results: Among 50 children, 20 received tissue adhesives, and 30 received sutures. Both methods showed comparable outcomes in terms of wound complications such as dehiscence (adjusted odds ratio = 1.56, 95% CI = 0.08–31.25) and infection (adjusted odds ratio = 2.17, 95% CI = 0.08–58.80). The cosmetic outcomes, assessed using the Hollander Wound Evaluation Score, were also consistent between groups (adjusted beta = −0.55, 95% CI = −1.15–0.05). Notably, those treated with tissue adhesives reported greater satisfaction (adjusted beta = 1.13, 95% CI = 0.63 −1.63) and experienced significantly less pain (adjusted beta = −3.03, 95% CI = −4.15–−1.90). Conclusions: Both techniques displayed similar rates of infection, dehiscence, and cosmetic outcomes. However, tissue adhesives were associated with increased patient comfort, especially in terms of reduced pain and greater satisfaction. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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11 pages, 1290 KiB

Open AccessArticle

Radiological Influencing Factors in the Diagnosis of Painful Habitual Instability of the Thumb Basal Joint as a Precursor of Carpometacarpal Arthritis of the Thumb—A Retrospective Study

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Alexandru Cristian Tuca

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Hanna Luze

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Sebastian P. Nischwitz

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Birgit Michelitsch

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Herwig Friedl

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David Benjamin Lumenta

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Werner Girsch

J. Pers. Med. 2023, 13(5), 704; https://doi.org/10.3390/jpm13050704 - 22 Apr 2023

Viewed by 1170

Abstract

Background: Painful habitual instability of the thumb basal joint (PHIT) is a rarely diagnosed condition that can severely impair hand function. Furthermore, it can increase the risk of developing carpometacarpal arthritis of the thumb (CMAOT). Clinical examination and radiographic imaging provide the foundation [...] Read more.

Background: Painful habitual instability of the thumb basal joint (PHIT) is a rarely diagnosed condition that can severely impair hand function. Furthermore, it can increase the risk of developing carpometacarpal arthritis of the thumb (CMAOT). Clinical examination and radiographic imaging provide the foundation for a correct diagnosis, but early detection is still challenging. We investigated two objective, radiographically obtainable parameters as potential risk factors for PHIT. Methods: Clinical data and radiographic images of 33 patients suffering from PHIT were collected and compared to those of 35 people serving as the control group. The two main objectives, the slope angle and the bony offset of the thumb joint, were gathered from the X-rays and statistically analyzed. Results: The analysis showed no differences between the study and the control group concerning the slope angle. Gender and the bony offset, on the other hand, had a significant influence. Female sex and higher offset values were associated with an increased risk of PHIT. Conclusions: The results of this study prove a connection between a high bony offset and PHIT. We believe this information can be valuable in early detection and will allow more efficient treatment of this condition in the future. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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11 pages, 3663 KiB

Open AccessArticle

Effects of Aerobic Exercise in the Intensive Care Unit on Patient-Reported Physical Function and Mental Health Outcomes in Severely Burned Children—A Multicenter Prospective Randomized Trial

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J. Pers. Med. 2023, 13(3), 455; https://doi.org/10.3390/jpm13030455 - 28 Feb 2023

Viewed by 897

Abstract

Severe burns are life-altering and can have lasting effects on patients’ physical and mental health. Alterations in physical function, changes in appearance, and psychological disturbances resulting from severe burns are especially concerning in children, as they are still in the early stages of [...] Read more.

