Postburn scalp reconstruction using a self-filling osmotic tissue expander.

Tissue expanders have been used in the past few decades for various reconstructive procedures. The conventional expander requires serial filling injections in repeated visits over a few months period, and carries a substantial complication rate. An osmotic self-filling expander was invented ten years ago, but has still not gained a wide spread use. We describe here our first experience with this expander in reconstruction of a post-burn scalp scar in a young patient, and discuss its advantages: no filling injections are needed, thus lowering the possibility of infection and significantly reducing the number of required visits to the outpatient clinic; the swelling is much more gradual and subtle and there is no pain that usually follows the filling injection; the small initial volume of the expander requires a relatively small pocket and can be performed under local anesthesia and results in a relatively short scar.

Investigating human microskin grafting technique in a new experimental model.

BACKGROUND: Microskin graft technique is a possible solution for treating major burns. The goal of this study was to investigate microskin graft techniques using a new model of grafting human skin onto athymic nude mice. MATERIALS AND METHODS: Twenty female nude mice were randomly divided into a research group and a control group (14 mice in the research group, six in the control group). On the 11th day after the procedure, the following parameters were investigated: percentage of epithelial coverage, degree of contracture, thickness of the epidermis, thickness of the dermis, number of blood vessels, number of melanocytes. RESULTS: The healing rate (epithelial coverage) of the wounds was an average of 100% (+/-0%) in the control group and 97% (+/-5%) in the research group (P>0.05). The average degree of wound contraction in the control group was 30% compared to 63% in the research group (P<0.01). The average thickness of the epidermis formed at the grafted site was 8.17 (+/-1.94)microm in the control group compared to 4.45 (+/-4.17)microm in the research group, at the wound margins (P>0.05). CONCLUSION: We found that the microskin graft, created by grinding a sheet of human skin, remained vital, and tissue of human origin was present at the grafted site. Our study shows that this novel method is feasible and has the advantage of enabling investigation of human skin on an animal model. Significant contracture appears to be a drawback of this technique, and we feel that the method should be improved before its clinical application on patients.

The role of the plastic surgeon in dealing with soft tissue injuries: experience from the second Israel-Lebanon war, 2006.

During the 2006 war between Israel and Lebanon, 282 Israeli soldiers were evacuated to Rambam Health Care Campus. Of these, 210 were admitted for observation or treatment, and 15 of these were admitted to the Department of Plastic and Reconstructive Surgery. Thirty-five other soldiers, hospitalized in other departments, required the care of Plastic Surgeons, either for conservative or surgical treatment. The injury profile observed was consistent with data from previous low-intensity warfare, which demonstrated that over 80% of injuries were produced by fragmentation weapons, such as artillery, mortarshells, rockets, and missiles. It differs, however, from our experience in previous wars and our expectations regarding burn wounds, both in incidence and severity, which were significantly lower as compared with the past. This article presents our management of extensive soft tissue injuries, and details 3 representative cases. It highlights the role of the Plastic Surgeon as part of the whole treatment in this type of injury and helps to predict the needs of the medical system in preparation for the future.

Controversies in fluid resuscitation for burn management: literature review and our experience.

The purpose of this review is to summarise the commonly used formulae for fluid resuscitation in major burns and to discuss the controversy surrounding the use of protein-based colloids as a component of these types of formulae. Fluid resuscitation in major burns is one of the most critical steps in managing this type of injury. In practice, a wide variety of formulae for fluid resuscitation has been suggested. Some propose only the use of crystalloids, while others combine the colloids together with crystalloids. A review was performed of the literature addressing fluid resuscitation formulae and our experience using our formula is presented. At the authors' burn centre a unique formula is in use, which combines plasma and crystalloids. Our experience using this specific formula extends over a period of 15 years and 356 patients with major burns have been resuscitated using this protocol. At our centre, 27 deaths were recorded, 19 of which had third degree burns of more than 80% total body surface area (TBSA). The protein-based colloids are included in most of the formulae and the beneficial effect is considered to be higher than the potential side effects. We are in favour of administering colloids during the resuscitation period for major burns, starting in the early period after injury.

Hair removal using intense pulsed light (EpiLight): patient satisfaction, our experience, and literature review.

Applications for intense pulsed light (IPL) for hair removal are gaining favor among other methods, including lasers, because of its noninvasive nature, versatility regarding different skin and hair types, safety, and ease of use. Hair removal using IPL was performed from January 2002 to December 2003 on 108 consecutive patients. Eighty of these patients answered a questionnaire and were enrolled in the study group. The investigated parameters were hair and skin type, number of pulses, fluence, pulse duration, pulse delay, the filters used, and the treated area. The patient assessment of improvement (satisfaction) rate was graded from 1 to 5 points: 1, worse; 2, no improvement; 3, mild improvement; 4, good result; and 5, excellent result. The patients had between 1 and 13 treatments most of them during 2 to 6 sessions. Sixty-seven percent of the patients reported no complications. Prolonged erythema for more than 7 days was reported by 16.25%, blisters by 6.25%, temporary hyperpigmentation by 8.75%, leukotrichia was present in 1 case, and 1 case of persistent hypopigmentation was noted in a young girl. An increased number of complications and a decreased satisfaction rate were noted with higher skin types, but it was not statistically significant. Patients who underwent fewer treatments (1-3 treatments) were more satisfied compared with those who had more than 7 treatments (P < 0.02). Sixty percent of the patients rated their satisfaction to be good to excellent and 65% would ill recommend this treatment to their friends. To minimize the complication rate the authors found that the preset parameters should be adjusted at every treatment session according to the skin response at the previous one. Permanent hair removal cannot be guaranteed and it is not possible to predict the improvement rate. Nevertheless, based on patient satisfaction rate in this study, the authors recommend using IPL for hair removal.

Using intense pulsed light for cosmetic purposes: our experience.

The authors' experience using intense pulsed light for skin rejuvenation is summarized and analyzed with regard to its efficacy, safety, and complications. Rejuvenation using intense pulsed light was performed on 59 patients over a 6-month period (January of 2002 to July of 2002); these patients served as the study group. The areas treated were the face, neck, chest, hands, and legs. The parameters used during the procedure, patient satisfaction, and complications are described. Ninety-five percent of the patients included in the study had one or two sessions. Good to very good results were reported by 93.1 percent. Most patients had minor side effects and only three patients (5 percent) experienced complications (hyperpigmentation or scars). Intense pulsed light is an effective and safe method for skin rejuvenation. Its efficacy is mainly manifested by eliminating senile pigmentation and telangiectasias and a achieving a younger and fresher appearance of the skin. Although in the literature intense pulsed light skin rejuvenation is mainly reported for the face, the authors have obtained good results by using it for other areas of the body. The majority of the patients were satisfied. The authors conclude that intense pulsed light skin rejuvenation is a safe and effective method for facial and nonfacial rejuvenation.