The use of telemedicine in burn care: development of a mobile system for TBSA documentation and remote assessment.

The requirements for accurate documentation within the process of burn assessment have increased dramatically over the years. TBSA (total body surface area) and burn depth are commonly determined by visual inspection, especially in the emergency or acute care setting. However, inexperience often results in incorrect estimation of these factors. In 2001, BurnCase 3D was initiated in order to develop a tool for objective burn assessment and documentation on mobile devices (Apple iPhoneTM). The centerpiece is a 3D model representing the actual patient. At two international burn meetings, a survey containing three pictures of patients was conducted and this data was collected. A patient-specific 3D model adapted to the height and weight of the real patient was created and the digital picture was superimposed in the computer system. The burns were transferred to the model and the TBSA in % was calculated by the software BurnCase 3D. The preferred methods of the 80 respondents for burn extent estimation were: the Rule of Nines (38%), the Rule of Palm (37%) and the Lund-Browder chart (18%). Analysis showed very high deviations of TBSA within the participants, even among the group of experts. In comparison to a computer-aided method we found massive overestimation of up to 230%. The use of BurnCase 3D could have a true impact on the quality of treatment in burns. In the acute care setting for burn injuries, telemedicine has great potential to help guide decisions regarding triage and transfer based on TBSA, burn depth, patient age and injury mechanism.

Les exigences en matière de documentation précise dans le processus de l'évaluation des brûlures ont augmenté de façon spectaculaire au cours des années. La SCT (surface corporelle totale) et la profondeur de la brûlure sont généralement déterminées par inspection visuelle, en particulier dans le contexte d'urgence ou de soins aigus. Cependant, l'inexpérience se traduit souvent par une estimation incorrecte de ces facteurs. En 2001, BurnCase 3D a été lancé afin de développer un outil d'évaluation des brûlures objectif et de la documentation sur les appareils mobiles d'Apple (iPhone™). La pièce maîtresse est un modèle 3D représentant le patient réel. Sur deux réunions de brûlures internationales, une enquête contenant trois photos de patients a été réalisée. Ces données ont été collectées. Un modèle 3D spécifique au patient adapté à la taille et le poids du patient réel a été créé et l'image a été superposée dans le système informatique. Les brûlures ont été transférés dans le modèle et le % de la surface corporelle totale a été calculé par le logiciel BurnCase 3D. Les méthodes préférées des 80 répondants pour l'estimation de la taille de la brûlure étaient : la règle des neuf (38%), la règle des palm (37%) et les tables de Lund et Browder (18%). L'analyse montre des écarts très élevés de SCT dans les participants, même parmi le groupe d'experts. Par rapport à un procédé assisté par ordinateur, nous avons trouvé surestimation massive de jusqu'à 230%. L'utilisation de BurnCase 3D pourrait avoir un véritable impact sur la qualité du traitement des brûlures. Dans le cadre de soins de courte durée pour les brûlures, la télémédecine a un grand potentiel pour aider à guider les décisions concernant le triage et le transfert sur la base de la SCT et la profondeur de la brûlure, l'âge du patient et le mécanisme de blessure.

Use of 2-octyl cyanoacrylate together with a self-adhering mesh (Dermabond™ Prineo™) for skin closure following abdominoplasty: an open, prospective, controlled, randomized, clinical study.

BACKGROUND: Abdominoplasty is one of the most commonly performed procedures in plastic surgery. The appearance of the scar is a major factor that contributes to the aesthetic outcome of the procedure and depends largely on the technique of wound closure. The new Prineo™ wound closure system was introduced to combine the effectiveness of 2-octyl cyanoacrylate (Dermabond™) together with a self-adhering mesh. METHODS: Fifty-two women and eight men aged between 21 and 65 years who were scheduled for abdominoplasty were included in the study. The total operating times after abdominoplasty of the traditional wound closure technique and the Prineo™-type wound closure technique were compared. Furthermore, an analysis comparing the cost of the two methods was performed. Two weeks after surgery the wounds were examined and graded using the Hollander Cosmesis Scale. At the 6- and 12-month follow-ups, the aesthetic outcome of the abdominal scar was evaluated using the Vancouver Scar Scale. Twelve months after surgery, the patients were asked to answer their part of the Patient Scar Assessment Scale. RESULTS: The mean total operating time for the new skin closure system was statistically significantly shorter than that of intradermal sutures. The mean price difference per patient was 104.27 (134.79$) in favor of Prineo™. The Hollander Cosmesis Scale indicated a significantly more favorable overall result with Prineo™ at 2 weeks after surgery. The Vancouver Scar Scale demonstrated a better cosmetic outcome in favor of Prineo™ 6 and 12 months after surgery. The Patient Scar Assessment Scale scores 12 months after surgery indicated that the patients noted significantly less pain, thickness, and irregularity with Prineo™. CONCLUSION: Based on our results, we conclude that Prineo™ is a safe and effective substitute for superficial skin closure, with good cosmetic results and no increase in wound complications. The use of Prineo™ decreases operative time and cost and enhances the patient's postoperative comfort. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Negative pressure therapy: theory and practice.

Negative pressure (wound) therapy, synonymous with topical negative pressure or vacuum therapy mainly cited as branded VAC® (vacuum-assisted closure) therapy, is a mode of therapy used to encourage wound healing. It is used both as primary treatment of chronic and complex wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. The device has come into wide and successful use, although the physiological basis of its effect is not yet fully understood, and with a delay, increasingly evidence-based data become available. A meta-analysis was made of peer-reviewed publications (PubMed-Medline) chosen on the basis of inclusion of the terms randomized clinical trial, vacuum-assisted closure, and topical negative pressure. Scientific data were evaluated from experimental animal studies, randomized clinical trials, observations of clinical applications, and case reports on all known effects of VAC therapy. Systematic analysis of the data shows efficacy concerning induction of wound healing mechanisms, especially in the early stage. Increased perfusion can be considered proven. Data analysis shows positive efficacy for treatment of infection. Although this therapy appears effective and its superiority to conventional techniques has been demonstrated, there are still some critical votes concerning efficacy. Because its mechanisms of action remain unclear, and because there is still some gap between evidence-based data and the excellent clinical results, further prospective, randomized, blinded studies are needed. Even so, we conclude that vacuum therapy, used when indicated and especially by experienced surgeons, is an excellent tool to support wound healing.

Surgical management of extensive gnathophyma.

Rhinophyma is an uncommon disease of the nose characterized by irregular skin thickening and nodular deformation. The extensive growth causing 'whisky nose' is due to hyperplasia of the sebaceous glands and the surrounding connective tissue. Other facial regions may concomitantly be affected. We present a case of extensive gnathophyma accompanying minor lesions of the nose. Surgical treatment led to an excellent cosmetic result.

[The impact of the VAC-treatment for locally advanced malignancy of the scalp]. / Stellenwert der V.A.C.(R)-Therapie beim fortgeschrittenen Kopfhautmalignom.

Locally advanced cutaneous malignancy of the scalp is a disease that requires an aggressive approach to resection and reconstruction. In cases where the pericranium is intact a split-thickness skin graft is a simple treatment, since direct closure often fails because due to the lack of elasticity of the scalp. If there is a loss of periosteum or a skull defect local or free flaps are necessary for sufficient coverage. Increasing geriatric and polymorbid patients with impaired wound healing require surgical treatment, considering pros and cons for general anaesthesia. A simple method of both, combining radicality of tumor resection with outer table bone and skin grafting as a two stage procedure, while minimizing perioperative risk using local anaesthesia and analgo-sedation, using the vacuum assisted closure device, is presented.