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BACKGROUND: In extensive burn injuries with lack of donor sites for skin grafting, the Meek technique of skin expansion can be an efficient and effective method in covering extensive wounds. The aim of this retrospective study was to present our experience with the Meek technique of grafting. METHODS: We performed a retrospective analysis of patients from our burn center who underwent Meek grafting between 2012 and 2016. Demographics, burn details, clinical course, operative management, and outcomes were collected and analyzed from patient records and operative notes. Outcome measures, including graft take rate, complications and need for further surgery, were recorded. RESULTS: Twelve patients had Meek grafting. The average age was 38 years (range: 15-66). The average percent total body surface area burned was 54.3% (range: 31%-77%). Eighty-three percent of grafted areas healed well, and no regrafting was necessary. In the remaining 17%, infection and hematoma were the leading cause of graft failure. CONCLUSIONS: Meek grafting constitutes a rapid and efficient surgical approach for the skin coverage of extensive full-thickness burn injuries with limited autograft donor sites.
HISTORIQUE: En cas de brûlures étendues et en l'absence de siège de donneur pour procéder aux greffes cutanées, la technique Meek d'expansion cutanée peut être une méthode efficace et efficiente pour recouvrir des plaies étendues. Cette étude rétrospective vise à présenter l'expérience des auteurs relativement à la technique de greffe Meek. MÉTHODOLOGIE: Les auteurs ont procédé à l'analyse rétrospective de patients du centre pour grands brûlés qui ont subi la technique de greffe Meek entre 2012 et 2016. Ils ont recueilli les données démographiques, les détails des brûlures, l'évolution clinique, la prise en charge opératoire et les résultats cliniques et ont analysé le dossier du patient et les notes de l'opération. Ils ont colligé les mesures des résultats cliniques, y compris le taux de prise de la greffe, les complications et la nécessité d'une nouvelle opération. RÉSULTATS: Douze patients d'un âge moyen de 38 ans (plage de 15 à 66 ans) ont subi la technique de greffe Meek. Le pourcentage moyen de la surface corporelle totale brûlée était de 54,3 % (plage de 31 % à 77 %). Ainsi, 83 % des zones greffées ont bien guéri et n'ont nécessité aucune nouvelle greffe. Dans les 17 % de zones restantes, l'infection et l'hématome étaient les principales causes d'échec de la greffe. CONCLUSIONS: La technique de greffe Meek est une approche opératoire rapide et efficace pour couvrir de peau des brûlures pleine épaisseur étendues lorsque les sièges d'autogreffe sont limités.
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Importance: Current therapeutic options for patients with extracranial head and neck arteriovenous malformations are limited. Surgical intervention, such as sclerotherapy or resection, often result in rapid recurrence and progression of disease. Objective: To assess the efficacy and tolerability of sirolimus as an adjuvant therapy for endovascular embolization in the management of complicated extracranial head and neck arteriovenous malformations. Design, Setting, and Participants: This case series examined 6 patients with extracranial head and neck arteriovenous malformations treated from January 1, 2013, to December 31, 2017, at a multidisciplinary vascular anomalies clinic within Stanford Hospital and Clinics. Intervention: Initiation of sirolimus at least 1 month prior to endovascular embolization, targeting a trough level of 10 to 15 ng/mL throughout the course of the endovascular embolization series and continued for at least 1 month after the series. Main Outcomes and Measures: Clinical manifestations; disease progression and overall response to treatment were assessed via clinical evaluation and radiographic imaging. Results: All 6 patients (4 male and 2 female patients; mean age, 24.5 years [range, 9-44 years]) responded favorably to the combination of sirolimus therapy followed by endovascular embolization, and 4 patients exhibited a near-complete response. The median duration of follow-up was 19 months (range, 6-40 months). One patient discontinued sirolimus soon after embolization and experienced regrowth of the arteriovenous malformation after 1 year. Sirolimus was resumed, which has stabilized his disease for more than 2 years. Mild adverse effects were noted in 4 patients. The combination therapy was well tolerated in all patients. One patient developed skin ulceration after embolization and required surgical debridement. Another patient developed pulmonary microthrombi after embolization with cyanoacrylate glue that resolved with a brief course of anti-inflammatory therapy. Conclusions and Relevance: Although further prospective trials are needed, this report suggests the benefit of a mammalian target of rapamycin inhibitor as an adjuvant therapy for surgical embolization of complex, extracranial head and neck arteriovenous malformations. The optimal dosing and therapeutic duration of sirolimus treatment before and after embolization remain to be determined.
