Bacterial fluorescence imaging as a predictor of skin graft integration in burn wounds.

BACKGROUND: Split-thickness skin graft (STSG)1 integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL)2 imaging (MolecuLight®), which accurately locates areas of bacterial loads above 104 CFU/gr, for graft site assessment and preparation could yield better outcomes. METHODS: This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>104 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm2) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed. RESULTS: 38 patients were enrolled in the study. The mean total body surface area (TBSA)3 involvement was 14.5 ± 12.4 % [range 0.8 - 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %. CONCLUSIONS: FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes. LEVEL OF EVIDENCE: Level IIA, Therapeutic study.

Equivalence in Color-coded Duplex Sonography Parameters before Complex Microsurgery.

Background: Color-coded duplex sonography (CCDS) is a widely proposed noninvasive diagnostic tool in microsurgery. CCDS has been applied to lower extremity salvage cases to define appropriate blood flow velocity criteria for achieving arterial success in diabetic foot and complex microsurgery cases. This study aimed to compare the success ratio of free flaps when using CCDS versus cases where CCDS was not used. Methods: We included complex microsurgery cases from 2019 to 2021. These cases were subsequently categorized into two groups: group A consisted of cases where CCDS parameters were applied, whereas group B comprised cases where CCDS was not performed at all. Results: The study encompassed 14 cases (11 men and three women). The age range varied from 23 to 62 years, with an average age of 42. Using CCDS analysis and planning demonstrated improved outcomes in comparison with cases where CCDS was not performed, albeit without statistical significance (P = 0.064). Conclusions: The application of CCDS proves to be beneficial in the realm of microsurgery. Although not achieving statistical significance, our data imply that CCDS utilization holds promise for enhancing microsurgical procedures.

Comparison of Nasal Analysis by Photographs (2D) against Low-cost Surface Laser Imaging (3D) and against Computed Axial Tomography Imaging.

Introduction In aesthetic surgery, we have a few evaluation tools that numerically and objectively measure the changes we make in patients. This article aimed to evaluate the nasal systematic analysis and compare findings between the three systems of nasal evaluation: photographs 2D, 3D surface imaging with the Kinect system, and 3D CT scan imaging. Methods We designed a longitudinal and descriptive prospective study with simple non-blind randomization. To compare the systematic nasal analysis between the three methods. If the findings are similar, all three methods would be useful in independent clinical scenarios. Results A total of 42 observations were included finding a minimum age of 21 with a mean of 28 years old. Also, 64% were female, 93% had adequate facial proportions, and 50% were Fitzpatrick III. For outcome statistics, we found differential nasal deviation between 3D images with a mean of 6.53 mm. While when comparing the nasal dorsum length, we found a statistical significance of p = 0.051. When comparing the nasal dorsum length index, we found no significant difference p = 0.32. Also, we did not find statistical significance when comparing the nasofrontal angle and tip rotation angle p = 1 for both. Conclusion We found that the population we serve has characteristics of Hispanic mestizo nose. The three methods seem to evaluate systematic nasal analysis in a very similar way, and any of them can be used depending on the scenario and the needs of plastic surgeons.

Auricular Total Reconstruction with Radial Forearm Prelaminated Flap Assisted by 3D Surface Imaging and 3D Printing.

The anatomic position of the auricle leaves it vulnerable to traumatic lesions. In most cases, the best reconstructive outcome is accomplished using a temporoparietal flap with a costal cartilage frame and a partial thickness skin graft. Exceptional cases may require different approaches because the reconstructive goals could be more structural than aesthetic. An important factor in this regard is the mechanical properties of the skin that will provide coverage. This study aimed to share a particular case of total auricular reconstruction assisted by 3D surface imaging and 3D printing in a radial forearm free flap. We present a 58-year-old man with a history of having tympanic barotrauma causing hearing loss, burdening him with the use of auricular devices for hearing assistance. Seven days before presenting for the initial treatment, he sustained ear trauma while performing mechanical reparations in a car. The wheel was activated, causing a total amputation of the right ear. He first went to another hospital' where they performed primary closure and then referred him to our unit. The team performed a prelaminated radial forearm free flap assisted by 3D scanning and planning. A detailed comparison between the left ear and the result of the reconstruction was measured and described. The radial forearm prelaminated free flap is a viable structural alternative with the disadvantage of poor auricular definition in some cases.

