Usage of Dermal Substitutes for Hand Coverage and Reconstruction

Abstract Background Hand coverage and reconstruction gives a challenge for plastic surgery. In this study we introduce a method for hand coverage and reconstruction by dermal substitutes which easy and simple to use. Objectives The aim of this study is to know the versatility of dermal substitutes in reconstruction & coverage of complex hand defects. Patients and Methods This was a cohort study conducted on 20 patients with hand tissue loss; to evaluate the versatility of dermal substitutes in reconstruction & coverage of complex hand defects. Patients attending El Helmeia armed forces hospital (plastic and reconstructive department) & Ain shams university hospital with follow up duration up to 6 months. All patients had clean wound & complex hand defects with exposed tendon and/or bone, Defects post trauma and after tumour excision and Post burn hypertrophic scars, keloid or contractures. Results We found that; the mean age of all patients was (23.5 ± 8.82) years. Regarding gender of the patients, the majority (80%) of patients were males; while (20%) were females. Regarding side of raw area; (55%) of patients had Rt-sided raw area, and (45%) had Lt-sided raw area. Regarding site of raw area; (20%) of patients had Finger-tip raw area, (20%) had Palm raw area, (10%) had Volar surface of little and ring raw area, (10%) had Volar surface of little finger raw area, (25%) had Dorsum raw area, (10%) had Dorsum of lateral 4 fingers raw area, while (5%) had Dorsum of middle finger raw area. Regarding Etiology of raw area; (70%) of raw areas caused by Trauma, (15%) caused after burn keloid removal, (10%) caused after burn contracture, and (5%) caused by donor site. Regarding Intervention data; (50%) of patients used Integra dermal substitute; and (50%) used Pelnac dermal substitute. Regarding follow up data; the average Time of removal was (3.65 ± 0.49) weeks, and the average Time for follow up was (3.25 ± 1.12) months. Comparative study between 20 hand tissue loss patients revealed; highly significant increase in Post-operative STSG satisfaction rate (70%); with highly significant statistical difference (p < 0.01), highly significant increase in Post-operative STSG good movement (80%); with highly significant statistical difference (p < 0.01). Conclusion The use of dermal substitutes cons gives an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.

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Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

10.21203/rs.3.rs-39680/v3 ◽

2020 ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Wenrui Qu ◽

Xiaolan Ou ◽

Rui Li ◽

...

Keyword(s):

Postoperative Complications ◽

Nerve Injury ◽

Donor Site ◽

Graft Loss ◽

Operation Time ◽

Plantar Artery ◽

Significant Difference ◽

Medial Plantar Artery ◽

Volar Surface

Abstract Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference between postoperative complications and 2-PD test result in patients without nerve injury. And in terms of overall function, Modified VSS score and 2-PD test (the patients with nerve injury), There were relatively obvious statistical differences, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.

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Comparison of Phacotrabeculectomy and Phacotrabeculectomy with Subconjunctival 5-Fluorouracil

Journal of Nepal Medical Association ◽

10.31729/jnma.2803 ◽

2014 ◽

Vol 52 (196) ◽

pp. 1010-1013

Author(s):

Nanda Kumari Gurung ◽

Prachand Gautam ◽

Shanti Gurung ◽

Binita Bhattarai

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Statistical Difference ◽

Surgical Techniques ◽

Significant Statistical Difference ◽

Keywords Glaucoma ◽

Group A ◽

Group B ◽

Age Range

Introduction: Glaucoma is the second leading cause of blindness worldwide. Phacotrabeculectomyis a technique in which glaucoma and cataract surgery performed. Methods: Prospective study was carried out in the department of glaucoma at Lumbini Eye Institute, Bhairahawa.100 patients who underwent phacotrabeculectomy within a period of two years. Patients were divided into two groups those who received 5FU (n=47) and no antifibrotic agent (n= 53). Results: The age range was from 38 to 80 years; mean age of 62.97±9.14 SD. 55% were male and 45% were female.The postoperative IOP reduction in last follow- up group A was mean=13.08±1.57SD and mean=13.23±1.73SD in group B. This was statically significant with P <0.001. Bleb survival was almost similar in two groups 3.17(78.31%) in group A and 3.20 (78.93%) in group B. 85% visual acuity was improved in both groups. Conclusions: Phacotrabeculectomy and phacotrabeculectomy with inj. 5FU, both were equally effective surgical techniques in terms of visual acuity, IOP control and bleb survival.There was no significant statistical difference vis-à-vis the success of Phacotrabeculectomy using of either these two techniques. Keywords: glaucoma; 5FU; intraocular pressure; phacotrabeculectomy.

