Metoidioplasty and groin flap phalloplasty as two surgical methods for the creation of a neophallus in female-to-male gender-confirming surgery: A retrospective study comprising 123 operated patients.

BACKGROUND: In gender-confirming surgery of the female-to-male gender dysphoric patient, there is currently no ideal method for the creation of a neophallus. Historically, in our clinic, groin flap phalloplasty (GFP) has been the dominating method, but during the last 20 years, it has gradually been replaced with metoidioplasty (MP). The aim of this study was to investigate whether this change of method has influenced factors such as the frequency of complications and the number of operations needed to complete the reconstruction of the neophallus. METHODS: This is a retrospective, single-centre, study comprising 123 consecutive female-to-male patients receiving a neophallus by GFP or MP between 2002 and 2015 at Linköping University Hospital, Sweden. RESULTS: One-hundred twenty-three patients underwent 126 primary surgical procedures (39 GFPs and 87 MPs) with the intention of reconstructing a neophallus. The mean number of procedures required in the GFP group was 5.2 ± 2.7 compared with that of 2.4 ± 1.7 in the MP group (p < 0.001). In the GFP group, 18/39 (46.2%) had a documented complication compared with 30/87 (34.5%) in the MP group; however, the difference was not statistically significant (p = 0.21). CONCLUSIONS: The present study shows that the shift in method from GFP to MP has resulted in a decreased number of complications as well as a decrease in total surgical occasions. Both methods were found to be associated with relatively high frequencies of complications, however, mostly minor.

Ischemic through-and-through necrosis of the lateral wall of the torso and inguinal region subsequent to flame injury and septic shock: a case report and literature review.

Post-burn infections still stand as the most common/serious complication of burn injuries: sepsis accounts for 50-60% of deaths in burn patients despite improvements in antimicrobial therapies. Among the many potential complications of sepsis/septic shock are hemodynamic instability and perfusion failure. We report the case of a patient developing massive soft tissue necrosis after an episode of acute post-burn septic shock, with possible explanation of an overdosage of vasopressors due to significant body weight increase as an effect of the burn resuscitation. The utility of vasopressor agents in the management of septic shock depends on the balance between increased perfusion pressure and the direct effect on the microvasculature. The almost inevitable body weight increase in the acute post-burn phase as an effect of the resuscitation makes this balance more difficult to maintain.

Les infections restent les complications les plus fréquentes et les plus sérieuses des brûlures: le sepsis est responsable de 50 à 60% des morts chez les patients brûlés, malgré les améliorations du traitement antimicrobien. Parmi les nombreuses complications potentielles de l'infection et du choc septique, figurent l'instabilité hémodynamique et l'échec des perfusions. Nous rapportons l'observation d'un patient développant une nécrose massive des parties molles après un épisode de choc septique, chez un brûlé avec comme explication possible, un surdosage de vaso-presseurs lors de la réanimation, responsable d'une augmentation significative du poids corporel. L'efficacité des agents vasopresseurs dans la prise en charge du choc septique dépend de l'équilibre entre l'augmentation de la pression perfusionnelle et l'effet direct sur la micro vascularisation. L'augmentation du poids corporel toujours inévitable lors de la phase aiguë de la brûlure, en relation directe avec la réanimation, rend plus difficile le maintien de cet équilibre.

Effectiveness of automated ultraviolet-C light for decontamination of textiles inoculated with Enterococcus faecium.

Healthcare textiles are increasingly recognized as potential vehicles for transmission of hospital-acquired infections. This study tested the ability of an automated ultraviolet-C (UV-C) room disinfection device (Tru-D Smart UV-C) to decontaminate textiles inoculated with Enterococcus faecium in a clinical setting. Contaminated polycotton (50/50 polyester/cotton) swatches were distributed to predefined locations in a ward room and exposed to UV-C light. UV-C decontamination reduced E. faecium counts by a mean log10 reduction factor of 1.37 (all P = 0.005, Wilcoxon signed rank test). UV-C decontamination may be a feasible adjunctive measure to conventional laundering to preserve the cleanliness of healthcare textiles in ward rooms.

Severe sepsis in the ICU is often missing in hospital discharge codes.

BACKGROUND: Different International Classification of Diseases (ICD)-based code abstraction strategies have been used when studying the epidemiology of severe sepsis. The aim of this study was to compare three previously used ICD code abstraction strategies to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus criteria for severe sepsis, in a setting of intensive care patients. METHODS: All patients (≥ 18 years of age) with severe sepsis according to the ACCP/SCCM criteria registered in the Swedish Intensive Care Registry (2005-2009) were included in the study. Using the Swedish National Patient Register, we investigated whether these patients fulfilled an ICD code compilation for severe sepsis at hospital discharge. RESULTS: Overall, 9271 patients with severe sepsis were registered in the Swedish Intensive Care Registry. A majority of these patients (55.4%) were discharged from the hospital with ICD codes that did not correspond to any of the ICD code compilations. A minority of patients (10.3%) were discharged with ICD codes corresponding to all three code abstraction strategies applied. Overall, the proportion of patients discharged with ICD codes corresponding to the criteria of Angus et al. was 15.1%, to the criteria of Flaatten was 39.8%, and to the criteria of Martin et al. was 16.0%. CONCLUSIONS: A majority of patients with severe sepsis according to the ACCP/SCCM criteria were not discharged with ICD codes corresponding to the ICD code abstraction strategies; thus, the abstraction strategies did not identify the correct patients.

