Life | Special Issue : Skin, Wound, Plastic Surgery and Hand Surgery

Research

12 pages, 841 KiB

Open AccessArticle

Confronting a New Challenge in Plastic Surgery: MDR Infections in Patients with Chronic Wounds

by Laura Răducu, Oriana Elena Moraru, Daniela-Elena Gheoca-Mutu, Teodora Peligrad, Andrada-Elena Țigăran, Abdalah Abu-Baker, Daniela-Elena Ion, Bogdan Mihai Ursuț, Cristian-Radu Jecan and Adelaida Avino

Life 2024, 14(4), 444; https://doi.org/10.3390/life14040444 - 27 Mar 2024

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Abstract

Background: The presence of a wound can be anywhere from non-problematic to life-threatening on a severity spectrum, with bacterial infection and resistance playing a major role in the development of chronicity, delaying wound healing. Wound colonization with multiple organisms and the limited number [...] Read more.

Background: The presence of a wound can be anywhere from non-problematic to life-threatening on a severity spectrum, with bacterial infection and resistance playing a major role in the development of chronicity, delaying wound healing. Wound colonization with multiple organisms and the limited number of effective antibiotics place a heavy burden on the healthcare system, with patients going through multiple surgeries during a prolonged hospitalization time. By analyzing the resistance patterns of pluri-bacterial populations and the approach used in managing complex cases, we aim to improve the protocols applied in caring for chronic wounds in our practice and share our experiences and observations. Methods: We designed a retrospective study on 212 diabetic and non-diabetic patients, aiming to evaluate the course of chronic wound treatment in our practice. We focused on the impact that MDR bacteria and diabetes have on surgical outcomes and their role in the healing process. Results: Patients who received empiric antibiotic therapy before being admitted eventually presented with multiple MDR bacteria compared to those who did not receive antibiotics (p = 0.014). The presence of at least one MDR bacteria in the wound bed was associated with ulcers reaching bone (p = 0.02) and was positively correlated with the number of surgeries performed (p < 0.001). Diabetes played a significant role in surgery-related complications (p = 0.02) and hospitalization time (p < 0.001). Conclusions: Proper management of chronic wounds requires a comprehensive, multidisciplinary approach and a thorough understanding of antibiotic usage. To address this need, we have developed and implemented a chronic wound treatment protocol in our clinic, with the goal of discharging patients once their ulcers have been treated and closed. A key summary of the protocol presented is to reduce the incidence of MDR bacteria and improve the patient’s quality of life. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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13 pages, 1799 KiB

Open AccessArticle

The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders

by Christian Smolle, Judith C. J. Holzer-Geissler, Patrick Mandal, Jessica Schwaller, Gert Petje, Johannes Rois, Lars-Peter Kamolz and Werner Girsch

Life 2024, 14(3), 318; https://doi.org/10.3390/life14030318 - 28 Feb 2024

Viewed by 639

Abstract

The vascularized fibula transfer is a well-established technique for extremity reconstruction, but operative planning and patient selection remains crucial. Although recently developed techniques for bone reconstruction, such as bone segment transfer, are becoming increasingly popular, bone defects may still require vascularized bone grafts [...] Read more.

The vascularized fibula transfer is a well-established technique for extremity reconstruction, but operative planning and patient selection remains crucial. Although recently developed techniques for bone reconstruction, such as bone segment transfer, are becoming increasingly popular, bone defects may still require vascularized bone grafts under certain circumstances. In this study, 41 cases, 28 (68%) men and 13 (32%) women (median age: 40 years), were retrospectively analyzed. Therapy-specific data (flap vascularity [free vs. pedicled] size in cm and configuration [single- vs. double-barrel], mode of fixation [internal/external]) and potential risk factors were ascertained. Indications for reconstruction were osteomyelitis at host site (n = 23, 55%), pseudarthrosis (n = 8, 20%), congenital deformity (n = 6, 15%), traumatic defect, and giant cell tumor of the bone (n = 2, 5% each). Complete healing occurred in 34 (83%) patients after a median time of 6 months. Confounders for prolonged healing were female gender (p = 0.002), reconstruction in the lower limb (p = 0.011), smoking (p = 0.049), and the use of an external fixator (p = 0.009). Six (15%) patients required secondary limb amputation due to reconstruction failure, and one patient had persistent pseudarthrosis at last follow-up. The only risk factor for amputation assessed via logistic regression analysis was preexisting PAOD (peripheral artery occlusive disease; p = 0.008) The free fibula is a reliable tool for extremity reconstruction in various cases, but time to full osseous integration may exceed six months. Patients should be encouraged to cease smoking as it is a modifiable risk factor. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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13 pages, 1126 KiB