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Surgical Outcome and Complications of Nasal Septal Perforation Repair with Temporal Fascia and Periosteal Grafts

Clinical Medicine Insights Ear Nose and Throat ◽

10.4137/cment.s23230 ◽

2015 ◽

Vol 8 ◽

pp. CMENT.S23230 ◽

Cited By ~ 11

Author(s):

Paula Virkkula ◽

Antti a. Mäkitie ◽

Seija i. Vento

Keyword(s):

Postoperative Infection ◽

Donor Site ◽

Neck Surgery ◽

University Hospital ◽

Septal Perforation ◽

Temporal Fascia ◽

Nasal Septal Perforation ◽

Main Technique ◽

Advancement Flaps

Aims Surgical treatment of nasal septal perforation remains a challenging field of rhinology. A large variety of techniques and grafts with promising results have been introduced for perforation repair. However, the use of fascia or fascia with periosteum has not been previously evaluated for a large sample of patients. Methods During the years 2007–2014, 105 operations were performed and 98 patients were treated for nasal septal perforation at the Department of Otorhinolaryngology–-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland. We performed a retrospective review of closure rates and complications. Follow-up time ranged from 1 to 62 months. Results Bleeding was the most common early complication (9%), followed by postoperative infection (5%) in the whole series. Our main technique, bipedicled advancement flaps with fascia or fascia and periosteum, was performed for 81 patients. We obtained successful closure in 78% of these patients with this operative technique and the rate increased to 86% during the last 3 years of the study period. Conclusions Perforation repair with temporal fascia or fascia with periosteum requiring only one donor site seems to be a reliable option for nasal septal perforation repair.

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THE PROTECTIVE STATUS OF SUBTOTAL OBLITERATION OF ARTERIOVENOUS MALFORMATIONS AFTER RADIOSURGERY

Neurosurgery ◽

10.1227/01.neu.0000348546.47242.5d ◽

2009 ◽

Vol 65 (4) ◽

pp. 709-718 ◽

Cited By ~ 10

Author(s):

Zuair Abu-Salma ◽

François Nataf ◽

May Ghossoub ◽

Michel Schlienger ◽

Jean-François Meder ◽

...

Keyword(s):

Comparative Analysis ◽

Arteriovenous Malformations ◽

Statistical Difference ◽

Bleeding Rate ◽

Significant Statistical Difference ◽

Significant Difference ◽

Complete Obliteration

Abstract OBJECTIVE Arteriovenous malformations (AVMs) treated by radiosurgery with complete obliteration of the nidus but a persisting early draining vein on follow-up angiography can be termed subtotally obliterated. However, these are persistent circulating AVMs. The significance of these lesions, their hemorrhage rate, and their management are analyzed. METHODS In a series of 862 consecutive patients with AVMs treated by radiosurgery, 121 patients (14%) achieved subtotal obliteration (STO). The angiographic evolution and rate of obliteration were studied. The pretreatment angiographic features, dosimetric parameters, and postradiosurgery hemorrhage rate were compared with those in the rest of the treated population. Finally, the options for follow-up and treatment were analyzed. RESULTS Of 121 subtotally obliterated AVMs, the bleeding rate was 0%; 53% of patients achieved complete obliteration. This occurred in 71% of those who had STO at 1 year. In the cases in which STO was detected at 2, 3, and 4 years, total obliteration eventually occurred in 43%, 28.5%, and 0%, respectively. Comparative analysis with AVMs in which a part of the nidus persisted showed a significant difference in the bleeding rate. Except for volume, no significant statistical difference in angiographic and dosimetric parameters was found between the STO group and the rest of the studied population with residual nidus. Six cases received further treatment, resulting in 2 cures and 2 treatment-related complications. CONCLUSION Subtotally obliterated AVMs are different from other partially obliterated AVMs, with a 0% bleeding rate. Their complete obliteration is a function of delay of appearance on follow-up angiography. Invasive follow-up and further treatment of these AVMs do not seem warranted.

