A Prospective, Within-Patient Controlled Study to Compare the Ability of the Non Adherent Drawtex®Hydroconductive Dressing to a Transparent Polyurethane Film Dressing (Standard of Care) on the Healing of Split-Thickness Skin Graft Donor Sites

Background: Dressing of split-thickness skin graft donor sites can be traumatic for the patient. The most advanced and expensive dressings have been compared to the most basic of dressings, with little or no consensus and an unpersuasive level of evidence. We aimed to determine the efficacy of the locally manufactured non-adherent, hydroconductive Drawtex? dressing and compare it to our current standard-of-care dressing, a thin transparent polyurethane film, in the healing of split-thickness donor sites. Methods: This prospective, within-patient controlled study included 27 adult participants, each with two split-thickness skin donor sites. The 54 donor site wounds were compared with regard to time to re-epithelialisation, perceived pain and healed wound quality. Results: By day 5, complete healing of donor site wounds, defined as >90% of epithelialized surface, was significantly higher in the hydroconductive dressing group compared to the polyurethane film group (22.2% and 3.7%, respectively;p < 0.0001). The hydroconductive dressing-treated donor site wounds were significantly less painful at 24-hours, 48-hours and 7-days post-operatively, and had fewer complications and superior wound healing quality. Conclusion: We have demonstrated that the relatively cheap and readily available dressing made locally in South Africa, Drawtex? is at least as safe, and potentially superior in wound healing, when compared to our current standard-of-care dressing.

Detecting flap compromise:an updated review of techniques to monitor microsurgical flaps postoperatively in breast reconstruction

Breast reconstructive surgery utilizing free tissue transfer has revolutionized the restoration of aesthetic and functional outcomes for patients.Even for the most routine free flap procedures,substantial hospital resources and costs are necessary.The effectiveness of free flap surgery,along with any reconstructive procedure,hinges upon meticulous patient selection,thorough pre-operative planning,well-informed peri-operative decision-making,and diligent post-operative monitoring and care for the patient.This article presents a review of standard clinical care monitoring techniques during the post-operative period,as well as the diverse strategies currently employed for post-operative flap monitoring.

Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons.Innovations in wound care,soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries.In this review,the principles of reconstruction of complex lower extremity traumatic wounds are outlined.These principles include appropriate initial evaluation of the patient and mangled extremity,as well as appropriate patient selection for limb salvage.The authors emphasize proper planning for reconstruction,timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option.The role of different reconstructive and wound care modalities is discussed,notably negative pressure wound therapy and dermal substitutes.The role of pedicled flaps and microvascular free-tissue transfer are discussed,as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium.Finally,the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds.Upon completion of this review,the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.

Aesthetic reconstruction of the severely disfigured burned face:a creative strategy for a"natural"appearance using pre-patterned autogenous free flaps

The author reviews his pioneering work in aesthetic restoration of the severely disfigured burn face first introduced in 1995 and refined over the past two decades. The reader will be exposed to the step by step approach to achieving cosmetic enhancement and functional rehabilitation of advanced facial burns. The"keystone"of the autogenous reconstruction is the pre-patterned, sculpted microvascular free flap designed to fit like the"piece of a puzzle"into the aesthetic units of the face to replace disfiguring burn scars. Aggressive intraoperative"sculpting"is employed both"in situ"at the donor site and during the flap transfer to simulate the normal facial contours and planes. Comparisons of the author's approach are made to the whole spectrum of reconstructive modalities ranging from conventional grafting to expanded pre-fabricated flaps and even to CTA face transplants;advantages/disadvantages of each are discussed. The pre-patterned, sculpted microvascular (MV) free flap offers the benefit of a single-stage transfer of composite skin/soft tissue hiding the seams at the junction of facial planes. When harvested from distant donor sites, the donor deformities can easily be concealed. The MV free tissue transfer offers the substrate that can be sculpted into nuanced facial components as well as the"palette"upon which the face can be painted with creative camouflage makeup. The soft contour and texture of the autogenous patterned transfers translates into a"natural"facial appearance while preserving fluid motions of facial expression.