Open AccessArticle

Objective Non-Invasive Bio-Parametric Evaluation of Regenerated Skin: A Comparison of Two Acellular Dermal Substitutes

by Silvia Rampazzo, Marco Ferrari, Maria Alessandra Sotgiu, Gabriella Piu, Maria Giuliana Solinas, Noemi Usai, Antonio Bulla, Pietro Luciano Serra, Federica Grieco, Andrea Montella, Vittorio Mazzarello and Corrado Rubino

Life 2024, 14(1), 121; https://doi.org/10.3390/life14010121 - 15 Jan 2024

Viewed by 774

Abstract

Several dermal substitutes are available on the market, but there is no precise indication that helps surgeons choose the proper one. Few studies have tried to compare different xenogeneic bioengineered products, but no objective bio-parametric comparison has been made yet. Fifteen patients who [...] Read more.

Several dermal substitutes are available on the market, but there is no precise indication that helps surgeons choose the proper one. Few studies have tried to compare different xenogeneic bioengineered products, but no objective bio-parametric comparison has been made yet. Fifteen patients who underwent skin reconstruction with Integra^® or Pelnac^® were retrospectively evaluated. After at least 12 months of follow-up, an objective and quantitative assessment of several skin biophysical properties, such as color, texture, elasticity, hydration, glossiness and trans-epidermal water loss, were measured with non-invasive skin measurement devices. The grafted skin showed a reduction of the superficial hydration level and a tendency to lower values of trans-epidermal water loss with both dermal substitutes. Melanic and hemoglobin pigmentation were higher in comparison to the donor site in both groups, while a melanic pigmentation increase versus the surrounding skin was seen just with Integra^®. Finally, the skin was found to be more elastic when reconstructed with Integra^®. The skin barrier appeared to be intact in both groups. Hence, these substitutes are valuable means of skin regeneration. Integra^® seems to be more advantageous for reconstructing areas that need more skin flexibility. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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11 pages, 1142 KiB

Open AccessArticle

The Implications of a Dermatopathologist’s Report on Melanoma Diagnosis and Treatment

by Asher Nethanel, Christofis Kyprianou, Aviv Barzilai, Ronnie Shapira-Frommer, Yaron Shoham, Rachel Kornhaber, Michelle Cleary, Galit Avinoam-Dar, Shirly Grynberg, Josef Haik, Assaf Debby and Moti Harats

Life 2023, 13(9), 1803; https://doi.org/10.3390/life13091803 - 24 Aug 2023

Viewed by 848

Abstract

An accurate and comprehensive histopathology report is essential for cutaneous melanoma management, providing critical information for accurate staging and risk estimation and determining the optimal surgical approach. In many institutions, a review of melanoma biopsy specimens by expert dermatopathologists is considered a necessary [...] Read more.

An accurate and comprehensive histopathology report is essential for cutaneous melanoma management, providing critical information for accurate staging and risk estimation and determining the optimal surgical approach. In many institutions, a review of melanoma biopsy specimens by expert dermatopathologists is considered a necessary step. This study examined these reviews to determine the critical primary histopathology Breslow score in which a histopathology review would be most beneficial. Histopathology reports of patients referred to our institute between January 2011 and September 2019 were compared with our in-house review conducted by an expert dermatopathologist. The review focused on assessing fundamental histologic and clinical prognostic features. A total of 177 specimens underwent histopathology review. Significant changes in the Breslow index were identified in 103 cases (58.2%). Notably, in many of these cases (73.2%), the revised Breslow was higher than the initially reported score. Consequently, the T-stage was modified in 51 lesions (28.8%). Substantial discordance rates were observed in Tis (57%), T1b (59%), T3a (67%) and T4a (50%) classifications. The revised histopathology reports resulted in alterations to the surgical plan in 15.3% of the cases. These findings emphasize the importance of having all routine pathologies of pigmented lesions referred to a dedicated cancer center and reviewed by an experienced dermatopathologist. This recommendation is particularly crucial in instances where the histopathology review can potentially alter the diagnosis and treatment plan, such as in melanoma in situ and thinner melanomas measuring 0.6–2.2 mm in thickness. Our study highlights the significant impact of histopathology reviews in cutaneous melanoma cases. The observed changes in Breslow scores and subsequent modifications in T-stage classification underline the need for thorough evaluation by an expert dermatopathologist, especially in cases of melanoma in situ and thin melanomas. Incorporating such reviews into routine practice within dedicated cancer centers can improve diagnostic accuracy and guide appropriate treatment decisions, ultimately leading to better patient outcomes. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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15 pages, 2318 KiB