Epidermal exfoliation of over 95% after a burn in an 18-month-old boy: Case report and review of the literature.

This report concerns an 18-month-old boy who presented with a 6% total body surface area scald. The subject of this report is unique in that he developed the largest exfoliation described in literature. After 3 days an epidermal exfoliation with the appearance of a deliberately inflicted scald developed. As the exfoliation progressed to over 95% total body surface area the suspicion of child abuse or neglect could be abandoned. The diagnosis Staphylococcal scalded skin syndrome was set, due to the finding of Staphylococcus aureus on swabs, the lack of mucosal engagement, and the patient's age. The boy's skin healed within 3 weeks. The few reports published are all case reports and most frequently described visually infected burns with smaller epidermal exfoliations, and clinically based exfoliation diagnosis. S. aureus often cause burn wound infections that can lead to complications caused by cross-infection. It is important for burn surgeons and intensive care specialists to be aware of the increased possibility of Staphylococcal scalded skin syndrome occurring in patients who have a reduced barrier to infection such as burn patients and also, that the diagnosis can be difficult to make.

Burns in Sweden: temporal trends from 1987 to 2010.

Our aim was to investigate the epidemiology of burned patients admitted to hospitals in Sweden, and to examine temporal trends during the last three decades. Our hypothesis was that there has been an appreciable decline in the number of patients admitted. Retrospective data about burned patients treated at Swedish hospitals 1987 - 2010 were obtained from the Swedish National Board of Health and Welfare. Patients with primary or secondary ICD diagnoses of burns were included, reviewed and statistically interpreted in terms of sex, age, incidence, mortality in hospital and duration of stay. A total of 30,478 patients were admitted to hospitals with burns. The absolute number of admissions declined by 42% (95% CI 39 to 44). There was a highly significant reduction of 45% (95% CI: 38 to 51) in the ageadjusted incidence (admissions/million population) over the years, and the reduction was significant for both sexes. Children aged 0-4 years (n=8308) were most likely to be admitted to hospital (27%). The median duration of stay shortened over time (p < 0.0001). There was an overall significant reduction in deaths at hospital/100 admissions over time (p <0.0001). We think that the improvements are the result of a combination of preventive measures, improved treatments and greater use of outpatient facilities. If we understand these trends and the relations between age-adjusted incidence and actual number of admissions, we can gain insight into what is needed for future provision of emergency health care.

Nous rapportons l'étude de l'épidémiologie des brûlures ayant nécessité une hospitalisation en Suède et son évolution au long des 3 dernières décennies, notre impression étant qu'il y avait eu une notable diminution de cette pathologie. Les données rétrospectives des 30,478 patients brûlés hospitalisés en Suède entre 1987 et 2010 ont été obtenues auprès de l'Office Public de la Santé et du Bien-être suédois. Les dossiers patients sortis avec un Diagnostic Principal ou un Diagnostic Secondaire « brûlure ¼ ont été revus. Les analyses ont porté sur l'âge, le sexe, l'incidence, la mortalité hospitalière et la durée de séjour. Le nombre total de patients a baissé de 42% (IC95 39 à 44%), réduction observable chez les 2 sexes et confirmée par une baisse de l'incidence (brûlés/million d'habitants) de 45% (IC95 38 à 51%). Les enfants de 0 à 4 ans (8,308), avaient un risque plus élevé (27%) d'être hospitalisés pour brûlure. La durée médiane d'hospitalisation s'est raccourcie (p<0,0001), la mortalité a diminué (p<0,0001). Nous pensons que ces améliorations peuvent s'expliquer par une combinaison de prévention, efficacité de la prise en charge et augmentation de l'ambulatoire. En intégrant plus finement ces données, il est possible d'explorer les paramètres de mise à disposition de soins d'urgence.

Late complications of high-voltage electrical injury might involve multiple systems and be related to current path.

Delayed complications of electrical burns are mostly unexpected, and the link between the injury and the symptoms often goes unrecognized. A possible relation between source-ground sites and late clinical manifestations was recently emphasized. We report a unique case of combined intestinal-spinal delayed complications following a high-voltage electrical injury, a possible explanation being a greater current flow through the right hemisoma. The potential for late complications is an additional feature that physicians must consider in managing electrical injuries. Manifestations are variable and presentation is confounding, but current flow path can constitute a precious source of information to predict complications in the late phase of management.