El colgajo libre de arteria perforante sural medial: revisión sistematizada de casos publicados y experiencia en tres centros de Latinoamérica / The medial sural perforating artery free flap: systematized review of published cases and experience in three centers in Latin America

Introducción y objetivo: El colgajo libre perforante de la arteria sural medial es un colgajo versátil, que se caracteriza por ser relativamente delgado, maleable, con una anatomía vascular fiable y baja morbilidad en el sitio donador. Se popularizó en Asia como una buena alternativa en la reconstrucción de cabeza y cuello. Sorprendentemente, se usa con poca frecuencia en América. Este artículo, a través de una revisión de la literatura y nuestra experiencia en 3 centros en América Latina, pretende ayudar a los microcirujanos latinoamericanos a familiarizarse con este colgajo, presentando la técnica quirúrgica, sus aplicaciones más comunes y las posibles soluciones a los problemas más comúnmente encontrados. Material y método: Realizamos la revisión bibliográfica en cuatro plataformas; Medline, Google Scholar, PubMed Central y Embase, obteniendo después de criterios de exclusión 572 pacientes de 36 artículos. A estos agregamos nuestra serie de casos como estudio retrospectivo en los Departamento de Cirugía Plástica de 3 centros en América Latina, entre mayo de 2015 y diciembre de 2020, con un total de 34 pacientes. Resultados: En total reunimos 606 pacientes entre la revisión de casos publicados y nuestra propia serie; de ellos, 75.1% hombres y 24.9% mujeres, con edad media de 49.1 años. El colgajo se usó principalmente en reconstrucción oral. El tamaño promedio del colgajo fue de 54.5 cm2, con un grosor de 5.9 mm y una longitud del pedículo de 9.7 cm. El tiempo de disección del colgajo y de cirugía fue de 74 y 370 min. respectivamente. La tasa de complicaciones fue de 12.7%: 3% en la zona donadora, 4.3% de pérdida total del colgajo, 4.1% con pérdida parcial y 1.3% con congestión venosa transitoria. (AU)

Background and objective: The medial sural artery perforator flap is vastly versatile. It is characterized by being wide, thin, flexible, adequate pedicle length, reliable vascular anatomy, and has low donor site morbidity. It has been popular in Asia as a good alternative, especially in head and neck reconstruction. But surprisingly, it's not frequently used in America. In this article, through a review of the literature and our experience from 3 centers in Latin America, we intend to help Latin-American microsurgeons get familiarized with this flap by presenting the surgical technique, the most common applications, and possible solutions to the most common problems encountered. Methods: For the literature review, the search was performed on 4 different platforms: Medline, Google Scholar, PubMed Central, and Embase. They were gathered, after exclusion criteria, 572 patients from 36 different publications. In addition to the previous, 34 more patients were added from our own experience in 3 different Latin-American hospitals, from May 2015 to December 2020. Results: A total of 606 patients were gathered through the systematic review and our clinical series, 75.1% male and 24.9% females, average age of 49.1 years. This kind of flap is commonly used for oral reconstruction. The average flap size was 54.5 cm2, with a 5.9 mm thickness and an average pedicle length of 9.7 cm. The average time for the flap harvest and surgery was 74 and 370 min, respectively. The complications rate reported was of 12.7%: 3% from donor complications, 4.3% from total flap loss, 4.1% from partial loss and 1.3% from venous congestion. (AU)

Initial Histological Evaluation of a Novel Dura Mater Graft Based on Capsule Granulation Harvested From Subcutaneous Tissue: Experimental Model.