Open AccessArticle

Pressure Ulcer Diagnosis Is Associated with Increased Mortality in Patients with End-Stage Renal Disease: A Retrospective Study

by Gabriela A. Duchesne, Jennifer L. Waller, Stephanie L. Baer, Lufei Young and Wendy B. Bollag

Life 2023, 13(8), 1713; https://doi.org/10.3390/life13081713 - 09 Aug 2023

Cited by 1 | Viewed by 1422

Abstract

Pressure ulcers are associated with multiple comorbidities and annually affect approximately 3 million Americans, directly accounting for approximately 60,000 deaths per year. Because patients with end-stage renal disease (ESRD) are known to present with unique factors which impair wound healing, pressure ulcers diagnosed [...] Read more.

Pressure ulcers are associated with multiple comorbidities and annually affect approximately 3 million Americans, directly accounting for approximately 60,000 deaths per year. Because patients with end-stage renal disease (ESRD) are known to present with unique factors which impair wound healing, pressure ulcers diagnosed in ESRD patients might independently increase the risk of mortality. To investigate the association between pressure ulcer diagnosis and mortality risk in the ESRD population, a retrospective analysis of the United States Renal Data System (USRDS) database was performed. The records of 1,526,366 dialysis patients who began therapy between 1 January 2005 and 31 December 2018 were included. Our analysis showed that the diagnosis of pressure ulcers in this population was independently associated with mortality even after controlling for confounding factors (p < 0.001). A Kaplan–Meier survival analysis demonstrated reduced survival in patients with a pressure ulcer diagnosis compared to those without a pressure ulcer diagnosis. These results establish pressure ulcers as a significant independent risk factor for mortality, as well as suggesting several comorbidities as potential risk factors for pressure ulcers in the ESRD population. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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12 pages, 882 KiB

Open AccessArticle

Blood Stream Infections in Burns: A 14-Year Cohort Analysis

by Yarden Nitsani, Tal Michael, Dor Halpern, Ariel Avraham Hasidim, Maayan Sher, Rotem Givoli Vilensky, Yuval Krieger, Eldad Silberstein and Yaron Shoham

Life 2023, 13(6), 1357; https://doi.org/10.3390/life13061357 - 09 Jun 2023

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Abstract

Background: Blood stream infections are a significant cause of morbidity and mortality in burns, and pathogen identification is important for treatment. This study aims to characterize the microbiology of these infections and the association between the infecting pathogen and the hospitalization course. Methods: [...] Read more.

Background: Blood stream infections are a significant cause of morbidity and mortality in burns, and pathogen identification is important for treatment. This study aims to characterize the microbiology of these infections and the association between the infecting pathogen and the hospitalization course. Methods: We conducted a cohort study that included records of burn patients treated at the Soroka University Medical Center between 2007–2020. Statistical analysis of demographic and clinical data was performed to explore relationships between burn characteristics and outcomes. Patients with positive blood cultures were divided into four groups: Gram-positive, Gram-negative, mixed-bacterial, and fungal. Results: Of the 2029 burn patients hospitalized, 11.7% had positive blood cultures. The most common pathogens were Candida and Pseudomonas. We found significant differences in ICU admission, need for surgery, and mortality between the infected and non-infected groups (p < 0.001). Pathogen groups differed significantly mean TBSA, ICU admission, need for surgery, and mortality (p < 0.001). Multivariate analysis showed flame (OR 2.84) and electric burns (OR 4.58) were independent risk factors for ICU admission and surgical intervention (p < 0.001). Gram-negative bacterial infection was found to be an independent predictor of mortality (OR = 9.29, p < 0.001). Conclusions: Anticipating specific pathogens which are associated with certain burn characteristics may help guide future therapy. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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12 pages, 4409 KiB