Severe burns are life-altering and can have lasting effects on patients’ physical and mental health. Alterations in physical function, changes in appearance, and psychological disturbances resulting from severe burns are especially concerning in children, as they are still in the early stages of identity formation. Exercise in the nonburn population has been shown to improve quality of life and result in better physical and mental status. However, the effect of early exercise on the quality of life in pediatric burn patients requires more research. Methods: Forty-eight children between the ages of seven and seventeen with ≥30% total body surface area (TBSA) burn were randomized in a 1:2 fashion to receive treatment with standard-of-care (SOC) or standard-of-care plus exercise (SOC+Ex). Surveys administered at admission and discharge collected patient-reported information regarding physical and mental health outcomes. The results are given as means +/− standard deviation. Significance was set at p < 0.05. Results: The average age of the SOC and SOC+Ex groups were 12 ± 3 and 13 ± 4 years, respectively. The average %TBSA burned in the SOC and SOC+Ex groups were 54 ± 17 and 48 ± 14, respectively. The SOC+Ex group averaged 10 ± 9 exercise sessions (range of 1 to 38 sessions) with an attendance rate of 25% (10 sessions out of 40 BICU days). Both groups demonstrated significant improvement in patient-reported physical and mental outcomes during hospital admission (p < 0.05) However, additional exercise did not exhibit any additional benefits for measured levels. Conclusions: Our recommendation is for all pediatric patients in the BICU to continue with the SOC and consult with their physician over the benefits of additional aerobic exercise. This study suggests that perhaps there is potential for increasing the amount of exercise that can be administered to pediatric burn survivors beyond SOC as we did not find aerobic exercise to be of any harm to any patients if it is performed properly and under supervision. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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10 pages, 730 KiB

Open AccessArticle

Introducing the “SIMline”—A Simulation Course in the Management of Severe Burns as a Tool in Undergraduate Medical Education

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Isabel Sawetz

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Sophie Hasiba-Pappas

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Lars-Peter Kamolz

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Judith C. J. Holzer-Geissler

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Alexandru Cristian Tuca

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David Benjamin Lumenta

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Thomas Wegscheider

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Hanna Luze

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Sebastian P. Nischwitz

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Raimund Winter

J. Pers. Med. 2023, 13(2), 338; https://doi.org/10.3390/jpm13020338 - 15 Feb 2023

Viewed by 1220

Abstract

Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the “SIMline”, [...] Read more.

Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the “SIMline”, a simulation training program explicitly designed for coaching medical students in burn management. Methods: A total of 43 students participated in the “SIMline” course, which took place at the training facility at the Medical University of Graz, between 2018 and 2019. The course provided theoretical classes, practical exercises, and a full-scale care process simulation training. The learning progress of the students was monitored via a formative integrated test. Results: Students showed great progress throughout the course of the “SIMline” program, as their test scores improved by an average of 88%. The passing rate was 0% at the first exam (prior to course) as compared to 87% at the final exam, taken after the training. Conclusions: Comprehensive practical training programs in burn care are underrepresented in medical education. The “SIMline” course presents a novel and effective approach in training medical students in burn management. However, follow-up evaluation is necessary to confirm long-term educational benefits. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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12 pages, 38891 KiB

Open AccessArticle

Modified Keystone Perforator Island Flap Techniques for Small- to Moderate-Sized Scalp and Forehead Defect Coverage: A Retrospective Observational Study

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J. Pers. Med. 2023, 13(2), 329; https://doi.org/10.3390/jpm13020329 - 15 Feb 2023

Cited by 1 | Viewed by 2348

Abstract

We aimed to demonstrate the effective application of keystone perforator island flap (KPIF) in scalp and forehead reconstruction by demonstrating the authors’ experience with modified KPIF reconstruction for small- to moderate-sized scalp and forehead defects. Twelve patients who underwent modified KPIF reconstruction of [...] Read more.

We aimed to demonstrate the effective application of keystone perforator island flap (KPIF) in scalp and forehead reconstruction by demonstrating the authors’ experience with modified KPIF reconstruction for small- to moderate-sized scalp and forehead defects. Twelve patients who underwent modified KPIF reconstruction of the scalp and forehead from September 2020 to July 2022 were enrolled in this study. In addition, we retrospectively reviewed and evaluated the patient’s medical records and clinical photographs. All defects (size range, 2 cm × 2 cm to 3 cm × 7 cm) were successfully covered using four modified KPIF techniques (hemi-KPIF, Sydney Melanoma Unit Modification KPIF, omega variation closure KPIF, and modified type II KPIF) with ancillary procedures (additional skin grafts and local flaps). All flaps (size range, 3.5 cm × 4 cm to 7 cm × 16 cm) fully survived, and only one patient developed marginal maceration that healed with conservative management. Furthermore, through the final scar evaluation with the patient satisfaction survey and Harris 4-stage scale, all patients were satisfied with their favorable outcomes at the average final follow-up period of 7.66 ± 2.14 months. The study showed that the KPIF technique with appropriate modifications is an excellent reconstructive modality for covering scalp and forehead defects. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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10 pages, 922 KiB

Open AccessArticle

Personalized Treatment Decisions for Traumatic Proximal Finger Amputations: A Retrospective Cohort Study

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J. Pers. Med. 2023, 13(2), 215; https://doi.org/10.3390/jpm13020215 - 26 Jan 2023

Cited by 1 | Viewed by 3130

Abstract

Ray and proximal phalanx amputations present valid surgical options for the management of severe traumatic finger injuries. However, among these procedures, the superior one for optimal functionality and quality of life for patients still remains unknown. This retrospective cohort study compares the postoperative [...] Read more.