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Comparative Study between Modified Transverse and Hayman Suture Regarding the Efficacy and Purperium Complications in Thi-Qar

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32b31737 ◽

2021 ◽

pp. 22-33

Author(s):

Aseel Mosa Jabber

Keyword(s):

Statistical Difference ◽

Post Partum ◽

High Rate ◽

P Value ◽

Post Partum Hemorrhage ◽

Significant Statistical Difference ◽

Surgeon Experience ◽

Compression Suture ◽

Uncontrolled Hemorrhage

Background: Main causes of death post-partum is the uncontrolled hemorrhage, that managed by different modalities, whereuterine compression suture had different efficacies as a main interventional tools of sever postpartum hemorrhage. Aim: comparing different sutures types (modified transverse and Hayman suture) regarding their efficacy through its impact and in determining the final outcome and complications of post-partum hemorrhage. Materials and methods: A prospective comparative analytical study including 122 females , who underwent delivery between march 2017and December 2019, all of them followed for , 1 week, 6,weeks 6 months. Were the samples collected from Bent-Al-Huda teaching hospital and Al-Rehman private hospital-Thi-Qar, 2 groups of study; 1st one (52) underwent modified B-lynch suturing (Hyman suturing) while the 2nd group(70) underwent transverse sutures of modified Ouahba suture, written consent had taken from all patients, SPSS version 24 used for analysis. Results: Among 122 delivered women suffer from primary post-partum hemorrhage, 52 (42.63%) were sutured by Hayman suture, and 70 (57.37%)were sutured by transverse suturing,There was significant statistical difference between the types of intervention and blood loss P value <0.05. There was significant statistical difference between the types of intervention and complication development (p value=0.0001). There was no significant independent predictors or determinant for the complication development except the type of intervention. Only follow-up period and complication were truly to be correlated with type of intervention, the other variable were confounders Conclusion: Even though the hemostasis had been achieved in both maneuver with excellent success rate, the transvers suture carrying high rate of persistent pain but the Hayman suture carry higher rate of serious complication such hysterectomy and intestinal obstruction. several factors determine the choosing of the suture type such as site, severity and cause of bleeding and the surgeon experience.

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A comparison of complications associated with nutrition between the patients receiving enteral or parenteral in the intensive care unit

International Journal of Clinical Anesthesia and Research ◽

10.29328/journal.ijcar.1001015 ◽

2020 ◽

Vol 4 (1) ◽

pp. 013-018

Author(s):

Asci Seyhan Sumeyra ◽

Eroglu Ahmet ◽

Asci Coskun

Keyword(s):

Intensive Care Unit ◽

Length Of Stay ◽

Parenteral Nutrition ◽

Statistical Difference ◽

Demographic Characteristics ◽

University Hospital ◽

Significant Difference ◽

Reason For Admission ◽

Enteral And Parenteral Nutrition

The aim of this study was to investigate and compare the complications including infection and mortality associated with enteral and parenteral nutrition on patients in the ICU of a university hospital. In this study, a total of 100 patients who were under follow-up in the ICU for two years were examined. In our study, demographic characteristics, the reason for admission, comorbidity, initial ICU laboratory values, morbidity and mortality during the follow-up period of the patients who only received enteral nutrition (EN) or parenteral nutrition (PN) were evaluated, and the results between two were compared as well as evaluating the complications within the groups. The comparison of the reason for admission between the EN and PN groups showed that surgical reasons were significantly higher in the PN group. Nosocomial infections, the presence of infection and the development of sepsis were significantly higher in the EN group. The 28-day mortality rate was higher in the PN group compared to the EN group. The length of stay in the ICU and on mechanical ventilation was longer in the EN group. There was no significant difference in the 28-day mortality, readmission to the ICU and repeated endotracheal intubation between the two groups. Because there is no statistical difference between EN and PN groups in point of infection and mortality, we conclude that the length of stay in the ICU and reason for admission play a more crucial role in the development of infection and on mortality rather than enteral or parenteral nutrition route.

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657 Bilayer Dermal Substitute in Management of Deep Hand Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.305 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S185-S185

Author(s):

Karalyn E Hillebrecht ◽

Jenny A Ziembicki

Keyword(s):