Open AccessArticle

Mid-Term Follow-Up Study of Children Undergoing Autologous Skin Transplantation for Burns

by Angyalka Válik, Katalin Harangozó, András Garami, Zsolt Juhász, Gergő Józsa and Aba Lőrincz

Life 2023, 13(3), 762; https://doi.org/10.3390/life13030762 - 11 Mar 2023

Viewed by 1186

Abstract

Deep partial and full-thickness burns require surgical treatment with autologous skin grafts after necrectomy, which is the generally accepted way to achieve permanent wound coverage. This study sought to examine the grafted and donor areas of children who underwent autologous skin transplantation, using [...] Read more.

Deep partial and full-thickness burns require surgical treatment with autologous skin grafts after necrectomy, which is the generally accepted way to achieve permanent wound coverage. This study sought to examine the grafted and donor areas of children who underwent autologous skin transplantation, using two assessment scales to determine the severity of the scarring and the cosmetic outcome during long-term follow-up. At the Surgical Unit of the Department of Paediatrics of the University of Pécs, between 1 January 2015 and 31 December 2019, children who had been admitted consecutively and received autologous skin transplantation were analyzed. Twenty patients met the inclusion criteria in this retrospective cohort study. The authors assessed the results using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). There was a significant difference in how parents and examiners perceived the children’s scars. In the evaluation of the observer scale, the most critical variables for the area of skin grafted were relief and thickness. Besides color, relief was the worst clinical characteristic on the patient scale. However, when medical professionals evaluated the donor site, significantly better results were obtained compared to the transplanted area (average observer scale score: 1.4 and 2.35, p = 0.001; VSS: 0.85 vs. 2.60, p < 0.001), yet it was similar to the graft site in the parents’ opinion (Patient Scale: 2.95 and 4.45, p = 0.181). Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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11 pages, 2831 KiB

Open AccessArticle

Enzymatic Debridement of Deep Thermal Burns in the Russian Federation: First Experience

by Andrey A. Alekseev, Natalia B. Malyutina, Alexander E. Bobrovnikov and Yaron Shoham

Life 2023, 13(2), 488; https://doi.org/10.3390/life13020488 - 10 Feb 2023

Cited by 5 | Viewed by 1688

Abstract

Since its approval in Europe a decade ago, NexoBrid^® enzymatic debridement of deep thermal burns has been gaining acceptance as standard practice around the world. The purpose of this study is to report the first experience with NexoBrid^® in the Russian [...] Read more.

Since its approval in Europe a decade ago, NexoBrid^® enzymatic debridement of deep thermal burns has been gaining acceptance as standard practice around the world. The purpose of this study is to report the first experience with NexoBrid^® in the Russian Federation. During 2019–2020, we conducted a post-registration clinical study assessing the safety and treatment results of NexoBrid^® enzymatic debridement. The study involved 15 adult patients suffering from deep thermal burns over an area ≤15% of their total body surface area. Patients were treated with NexoBrid^® within 3 days of injury, followed by spontaneous or surgical wound closure. Complete eschar removal was achieved in twelve patients, 80% eschar removal in two patients, and 70% in one patient. Complete spontaneous epithelialization of wounds was achieved in 12 patients (80%) within 18 ± 1.9 days after the start of treatment. We did not witness pathological scarring during follow-up, and there were no significant safety issues throughout the study. Early use of NexoBrid^® resulted in rapid, effective, and safe eschar removal with good results and sufficient preservation of viable dermis to allow for spontaneous healing in 80% of patients. These results demonstrate the ability to minimize surgical intervention and hopefully lead to better long-term scarring results. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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10 pages, 4257 KiB

Open AccessArticle

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case–Control Study

by Konstantinos Seretis, Anastasia Boptsi, Eleni Boptsi and Efstathios G. Lykoudis

Life 2023, 13(2), 442; https://doi.org/10.3390/life13020442 - 04 Feb 2023

Cited by 3 | Viewed by 2074

Abstract

Background: The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery [...] Read more.