Ray and proximal phalanx amputations present valid surgical options for the management of severe traumatic finger injuries. However, among these procedures, the superior one for optimal functionality and quality of life for patients still remains unknown. This retrospective cohort study compares the postoperative effects of each amputation type to provide objective evidence and to create a paradigm for clinical decision-making. A total of forty patients who had received either ray or proximal phalanx-level amputations reported on their functional outcomes using a combination of questionnaires and clinical testing. We found a decreased overall DASH score following ray amputation. Particularly, Part A and Part C of the DASH questionnaire were consistently lower compared with amputation at the proximal phalanx. Pain measurements in the affected hand were also significantly decreased during work and at rest in ray amputation patients, and they reported decreased cold sensitivity. Range of motion and grip strength were lower in ray amputations, which is an important preoperative consideration. We found no significant differences in reported health condition, evaluated according to the EQ-5D-5L, and blood circulation in the affected hand. We present an algorithm for clinical decision-making based on patients’ preferences to personalize treatment. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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11 pages, 1001 KiB

Open AccessArticle

Risk Stratification of Local Flaps and Skin Grafting in Skin Cancer-Related Facial Reconstruction: A Retrospective Single-Center Study of 607 Patients

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Frederik Penzien Wainer Mamsen

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Claes Hannibal Kiilerich

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Jørgen Hesselfeldt-Nielsen

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Iselin Saltvig

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Celine Lund-Nielsen Remvig

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Hannah Trøstrup

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Volker-Jürgen Schmidt

J. Pers. Med. 2022, 12(12), 2067; https://doi.org/10.3390/jpm12122067 - 15 Dec 2022

Cited by 3 | Viewed by 1580

Abstract

Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications [...] Read more.

Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications in relation to full-thickness skin grafts (FTSG) or local flaps in 607 patients who underwent facial surgery and reconstruction at a high-volume center for facial cancer surgery at a tertiary university hospital. Results: Between 01.12.2017 and 30.11.2020, 304 patients received reconstructive flap surgery and 303 received FTSG following skin cancer removal in the face. Flap reconstruction was predominantly performed in the nasal region (78%, n = 237), whereas FTSG reconstruction was performed in the nasal (41,6%, n = 126), frontal (19.8%, n = 60), and temporal areas (19.8%, n = 60), respectively. Patients undergoing FTSGs had a significantly higher risk of hematoma (p = 0.003), partial necroses (p < 0.001), and total necroses (p < 0.001) compared to flap reconstruction. Age and sex increased the risk of major complications (hematoma, partial or total necrosis, wound dehiscence, or infection) for FTSG, revealing that men exhibited 3.72 times increased risk of major complications compared to women reconstructed with FTSG. A tumor size above 15 mm increased the risk of hematoma and necrosis significantly. In summary, local flaps for facial reconstruction after skin cancer provide lower complication rate compared with FTSGs, especially in elderly and/or male patients. The indication for FTSG should be considered critically if the patient’s tumor size and location allow for both procedures. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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16 pages, 2641 KiB

Open AccessArticle

Treatment of Complex Wounds with NovoSorb^® Biodegradable Temporising Matrix (BTM)—A Retrospective Analysis of Clinical Outcomes

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J. Pers. Med. 2022, 12(12), 2002; https://doi.org/10.3390/jpm12122002 - 03 Dec 2022

Cited by 1 | Viewed by 2190

Abstract

Complex and chronic wounds represent a highly prevalent condition worldwide that requires a multimodal and interdisciplinary treatment approach to achieve good functional and aesthetic outcomes. Due to increasing costs of health care, an aging population and an increase in difficult-to-treat microbial colonization of [...] Read more.

