Drug-induced immunosuppression in plastic and reconstructive surgery: A matched pair outcome analysis of 108 patients.

BACKGROUND: Plastic and reconstructive surgeons occasionally have to manage patients with the intake of immunosuppressive drugs while the individual risks for complications present unclear. This study aimed to analyze complication rates after surgery on patients with drug-induced immunosuppression. METHODS: Patients with a perioperative intake of immunosuppressive drugs who had undergone plastic surgery between 2007 and 2019 in our Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery were analyzed retrospectively. Another cohort with the same or similar surgical procedures but without drug-induced immunosuppression was determined. A total of 54 immunosuppressed patients (IPs) were case-control matched with 54 comparable control patients (CPs). The 2 groups were compared for the outcome parameters of complication rate, revision rate, and length of hospital stay. RESULTS: Matching achieved a 100% match for surgical procedures and sex. The mean age difference within paired patients was 2.8 years (0-10 years), while the mean age was 58.1 years in all patients. A total of 44% of IP showed signs of impaired wound healing in contrast to only 19% of CP (OR 3.440; 95%CI: 1.471-8.528; p = 0.007). The median hospital stay of IP was 9 days (range 1-110 days) compared to 7 days (range 0-48 days) of CP (p = 0.102). The revision operation rate was 33% in IPs and 21% in CPs (p = 0.143). CONCLUSIONS: Patients with drug-induced immunosuppression who underwent plastic and reconstructive surgery have an increased risk for impaired wound healing in general. Additionally, our study showed a trend towards a longer hospital stay and operation revision rate. Surgeons have to consider these facts when treatment options are discussed in patients with drug-induced immunosuppression.

Sustained high demand for intensive care unit resources for the treatment of burn patients during the COVID-19 pandemic in Northern Germany: A single-centre cross-sectional study.

Introduction: The ongoing COVID-19 pandemic caused by SARS-CoV-2 has changed everyday life worldwide. To reduce disease transmission, governments introduced various policies such as social distancing, stay-at-home orders, and travel restrictions. The goal of this study was to investigate the characteristics of burn patients admitted to the burn intensive care unit before and during the COVID-19 pandemic. Patients and methods: A retrospective descriptive analysis of the hospital's burn registry was performed from 1 March 2019 until 1 January 2022. Results: A total of 326 patients were included in this study. Eighty-eight patients presented before and 238 patients during the COVID-19 pandemic. The majority of burns occurred during private incidents (80% [2022], 92% [2020]), and burns were most frequently caused by flames (24% [2022], 32.99% [2021]). Work-related injuries occurred less frequently (7.76% [2020], 20% [2022]). Constant results were obtained regarding severity and total body surface area affected (1-80%). Conclusion: This study highlights high numbers of burn patients admitted to the burn intensive care unit before and during the COVID-19 pandemic. Consequently, burn intensive care units must retain their special position within the national health system and should not be included in resource relocation during the prioritisation of intensive care resources. Multicentre studies should focus on the national impact of COVID-19 on the treatment of burn patients.

[Reconstruction in polytraumatized burn patients]. / Rekonstruktion beim polytraumatisierten Brandverletzten.

BACKGROUND: Polytraumatized burn patients represent a rare patient collective and necessitate an individualized treatment concept due to the particular combination of injuries. OBJECTIVE: Against the background of this special injury pattern, especially with deep burns overlying the fracture zone, the question of a specific and interdisciplinary treatment algorithm arises. MATERIAL AND METHODS: This article is based on a PubMed database search and experiences of a trauma center for severely injured burn patients at a university hospital, with presentation of the special therapeutic requirements and goals exemplified by a case report. RESULTS: The evaluation of the literature search and own treatment results comes to the conclusion that the rate and extent of amputations and infections can be reduced by an early and interdisciplinary involvement of the plastic surgeon by early combined fracture stabilization, excision of necrotic tissue and immediate skin grafting. Furthermore, plastic reconstructive procedures enable a functional and esthetic reconstruction with optimized prosthesis fitting. CONCLUSION: Polytraumatized severely burned patients necessitate an interdisciplinary treatment approach, whereby preservation of length, functionality and esthetic appearance of the affected extremities and concurrent avoidance of bone and soft tissue infections have utmost priority.

In vitro construction of artificial blood vessels using spider silk as a supporting matrix.

Recent research has vigorously pursued the development of tissue-engineered vascular grafts (TEVs). One of the striking points of the early phase is the instability of the artificial blood vessels and lack of vascular resistance, which is supposed to be a consequence of unstable scaffolds. Therefore, alternative biological approaches are necessary to improve the physical properties of the artificial vessel walls. We developed blood vessel-like constructs based on native spider silk as a scaffold. C2C12 and ST1.6R cells were seeded on the surface of scaffolds and cultivated under pulsatile flow (max. ~135  mmHg and min. ~90  mmHg) in a bioreactor. Constructed grafts were compared to human blood vessels and cell seeded scaffolds cultured in the absence of bioreactor. Mechanical properties, morphological structures and expression of marker genes were assessed by strength and strain experiments, SEM, histological staining, immunohistology, Western blotting and quantitative real-time PCR. The results indicate that the constructed vessel resembles native blood vessels in morphological structure as well as in function and expression of biomarkers. Spider silk scaffolds seem to provide an optimal and stable basis for vessel constructs.