Background: The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery operations performed on the upper limbs. Methods: Patients who underwent those operations under WALANT were matched and compared with patients who had general or regional anesthesia without infiltration of a local anesthetic solution. All operations were performed by the same surgeon. Data from 98 operations were collected and analyzed for the total operation time, operation theatre time and complication and patient satisfaction rates. Results: All operations under WALANT, mainly skin tumor excision and flap repair or skin grafting and burn escharectomy with or without skin grafting, were completed successfully. No statistical difference in total operation time and complication rates was revealed. Statistical significance favoring WALANT was identified regarding the mean operation theatre time and patient satisfaction. Conclusions: WALANT is an effective method for common plastic surgery operations performed on the upper limbs that is associated with better operation theatre occupancy and high patient satisfaction rates. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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Review

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14 pages, 2842 KiB

Open AccessReview

Alloplastic Epidermal Skin Substitute in the Treatment of Burns

by Aleksandra Barbachowska, Tomasz Korzeniowski, Agnieszka Surowiecka and Jerzy Strużyna

Life 2024, 14(1), 43; https://doi.org/10.3390/life14010043 - 27 Dec 2023

Viewed by 985

Abstract

The goal of burn wound treatment is to ensure rapid epithelialization in superficial burns and the process of rebuilding the lost skin in deep burns. Topical treatment plays an important role. One of the innovations in the field of synthetic materials dedicated to [...] Read more.

The goal of burn wound treatment is to ensure rapid epithelialization in superficial burns and the process of rebuilding the lost skin in deep burns. Topical treatment plays an important role. One of the innovations in the field of synthetic materials dedicated to the treatment of burns is epidermal skin substitutes. Since the introduction of Suprathel^®, the alloplastic epidermal substitute, many research results have been published in which the authors investigated the properties and use of this substitute in the treatment of wounds of various origins, including burn wounds. Burn wounds cause both physical and psychological discomfort, which is why ensuring comfort during treatment is extremely important. Alloplastic epidermal substitute, due to its biodegradability, plasticity, no need to remove the dressing until healing, and the associated reduction in pain, is an alternative for treating burns, especially in children. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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Other

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10 pages, 1954 KiB

Open AccessCase Report

A Complex Case of Clino-Syndactyly with Fourth Metacarpal Aplasia

by Hermann Nudelman, Aba Lőrincz, Anna Gabriella Lamberti, Tamás Kassai and Gergő Józsa

Life 2023, 13(9), 1943; https://doi.org/10.3390/life13091943 - 21 Sep 2023

Viewed by 776

Abstract

Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The incidence is 1 out of 2500 children, predominantly occurring in boys and Caucasians. Clinically, the malformation may [...] Read more.

Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The incidence is 1 out of 2500 children, predominantly occurring in boys and Caucasians. Clinically, the malformation may present as a soft tissue or bony fusion, resulting in the union of the fingers characterised as complete or incomplete. This fusion may involve the phalanges but may also extend to the carpal/tarsal bones, even to the metacarpal or metatarsal level, rarely to the distal end of the forearm and lower leg. The malformation is mostly isolated but may occur together with other disorders or malformations such as synostosis, acro-syndactyly, cleft hand, clinodactyly, or polydactyly. Syndromic syndactyly can be observed in cases of Apert syndrome, Poland’s syndrome, Pfeiffer syndrome, and many others. A girl born in June of 2019 was diagnosed with congenital malformation of the right hand at birth—affecting the right middle, ring, and little fingers, respectively. After X-ray imaging, the fusion of the third and fourth proximal phalanges to a common metacarpal was identified, forming a unique diagnosis of clino-syndactyly with metacarpal aplasia. Surgical intervention was advocated for, including a wedge osteotomy to correct the synchondrosis at the phalangeal base and a dorsal flap to close the interdigital space created during the correction of the III and IV. fingers. A trapezoid flap for the release of the syndactyly of the IV and V. fingers was applied. The paper aims to present this surgical correction and its results regarding an atypical case of syndactyly with clinodactyly and metacarpal aplasia. Full article

(This article belongs to the Special Issue Skin, Wound, Plastic Surgery and Hand Surgery)

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