Complex and chronic wounds represent a highly prevalent condition worldwide that requires a multimodal and interdisciplinary treatment approach to achieve good functional and aesthetic outcomes. Due to increasing costs of health care, an aging population and an increase in difficult-to-treat microbial colonization of wounds, complex wounds will become a substantial clinical, social and economic challenge in the upcoming years. In plastic reconstructive surgery, a variety of dermal skin substitutes have been established for clinical use. Since its approval as a dermal skin substitute in Germany, NovoSorb^® Biodegradable Temporising Matrix (BTM) has become a valuable therapeutic option for the treatment of full-thickness wound defects. The clinical data published to date are limited to case reports and small-scale case series with the main focus on single wounds. The aim of this single-center study was a retrospective analysis of our own patient collective that has received treatment with BTM for complex wounds. Overall, BTM showed to be a reliable and versatile reconstructive option, especially for patients with multiple co-morbidities and microbiologically colonized wounds. Although the preliminary findings have produced promising results, further investigation and research are warranted regarding long-term outcomes and additional clinical applications. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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13 pages, 2507 KiB

Open AccessArticle

In Vitro Differentiation of Myoblast Cell Lines on Spider Silk Scaffolds in a Rotating Bioreactor for Vascular Tissue Engineering

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J. Pers. Med. 2022, 12(12), 1986; https://doi.org/10.3390/jpm12121986 - 01 Dec 2022

Cited by 1 | Viewed by 1149

Abstract

Functional construction of tissue-engineered vessels as an alternative to autologous vascular grafts has been shown to be feasible, however the proliferation of seeded smooth-muscle cells remains a limiting factor. We employed a rotating bioreactor system to improve myoblast cell differentiation on a spider [...] Read more.

Functional construction of tissue-engineered vessels as an alternative to autologous vascular grafts has been shown to be feasible, however the proliferation of seeded smooth-muscle cells remains a limiting factor. We employed a rotating bioreactor system to improve myoblast cell differentiation on a spider silk scaffold for tissue-engineered vessel construction. C2C12 myofibroblast cells were seeded on the surface of spider silk scaffold constructs and cultivated in a rotating bioreactor system with a continuous rotation speed (1 rpm). Cell function, cell growth and morphological structure and expression of biomarkers were analyzed using scanning electron microscopy, the LIVE/DEAD^® assay, Western blot and quantitative real-time PCR analyses. A dense myofibroblast cell sheet could be developed which resembled native blood vessel muscular tissue in morphological structure and in function. Bioreactor perfusion positively affected cell morphology, and increased cell viability and cell differentiation. The expression of desmin, MYF5 and MEF2D surged as an indication of myoblast differentiation. Cell-seeded scaffolds showed a tear-down at 18 N when strained at a set speed (20 mm min⁻¹). Spider silk scaffolds appear to offer a reliable basis for engineered vascular constructs and rotating bioreactor cultivation may be considered an effective alternative to complex bioreactor setups to improve cell viability and biology. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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13 pages, 1311 KiB

Open AccessArticle

The Postsurgical Clavien–Dindo Classification in Minor Surgery Can Improve Perception and Communication (Investigation on Blepharoplasty)

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Gertraud Eylert

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Christina Wolfsberger

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Frederike Reischies-Meikl

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David Benjamin Lumenta

J. Pers. Med. 2022, 12(11), 1900; https://doi.org/10.3390/jpm12111900 - 14 Nov 2022

Cited by 1 | Viewed by 1046

Abstract

The postsurgical Clavien–Dindo classification in minor surgery can improve perception and communication (Investigation on Blepharoplasty). Background: Minor surgery lacks a standardized postoperative complication classification. This leads to the presentation of inaccurate postsurgical complication rates and makes comparisons challenging, especially for patients seeking information. [...] Read more.