Functional Limitation ◽

Graft Loss ◽

Retrospective Chart Review ◽

Operative Management ◽

Dermal Substitute ◽

Full Thickness ◽

Dermal Substitutes ◽

Minimal Scarring ◽

Hand Burns

Abstract Introduction Bilayer dermal substitutes, composed of bovine collagen cross-linked with glycosaminoglycan and silicone, have become increasingly integrated into the algorithm for management of complex burns. In complex hand burns, dermal substitutes improve functional and aesthetic outcomes while also allowing early excision in high percentage TBSA burns. We detail the outcomes of 17 patients with 25 cases of complex hand burns managed at our center using a staged procedure of cadaveric allografting followed by dermal substitute placement and early definitive STSG. Methods Between Jan 2018 and Aug 2019, all patients who sustained deep partial/full thickness burns to their hands managed with dermal substitution were identified. Patients less than 18 yo, with additional non-burn trauma to the hands, and with initial operative management at another center prior to transfer were excluded. A retrospective chart review was used to collect data regarding time to operative excision, placement of allografts and substitutes, definitive STSG, and functional outcome. Results 17 patients from 18 and 89 yo presented with 25 deep partial/full thickness hand burns. TBSA varied from 0.75 to 78% (mean 17.7%). On average, patients underwent first excision 5.3 (2–16) days after initial burn or 4.2 days after presentation. Our protocol often uses allografting prior to placement of the dermal substitute, therefore, 22 of 25 burned hands received cadaver allografts at initial excision. Dermal substitute was placed an average of 9.2 days later. 3 of 25 burns had immediate application of dermal substitute at first excision. Following substitute, non-meshed, split-thickness autografts were placed on 18 hands. 5 of the burns did not require STSG and two hands were not further evaluated due to loss of patient follow-up. Of the 25 cases, all had near complete incorporation of the substitute without need for revision. In follow-up, patients who did not require STSG have shown no major limitations in ROM/scarring. Of those who underwent STSG, 6 hands underwent contracture release, with 2 of these progressing to amputation. One hand required repeat autografting due to graft loss. All remaining 18 hands healed well with near complete graft take and minimal scarring or functional limitation. Conclusions Dermal substitutes assist in the closure of complex deep hand burns. Cadaveric allografting prior to placement of the substitute ensures an appropriately excised wound base, allowing for near complete integration without need for reapplication. Autografting following dermal substitution placement may be initiated earlier than previously pursued and occasionally allows for healing without STSG.

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Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

10.21203/rs.3.rs-39680/v4 ◽

2020 ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Wenrui Qu ◽

Xiaolan Ou ◽

Rui Li ◽

...

Keyword(s):

Postoperative Complications ◽

Nerve Injury ◽

Donor Site ◽

Graft Loss ◽

Operation Time ◽

Plantar Artery ◽

Significant Difference ◽

Medial Plantar Artery ◽

Volar Surface

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Treatment of Defects on the Volar Surface of the Finger using the Dorsal Digital–metacarpal Flap Versus the Free Medial Plantar Artery Flap: A Comparative Study

10.21203/rs.3.rs-39680/v1 ◽

2020 ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Wenrui Qu ◽

Xiaolan Ou ◽

Rui Li ◽

...

Keyword(s):

Donor Site ◽

Graft Loss ◽

Donor Site Morbidity ◽

Plantar Artery ◽

Reconstruction Methods ◽

Finger Reconstruction ◽

Tissue Defects ◽

Medial Plantar Artery ◽

Volar Surface

Abstract Background Few cases are reported on the treatment of defects on the volar surface of the finger, and its utility for digital resurfacing remains unclear. This study compared the outcomes of the free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction. Methods This cohort study was conducted on 24 patients who had soft-tissue defects on the volar side of the finger from March 2014 to March 2017. The patients were divided into the following 2 groups: the MPAF group and the DDMF group. The operative time as well as complications, including flap necrosis, graft loss, infection, paresthesia, donor-site morbidity, and two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire (MHQ) was applied to conduct follow-up assessment. Results After more than 12 months of follow-up, the results were significant. In terms of overall function, MPAF was superior to DDMF (p < 0.005). Conclusion The MPAF and the DDMF are available and reliable for reconstruction of the volar surface of the finger; however, the MPAF offers better functional outcomes with a lower frequency of postoperative complications.

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Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

10.21203/rs.3.rs-39680/v2 ◽

2020 ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Wenrui Qu ◽

Xiaolan Ou ◽

Rui Li ◽

...

Keyword(s):

Postoperative Complications ◽

Donor Site ◽

Graft Loss ◽

Operation Time ◽

Donor Site Morbidity ◽

Plantar Artery ◽

Significant Difference ◽

Medial Plantar Artery ◽

Volar Surface

Abstract Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference in postoperative complications and the results (2-PD and Modified VSS score) were significant. In terms of overall function, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.

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