Les complications tardives des électrisations par haut voltage sont le plus souvent inattendues et le lien avec l'accident initial est fréquemment non reconnu. Une relation possible entre le trajet source-terre et les complications tardives a récemment été mise en évidence. Nous rapportons le cas de complication tardive touchant à la fois l'intestin et la moëlle épinière, pouvant être expliqué par le passage préférentiel du courant dans l'hémicorps droit. La possibilité de complications tardives doit être prise en compte des électrisations par haut voltage. Ces manifestations sont variables et la clinique peut être peu claire, mais le trajet supposé du courant peut être un argument permettant de relier l'atteinte initiale et les complications tardives.

Glucocorticoid receptor expression and binding capacity in patients with burn injury.

BACKGROUND: Burn injuries are associated with strong inflammation and risk of secondary sepsis which both may affect the function of the glucocorticoid receptor (GR). The aim of this study was to determine GR expression and binding capacity in leucocytes from patients admitted to a tertiary burn center. METHODS: Blood was sampled from 13 patients on admission and days 7, 14 and 21, and once from 16 healthy subjects. Patients were grouped according to the extent of burn and to any sepsis on day 7. Expression and binding capacity of GR were determined as arbitrary units using flow cytometry. RESULTS: GR expression and binding capacity were increased compared to healthy subjects in most circulating leucocyte subsets on admission irrespective of burn size. Patients with sepsis on day 7 displayed increased GR expression in T lymphocytes (51.8%, P < 0.01) compared to admission. There was a negative correlation between GR binding capacity in neutrophils and burn size after 14 days (P < 0.05). CONCLUSIONS: GR expression and binding capacity are increased in most types of circulating leucocytes of severely burned patients on their admission to specialized burn care. If sepsis is present after 1 week, it is associated with higher GR expression in T lymphocytes and NK cells.

Tissue engineering--body parts from the Petri dish.

The development of methods to regenerate human tissues and organs by tissue engineering (TE), will have a dramatic influence on many medical specialities in the future. The essence of plastic surgery is to reconstruct disrupted and damaged tissues by the use of a plethora of techniques spanning from small local skin flaps to highly advanced microsurgery and free composite grafts. However, these methods only focus on moving tissue from one part of the patient to another without actual regeneration. To be able to take the next step in development of the speciality it is of necessity to address this issue. Hence it follows naturally that plastic surgeons lead and represent the driving force of the development within the research of tissue engineering. In this paper we would like to present active research and also give an overview of areas in tissue engineering that are of special interest to the plastic surgeon.

Mammary epithelial cell and adipocyte co-culture in a 3-D matrix: the first step towards tissue-engineered human breast tissue.

Reconstruction of the female breast after cancer surgery is a demanding task where the methods used today suffer from several disadvantages. In the present study we have investigated the possibility to use tissue engineering methods to regenerate human autologous breast tissue. Human mammary epithelial cells and preadipocytes were derived from breast tissue biopsies from healthy women undergoing reduction mammoplasty, and the two celltypes were co-cultured with conventional cell culture methods as well as in 3-D matrices. The study shows that it is possible to harvest both human mammary epithelial cells and preadipocytes in a single session, propagate several subcultures, and that the cells maintain a normal intercellular distribution and growth-pattern when co-cultured in a 3-D collagen gel. We propose that growth and formation of a tissue closely resembling normal human breast tissue be readily obtained in the described in vitro cell culture set-up using basic tissue engineering principles. This concept may be of great importance in the development of new methods for reconstruction of the human breast.

[Burn injuries in Sweden 1987-1996. The number of hospitalized patients has been reduced and the mortality lowered by 70 per cent]. / Brännskador i Sverige 1987-1996. Antalet sjukhusvårdade har minskat och dödligheten sjunkit med 70 procent.

Continuous improvement in burn trauma care has led to decreasing mortality, morbidity, and length of hospital stay. Current data from the Swedish population is lacking, which was the reason for this investigation. Data was gathered from the Swedish database for medical care (based on ICD-9). All Swedish care providers are enrolled and assumed to report data. Hence, the quality of the database is considered reasonably good, although data from individual patients may be incorrectly recorded due to clerical errors. Available data indicate that the number of burn victims seeking medical care has decreased by 16% during the past decade, whereas mortality has decreased by 70%! The demographic data is otherwise similar to what has previously been reported in the international literature.

[Recreation of tissue--the plastic surgeon's spring-board in to the 21st century]. / Nyskapa vävnad--plastikkirurgins språngbräda in i 2000-talet.

During recent years, a new field has appeared, in which the principles of life sciences and engineering are applied to the development of methods of regenerating human tissue and organs. Since the emergence of this interdisciplinary field, plastic surgeons have been deeply involved in its development, both in the early stages and in introducing the methods into clinical practice. The article consists in discussion of the possibilities these methods offer and the impact they may have on the field of plastic and reconstructive surgery.