The postsurgical Clavien–Dindo classification in minor surgery can improve perception and communication (Investigation on Blepharoplasty). Background: Minor surgery lacks a standardized postoperative complication classification. This leads to the presentation of inaccurate postsurgical complication rates and makes comparisons challenging, especially for patients seeking information. This study aims to evaluate a standardized five-step complication grading system (Clavien–Dindo Classification, CDC) on the example of blepharoplasty, which is the most performed minor aesthetic surgery worldwide. Methods: A retrospective observational exploratory study of patients (N = 344) who received a bilateral upper eyelid blepharoplasty under local anesthesia from the same surgical staff was performed. Data were retrieved from the electronic patient record: the CDC grading and the surgeon-reported complications (N = 128) at the first follow-up on day 7. In addition, a telephone survey with patients (N = 261) after 6 months was performed, which consisted of 7 complication-related yes/no questions. Results: Based on the CDC, 41.6% of patients were classified as having no complications, and 58.4% had one. Furthermore, 1 patient (0.3%) received a revision under general anesthesia (CDC IIIb), 18 patients (5.2%) were re-operated under local anesthesia (CDC IIIa), 23 patients (6.7%) required pharmacological intervention (CDC II), and 159 patients (46.2%) had a complication from the normal postoperative course and received supportive treatment (CDC I). Moreover, 90.5% of the mentioned complications accounted for Grade I and II; 94% of the patients subjectively experienced no complications; 51% of patients were pleased with the surgery even though a complication occurred according to the CDC; 34% of complications escaped the awareness of the surgeon. Conclusions: Grade I and II complications occurred frequently. Complications escaped the perception of the patients and surgeons. The classification identifies a wide variety of postsurgical complications and allows a standardized comparison in minor surgery objectively. Potential: The CDC in minor procedures can improve the (institutional) preoperative communication with patients regarding potential postoperative expectations. Furthermore, the classification can be a useful tool to detect complication-related costs, identify insurance-related requests, and support evidence in medicolegal disputes. The example of blepharoplasty can be translated to various other and even less invasive procedures. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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8 pages, 1372 KiB

Open AccessArticle

Suction Drain Volume following Axillary Lymph Node Dissection for Melanoma—When to Remove Drains? A Retrospective Cohort Study

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Judith C. J. Holzer-Geissler

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David Benjamin Lumenta

J. Pers. Med. 2022, 12(11), 1862; https://doi.org/10.3390/jpm12111862 - 07 Nov 2022

Viewed by 1270

Abstract

Postoperative complications such as seroma formation and wound-site infection occur following completion axillary lymph node dissection (ALND) for melanoma. We analyzed the impact of time-to-drain removal and drainage volume on seroma formation after ALND. We retrospectively analyzed data from 118 patients after completion [...] Read more.

Postoperative complications such as seroma formation and wound-site infection occur following completion axillary lymph node dissection (ALND) for melanoma. We analyzed the impact of time-to-drain removal and drainage volume on seroma formation after ALND. We retrospectively analyzed data from 118 patients after completion ALND for melanoma. Primary endpoints were daily amount of drainage volume, seroma formation and time-to-drain removal. Secondary endpoints included patient-related, disease-specific and perioperative parameters as well as the number of histologically analyzed lymph nodes and surgical complications graded by the Clavien–Dindo classification (CDCL). Statistical analyses were performed using logistic regression models. Drain removal around the 8th postoperative day was statistically associated with a lower risk for the occurrence of seroma formation (p < 0.001). Patients with an increased drainage volume during the early postoperative days were more prone to develop seroma after drain removal. With 49% (CDCL I and II), most complications were managed conservatively, while only 5.9% (CDCL III) required revision surgery (CDCL overall: 55.9%). ALND is a safe procedure with a low rate of severe CDCL III type of complications. To decrease seroma evacuation, our results imply that drains should be removed around the 8th postoperative day to reduce the risk of infection, readmission or prolonged hospitalization. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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7 pages, 707 KiB

Open AccessArticle

Inferior Pedicle Reduction Mammoplasty as Corrective Surgery after Breast Conserving Surgery and Radiation Therapy

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J. Pers. Med. 2022, 12(10), 1569; https://doi.org/10.3390/jpm12101569 - 23 Sep 2022

Viewed by 1075

Abstract

Background/Aim—Twenty patients had corrective reconstruction surgery by means of a reduction mammaplasty or mastopexy after a previous BCS (Breast Conserving Surgery) and RT (Radiation Therapy); the risk factors and post-operative complications were reported in order to define a safe and effective technique for [...] Read more.