INTRODUCTION: Autografts are useful but unfortunately are limited in big dural defects, in such cases, synthetic implants have been recommended. Extensive evidence in the literature suggests that sometimes synthetic implants had high rates of complications like infections. This paper aims to present a novel dura matter graft based on capsule granulation tissue harvested from subcutaneous space as a dura substitute and its histological findings. MATERIALS AND METHODS: Wistar rats between 240 and 430 grams of both genders were included. First stage procedure introducing silicon spheres in the subcutaneous tissue. Second stage procedure 4 weeks later harvested de capsule granulation tissue that contain them. Then a craniectomy was performed to create a dura mater defect. This defect was reconstructed with the granulation tissue was placed onlay the defect. After another 4 weeks the subjects were euthanized and sent to an external pathology unit for analysis with validated integration scales. RESULTS: A total of 5 subjects were included (3 males and 2 females) with weight between 240 and 430 grams. Only 2 outcome out of 6 scales had significance difference between the samples: adhesions P = 0.011 and integration P = 0.006. CONCLUSIONS: The histological findings shown that capsule granulation graft is a compatible, autologous compatible substitute for dura mater. It has a great potential of full integration and an acceptable grade of adhesions.

Evaluation of Predictive Values of an Automatic Device Measuring Oximetry in Free Flaps.

Free-flap monitoring is challenging to perform in some centers. It requires the availability of trained health care personnel for 24 hours a day and seven days a week. Many methods had been proposed for flap monitoring, and none of them are superior to clinical evaluation. This study aimed to present a murine model to evaluate the accuracy (sensitivity, specificity, and the positive or negative predictive values) of a device. Wistar rats weighing 240-490 g were included for intervention and data collection. A murine model of left inferior epigastric vessel flaps was implemented. Intermittent pedicle clamping was performed to calculate the accuracy of the device that detects flow obstruction. The general variables studied were age, weight, and gender. The sensitivity, specificity, and negative or predictive values were calculated. The results showed a sensitivity of 97%, a specificity of 95% with a positive predictive value of 95%, and negative predictive value of 97%. The sensitivity and specificity showed excellent results within the range of clinical security. We require more data to analyze the multiparameter monitoring to see if it is feasible and cost-effective.

Time Reduction by Prebending Osteosynthesis Plates Using 3D-Printed Anatomical Models, In Patients Treated With Open Reduction and Internal Fixation.

INTRODUCTION: The incidence of facial bones fractures is 18 to 32 for each 100,000 inhabitants. The most affected population are young working people. Fractures are most commonly caused by assaults and motor vehicle accidents. Its cost of care reaches 1.06 billion dollars. Premodeling osteosynthesis plates with anatomical models can decrease surgical time, bleeding, and increase patient satisfaction. This study aims to evaluate the impact of premodeled osteosynthesis plates, using anatomical models in patients with facial fractures. MATERIAL AND METHODS: Patients with facial fractures treated by open reduction and internal fixation were included-Group A without premolding plates and Group B with premolding. The variables studied were: age, sex, etiology of the fractures, number of fractures, among other variables that reflect the quality of the results. RESULTS: A total of 17 osteosynthesis plates were included in 6 patients. The age was 22 to 47 years; all patients were male. The maximum surgery time was 129 to 300 minutes. The average time to start work was 4.8 weeks. When comparing the variables between the groups, we found no difference between the groups for bleeding P = 0.24, the start of work P = 0.19, the time of surgery P = 0.082, or for osteosynthesis time P = 0.15. There was only a significant difference in patient satisfaction, P = 0.04. CONCLUSIONS: The evidence collected shows that premodeling the plates only improves patients' satisfaction among facial fractures treated by open reduction and internal fixation.

Aplicaciones de la impresión 3D en cirugía plástica reconstructiva / Use of 3D printing in reconstructive plastic surgery

Resumen La impresión 3D es una tecnología interesante en constante evolución. También conocida como manufactura aditiva, consiste en la conversión de diseños digitales a modelos físicos mediante la adición de capas sucesivas de material. En años recientes, y tras el vencimiento de múltiples patentes, diversos campos de las ciencias de la salud se han interesado en sus posibles usos, siendo la cirugía plástica una de las especialidades médicas que más ha aprovechado sus ventajas y aplicaciones, en especial la capacidad de crear dispositivos altamente personalizados a costos accesibles. Teniendo en cuenta lo anterior, el objetivo del presente artículo es describir los usos de la impresión 3D en cirugía plástica reconstructiva a partir de una revisión de la literatura. Las principales aplicaciones de la impresión 3D descritas en la literatura incluyen su capacidad para crear modelos anatómicos basados en estudios de imagen de pacientes, que a su vez permiten planificar procedimientos quirúrgicos, fabricar implantes y prótesis personalizadas, crear instrumental quirúrgico para usos específicos y usar biotintas en ingeniería tisular. La impresión 3D es una tecnología prometedora con el potencial de implementar cambios positivos en la práctica de la cirugía plástica reconstructiva en el corto y mediano plazo.