Nanofibrillar collagen scaffolds for lymphedema treatment:current applications and future directions

Aim:Biosynthetic scaffolds represent cutting-edge therapeutic efforts for secondary lymphedema.In particular,nanofibrillar collagen scaffolds have shown efficacy in both preclinical and clinical contexts,and there has been growing interest in these scaffolds in recent years.This study systematically reviewed the current literature on nanofibrillar collagen scaffolds for lymphedema treatment to synthesize findings and highlight areas for further research.Methods:This was a systematic scoping review of the literature on nanofibrillar collagen scaffolds for lymphedema treatment.Results:Upon review of the literature,32 relevant articles were identified,of which seven articles specifically investigating nanofibrillar collagen scaffolds were selected for inclusion.Of these articles,three investigated scaffold placement in small or large animal models,while four were clinical investigations ranging from case reports to retrospective cohort studies.Across all studies,scaffold implantation was associated with significant improvement in lymphedema symptoms compared to untreated controls,especially when used in combination with physiologic microsurgical procedures such as vascularized lymph node transfer.However,even when used alone or in combination with lymph node fragments,subcutaneous placement of these scaffolds improved lymphedema symptoms.Additionally,in a rodent model of lymphedema,scaffold placement at the time of lymph node harvest forestalled the development of lymphedema,highlighting the preventative capacity of these scaffolds as well.Conclusion:Nanofibrillar collagen scaffolds have been demonstrated to effectively treat and/or prevent secondary lymphedema in both preclinical and clinical investigations.Ultimately,these scaffolds represent a promising intersection of tissue engineering and lymphedema therapy,and further clinical investigation is warranted.

Current applications of propeller flaps in reconstruction of trunk wounds

Aim: Propeller flaps provide excellent reconstructive options for defects of many etiologies. Trunk wounds are a commonly encountered issue for the plastic surgeon and multiple techniques to address them should be prepared for implementation. Propeller flaps are a subject rarely brought up as an option to address these wounds. The authors sought to elucidate this topic in the current plastic surgery literature available. Methods: A PubMed search was conducted based upon the defined inclusion and exclusion criteria and publications reviewed in detail. Search terms included 'trunk wound propeller flap', 'trunk propeller flap', and 'freestyle trunk wound flap'. Duplicate studies were excluded. Data was extracted from each study pertaining to trunk wounds and reconstructions with propeller flaps. Results: The electronic search yielded 49 results with 21 studies ultimately meeting inclusion criteria. A total of 365 flaps were described collectively amongst the included studies. Among them, 190 propeller flaps addressing trunk defects were performed across all studies reviewed to address a total of 165 defects of the trunk: 14 abdomen, 101 back, 50 chest defects and adjacent respective flaps were utilized for surgical reconstruction. Overall, cancer excision wounds were by far the most prevalent with 105 cases (59.0%). Defect sizes of those specified in the articles ranged from 2 cm × 5 cm to 30 cm × 24 cm. Of the 190 propeller flaps identified, 63 total complications were identified. The most common complication was 48 total cases of transient venous congestion (25.3%). The second most common complication was partial flap necrosis (6.3%). No total flap loss was noted. There were 2 cases of seroma (1.1%) and 1 case of wound breakdown (0.5%). Conclusion: Propeller flaps are a viable reconstructive option for trunk wounds and should be in the armamentarium of plastic and reconstructive surgeons. Few studies are available in the literature regarding propeller flap reconstruction in trunk wounds. More aggregate data is needed in order to further review, evaluate, and refine propeller flap techniques and results.

Post-traumatic lymphedema:review of the literature and surgical treatment options

Post-traumatic lymphedema(PTL)is a complex,debilitating,and potentially common disease which has received limited attention to date.The available literature is reviewed to identify injury patterns and critical lymphatic areas associated with the disease.A deeper understanding of these critical anatomic regions allows the reconstructive surgeon to potentially identify PTL patients earlier in order to apply surgical and nonsurgical interventions in the acute phase,improving lymphatic physiology and,ultimately,patient outcomes.Current diagnostic and treatment approaches are discussed in detail,with a focus on lymphatic microsurgical techniques developed and applied to PTL within the last decade.