Background/Aim—Twenty patients had corrective reconstruction surgery by means of a reduction mammaplasty or mastopexy after a previous BCS (Breast Conserving Surgery) and RT (Radiation Therapy); the risk factors and post-operative complications were reported in order to define a safe and effective technique for reduction mammaplasty in previously irradiated breast cancer patients. Materials and Methods—From June 2011 to December 2019, 20 pts. were operated on at the Breast Surgery Clinic of San Martino Policlinic Hospital, Genoa, Italy. Pre- and post-operative parameters included clinic-pathological features of the primary tumor; a lapse of time from primary radio-surgery; the extent of follow-up; the rate of post-operative wound infections; the persistence of breast asymmetry, and a post-operative patient satisfaction index by means of a BREAST-Q questionnaire. Results—Three patients (15%) developed minor complications in the irradiated breast, but no complication was observed into the non-irradiated breast. No statistically significant correlation was found between the post-operative complications and the risk factors. The statistical analysis of BREAST-Q questionnaire responses gave an average patient’s satisfaction index that was equal to 90.8/100 (range: 44 to 100). Conclusions—Inferior pedicle reduction mammoplasty is an effective reduction mammoplasty technique in regard to the extent of breast tissues that are to be removed both in irradiated and contralateral breast; moreover, the incidence of post-operative complications is clearly limited when a careful technique is adopted, and it can be reasonably applied also in patients with co-morbidity factors. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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11 pages, 815 KiB

Open AccessArticle

A Randomized Controlled Trial of Three Advanced Wound Dressings in Split-Thickness Skin Grafting Donor Sites—A Personalized Approach?

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Andrzej Hecker

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David Benjamin Lumenta

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J. Pers. Med. 2022, 12(9), 1395; https://doi.org/10.3390/jpm12091395 - 27 Aug 2022

Cited by 1 | Viewed by 2214

Abstract

Background: Split-thickness skin grafting (STSG) is a frequently used reconstructive technique, and its donor site represents a standardized clinical model to evaluate wound dressings. We compared hydroactive nanocellulose-based, silver-impregnated and ibuprofen-containing foam wound dressings. Methods: A total of 46 patients scheduled for elective [...] Read more.

Background: Split-thickness skin grafting (STSG) is a frequently used reconstructive technique, and its donor site represents a standardized clinical model to evaluate wound dressings. We compared hydroactive nanocellulose-based, silver-impregnated and ibuprofen-containing foam wound dressings. Methods: A total of 46 patients scheduled for elective surgery were evaluated on the STSG donor site for wound healing (time-to-healing, Hollander Wound Evaluation Scale), pain level (Visual Analogue Scale), and handling (ease of use), as well as scar quality (Patient Scar Assessment Scale, Vancouver Scar Scale) after 3, 6 and 12 months. Results: Almost all dressings compared equally well. We observed statistically relevant differences for pain level favoring the ibuprofen-containing dressing (p = 0.002, ΔAIC = 8.1), and user friendliness in favor of nanocellulose (dressing removal: p = 0.037, ΔAIC = 2.59; application on patient: p = 0.042, ΔAIC = 2.33; wound adhesion: p = 0.017, ΔAIC = 4.16; sensation on skin: p = 0.027, ΔAIC = 3.21). We did not observe any differences for wound healing across all groups. Treatment with hydroactive nanocellulose and the ibuprofen-containing foam revealed statistically relevant better scar appearances as compared to the silver wound dressing (p < 0.001, ΔAIC = 14.77). Conclusion: All wound dressings performed equally well, with the detected statistical differences hinting future directions of clinical relevance. These include the reserved use of silver containing dressings for contaminated or close to contaminated wounds, and the facilitated clinical application of the nanocellulose dressing, which was the only suitable candidate in this series to be impregnated with a range of additional therapeutic agents (e.g., disinfectants and pain-modulating drugs). Personalized donor site management with the tested dressings can meet individual clinical requirements after STSG and improve management strategies and ultimately patient outcomes. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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Review

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13 pages, 1061 KiB

Open AccessReview

Clinical Applications of Three-Dimensional Printing in Upper Extremity Surgery: A Systematic Review

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David Benjamin Lumenta

J. Pers. Med. 2023, 13(2), 294; https://doi.org/10.3390/jpm13020294 - 06 Feb 2023

Cited by 2 | Viewed by 1117

Abstract

Three-dimensional printing for medical applications in surgery of the upper extremity has gained in popularity as reflected by the increasing number of publications. This systematic review aims to provide an overview of the clinical use of 3D printing in upper extremity surgery. Methods: [...] Read more.