Abstract 3D printing is an interesting technology in constant evolution. Also known as additive manufacturing, it consists of the conversion of digital designs into physical models by successively adding material layer by layer. In recent years, and after the expiration of multiple patents, several fields of health sciences have approached this type of technology, plastic surgery being one of the medical specialties that has taken advantage of its benefits and applications, especially the ability to create highly customized devices at low costs. With this in mind, the objective of this work is to describe the uses of 3D printing in reconstructive plastic surgery based on a literature review. The main applications of 3D printing described in the literature include its ability to create anatomical models based on patient imaging studies, which in turn allow planning surgical procedures, manufacturing custom implants and prostheses, creating surgical or instrumental simulators, and using bioinks in tissue engineering. 3D printing is a promising technology with the potential to cause positive changes in the field of reconstructive plastic surgery in the short and medium term.

Laparoscopic treatment in Type IV Giant Paraesophagic Hernia and intestinal occlusion a case report.

INTRODUCTION: A Giant Hiatal Paraesophageal Hernia (GPEH) is a Hiatal Hernia (HH) that includes more than 30% of the stomach in the thorax. The gold standard form of repair today is the laparoscopic abdominal approach in elective scenarios. Laparoscopic HH repair advantages include, less postoperative pain, small incisions, reduced postoperative respiratory complications are reduced, shorter hospital stay. The objective of this paper is to describe a patient undergoing with upper intestinal obstruction and a GPEH Type IV, approached laparoscopically. CASE PRESENTATION: We received a female patient 59 years old, she came with symptoms abdominal pain, emesis of intestinal characteristics and obstipation, with an evolution of 5 days. She also referred dyspnea; she went to another institution where made a CAT scan finding a GPEH. We decided to realize the procedure laparoscopically. We follow the principal objectives, reducing the hernia, dissecting al de hernia sac excision, Hiatal reparation with no mesh, and Nissen type fundoplication without Collis Gastroplasty. The patient stayed for seven days for surveillance and when the leukocyte and LDH went to a regular rate patient was discharged. With no complications with normal intestinal function and nearly no pain. DISCUSSION: We present a GPEH case associated with upper intestinal obstruction, with clinical findings that suggested ischemia. The approach of the treatment was abdominal laparoscopy. CONCLUSION: In elective patients Laparoscopy is superior than abdominal approach. Randomized trials comparing laparoscopic versus open approach are needed to conclude that laparoscopic approach is superior to open approach, in potentially GPEH complicated patients.

[Dysmorphic neonatal syndrome and Ogilvie syndrome]. / Síndrome dismórfico neonatal y síndrome de Ogilvie.

BACKGROUND: Acute colonic pseudo-obstruction, or Ogilvie syndrome, is a motility abnormality characterised by rapid and progressive dilation of the large intestine. To achieve a diagnosis it is fundamental to exclude mechanical obstruction with imaging studies such as computer axial tomography. The combined incidence of Ogilvie and dysmorphic syndrome has not been described. CLINICAL CASE: Female patient of 28 years old with a history of infant cerebral palsy came to emergency room with 4 days of intestinal obstruction. She had hypokalaemia that was reverted, but persisted with obstruction. Later after 72h with recovery of fluids and electrolytes and administration of prokinetics, the obstruction reversed. She was discharged with no complications. CONCLUSIONS: Non-invasive medical treatment solves most cases. Promising results have been achieved with neostigmine. In the event of no response to drug therapy, the next step is endoscopic treatment. Even with high recurrence this is preferred due to its lower level of complications in contrast to surgical decompression. Neonatal dysmorphic syndrome is often associated with disorders of the central nervous system. So far, there have been no reports on the incidence of this disease with Ogilvie syndrome, although 9% of cases have been described as associated with neurological events. Conservative management in this disease is the initial approach. Interventions should be reserved for when conservative treatment fails.