Efficacy of tilapia skin xenograft compared to paraffin-impregnated gauze as a full-thickness burn dressing after excisional debridement: A case series

Introduction and importance Due to its high collagen, good adherence to wound bed, and great wound healing properties, Tilapia (Oreochromis niloticus) skin has been studied as a biomaterial in regenerative medicine, including as a burn dressing. This paper evaluated the efficacy of tilapia skin xenograft as a temporary full-thickness burn dressing. Methods Four acute burn patients aged 23–48 years old with total body surface area ranging from 27.5 to 37% with a similar burn area on both sides of the limbs were included. Each limb was dressed in tilapia skin or paraffin-impregnated gauze. Two subjects passed away due to septic shock. All limbs treated with tilapia skin xenograft required fewer dressing changes compared to the limbs treated with paraffin-impregnated gauze. All remaining subjects underwent skin autograft transplantation surgery on the eleventh day after the debridement surgery. No allergic reaction was found in any of the subjects. Outcomes The tilapia xenograft performed better in controlling and containing the exudates compared to the paraffin-impregnated gauze, as reflected in the fewer dressing changes needed. The cause of death of the two patients was questionable as both of them have severe pneumonia and COVID-19 still could not be ruled out yet. Conclusion The tilapia skin xenograft was not inferior to the standard paraffin-impregnated gauze for full-thickness burn dressing in terms of time needed for wound bed preparation for autograft surgery.

Omphalopagus conjoined twins separation during coronavirus disease-19 pandemic era: A case report.

INTRODUCTION AND IMPORTANCE: Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. CASE PRESENTATION: Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. CLINICAL DISCUSSION: Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. CONCLUSION: The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight.

Use of local perforator flaps for closure of a thoraco-omphalopagus conjoined twin defect after separation during the COVID-19 pandemic.

INTRODUCTION: Conjoined twins are a rare medical phenomenon that poses unique challenges for surgeons. Separation of conjoined twins involves multidisciplinary teamwork, complex medical management and surgical planning, and multi-stage operations and often still has a high mortality and morbidity rate. In the times of the COVID-19 pandemic, separation of conjoined twins pose even greater challenges. Aiming for the best outcome possible, while minimizing the risk of COVID transmission and ensuring the safety of the personnel, is paramount. This case report presents thoraco-omphalopagus twins who were successfully separated at 4 months of age. The preoperative planning, operative details, postoperative follow-ups, and outcomes are discussed. METHODS: The absence of a tissue expander and the inability to acquire it due to travel restrictions from COVID-19 further complicated the management on this patient. A Routine Polymerase Chain Reaction (PCR) swab test was performed on the patients and personnel. Standardized personnel protective equipment (PPE) was worn during ward and surgical care. After separation of the twins by cardiothoracic and pediatric surgeons, one twin underwent immediate skin closure using a double keystone perforator island flap and a lower abdominal perforator flap. Due to extensive defects, closure was delayed for the second twin. After a series of dressing changes, eventually local perforator flaps could be raised to close the defect using staged tension sutures and skin grafts for secondary defects. RESULTS: Both twins were discharged with no significant morbidity, and no personnel were exposed to COVID-19 infection during the management. CONCLUSION: Preoperative coordination and planning, multidisciplinary effort, adherence to screening protocols for COVID, and strict use of standardized PPE all contributed to the successful separation of thoraco-omphalopagus conjoined twins during the COVID-19 pandemic.