Three-dimensional printing for medical applications in surgery of the upper extremity has gained in popularity as reflected by the increasing number of publications. This systematic review aims to provide an overview of the clinical use of 3D printing in upper extremity surgery. Methods: We searched the databases PubMed and Web of Science for clinical studies that described clinical application of 3D printing for upper extremity surgery including trauma and malformations. We evaluated study characteristics, clinical entity, type of clinical application, concerned anatomical structures, reported outcomes, and evidence level. Results: We finally included 51 publications with a total of 355 patients, of which 12 were clinical studies (evidence level II/III) and 39 case series (evidence level IV/V). The types of clinical applications were for intraoperative templates (33% of a total of 51 studies), body implants (29%), preoperative planning (27%), prostheses (15%), and orthoses (1%). Over two third of studies were linked to trauma-related injuries (67%). Conclusion: The clinical application of 3D printing in upper extremity surgery offers great potential for personalized approaches to aid in individualized perioperative management, improvement of function, and ultimately help to benefit certain aspects in the quality of life. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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Other

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10 pages, 8096 KiB

Open AccessCase Report

Metacarpophalangeal Joint Reconstruction of a Complex Hand Injury with a Vascularized Lateral Femoral Condyle Flap Using an Individualized 3D Printed Model—A Case Report

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J. Pers. Med. 2023, 13(11), 1570; https://doi.org/10.3390/jpm13111570 - 02 Nov 2023

Viewed by 457

Abstract

This case report describes the surgical management of a patient with a complex hand trauma. This injury included tendon, vascular, and nerve injuries, a partial amputation of the index finger, fractures of the third proximal phalanx, and destruction of the metacarpophalangeal joint of [...] Read more.

This case report describes the surgical management of a patient with a complex hand trauma. This injury included tendon, vascular, and nerve injuries, a partial amputation of the index finger, fractures of the third proximal phalanx, and destruction of the metacarpophalangeal joint of the fifth finger. Firstly, the acute treatment of a complex hand injury is described. Secondly, the planning and execution of a joint reconstruction using a vascularized lateral femoral condylar flap, assisted by an individual 3D model, is illustrated. Precise reconstruction of the affected structures resulted in good revascularization as well as an anatomical bone consolidation. Intensive physical therapy, including autonomous proprioceptive range-of-motion exercises by the patient, resulted in significant functional improvement of the hand in daily life. Overall, we report on the successful reconstruction of a metacarpophalangeal joint by using a vascularized flap from the lateral femoral condyle. Furthermore, this case report highlights the efficacy of integrating individualized 3D printing technology to plan complex reconstructions, opening up promising opportunities for personalized and optimized interventions. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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8 pages, 564 KiB

Open AccessBrief Report

Textured vs. Smooth Breast Implants Using the Jones Criteria—What Is the Currently Available Evidence for BIA-ALCL?: A Systematic Review

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David Benjamin Lumenta

J. Pers. Med. 2023, 13(5), 816; https://doi.org/10.3390/jpm13050816 - 11 May 2023

Cited by 1 | Viewed by 980

Abstract

Breast-Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) is a rare low-incidence type of T-cell non-Hodgkin lymphoma, arising in the capsule around breast implants, and predominantly associated with the use of macro-textured breast implants. The purpose of this study was to use an evidence-based approach to [...] Read more.

Breast-Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) is a rare low-incidence type of T-cell non-Hodgkin lymphoma, arising in the capsule around breast implants, and predominantly associated with the use of macro-textured breast implants. The purpose of this study was to use an evidence-based approach to systematically identify clinical studies comparing smooth and textured breast implants in women with regard to the risk of developing BIA-ALCL. Methods: A literature search in PubMed in April 2023 and the article reference list of the French National Agency of Medicine and Health Products decision from 2019 were screened for applicable studies. Only clinical studies where the Jones surface classification could be applied (required information: breast implant manufacturer) for comparison of smooth and textured breast implants were considered. Results: From a total of 224 studies, no articles were included due to the lack of fit to the strict inclusion criteria. Conclusions: Based on the scanned and included literature, implant surface types in relation to the incidence of BIA-ALCL were not evaluated in clinical studies and data from evidence-based clinical sources plays a minor to no role in this context. An international database that combines breast implant-related data from (national, opt-out) medical device registries is, therefore, the best available option to obtain relevant long-term breast implant surveillance data on BIA-ALCL. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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8 pages, 886 KiB

Open AccessBrief Report

The Sinus Tract in Bone and Joint Infection: Minimally Invasive Salvation or Prolonged Suffering? A Multicenter Study

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Sebastian Martin Klim

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Irene Katharina Sigmund

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Andrzej Hecker

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Patrick Reinbacher

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Lukas Leitner

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Gerwin Alexander Bernhardt

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Andreas Leithner

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Sophie Wanko

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Mathias Glehr

J. Pers. Med. 2023, 13(5), 737; https://doi.org/10.3390/jpm13050737 - 26 Apr 2023

Viewed by 1857

Abstract

This study assessed the quality of life (QOL) and the functional outcome in daily living in patients with a chronic, treatment-resistant periprosthetic joint infection (PJI) or osteomyelitis, living with a natural or iatrogenic sinus tract. Methods: A follow-up examination in three national reference [...] Read more.

This study assessed the quality of life (QOL) and the functional outcome in daily living in patients with a chronic, treatment-resistant periprosthetic joint infection (PJI) or osteomyelitis, living with a natural or iatrogenic sinus tract. Methods: A follow-up examination in three national reference centers for septic bone and joint surgery was performed utilizing the Hospital Anxiety and Depression Scale (HADS-D/A), the Visual Analogue Scale (VAS), and the Short Form-36 (SF-36) score, including patients with a chronic sinus tract due to treatment-resistant PJI or osteomyelitis. Results: In total, 48 patients were included, with a mean follow-up time of 43.1 ± 23.9 months. The mean SF-36 Mental Component Summary (MCS) was 50.2 (±12.3) and the Physical Component Summary (PCS) was 33.9 (±11.3). The mean HADS-D was 6.6 (±4.4) and HADS-A was 6.2 (±4.6), and the VAS was 3.4 (±2.6). The SF-36 MCS showed no significant differences between the study group and the standard population (47.0, p = 0.10), as well as the HADS-A. The PCS in the study population was significantly worse (50.0, p < 0.001), as was the HADS-D. Conclusions: A sinus tract represents a treatment option in selected cases with an acceptable QOL. The treatment should be considered for multimorbid patients with a high perioperative risk or if the bone or soft tissue quality prevents surgery. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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13 pages, 841 KiB

Open AccessSystematic Review

Does Electrical Stimulation through Nerve Conduits Improve Peripheral Nerve Regeneration?—A Systematic Review

by

Sophie Hasiba-Pappas

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Lars-P. Kamolz

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Hanna Luze

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Sebastian P. Nischwitz

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Judith C. J. Holzer-Geissler

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Alexandru Cristian Tuca

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J. Pers. Med. 2023, 13(3), 414; https://doi.org/10.3390/jpm13030414 - 26 Feb 2023

Cited by 1 | Viewed by 1330

Abstract

Background: Peripheral nerve injuries affect over 2% of trauma patients and can lead to severe functional impairment and permanent disability. Autologous nerve transplantation is still the gold standard in the reconstruction of nerve defects. For small defects, conduits can be considered for bridging. [...] Read more.

Background: Peripheral nerve injuries affect over 2% of trauma patients and can lead to severe functional impairment and permanent disability. Autologous nerve transplantation is still the gold standard in the reconstruction of nerve defects. For small defects, conduits can be considered for bridging. Lately, the combined use of conduits and electrical stimulation has gained attention in the treatment of peripheral nerve injury. This review aimed to present the currently available data on this topic. Methods: PubMed, Embase, Medline and the Cochrane Library were searched for studies on electrical stimulation through nerve conduits for nerve defects in in vivo studies. Results: Fifteen studies fit the inclusion criteria. All of them reported on the application of nerve conduits combined with stimulation for sciatic nerve gaps in rats. Functional, electrophysiological and histological evaluations showed improved nerve regeneration after electrical stimulation. High variation was observed in the treatment protocols. Conclusion: Electrically stimulated conduits could improve peripheral nerve regeneration in rat models. The combined application of nerve guidance conduits and electrical stimulation shows promising results and should be further evaluated under standardized conditions. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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