China
Africa
Explore chapters and articles related to this topic
Delayed oncoplastic repair—before radiotherapy
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
The timing of oncoplastic repair is ultimately based upon whether or not clear margins are obtained at the initial excision. Final endpoints include aesthetic outcome, patient satisfaction, and the need for surgical re-excision or mastectomy. The untoward effects of reduction mammoplasty following breast conservation have been examined; Spear and colleagues have reported complications in 5/18 women (32%) ranging from minor delayed healing, superficial infection, and mild skin necrosis to major events (extensive fat necrosis requiring flap reconstruction).17 Specific studies comparing oncoplastic reduction mammoplasty or latissimus dorsi flap reconstruction prior to radiation have revealed superior outcomes when compared to delayed reduction mammoplasty or latissimus dorsi flaps after radiation. Kronowitz and colleagues reported complication rates of 26% and 42% in immediate and delayed cohorts, respectively.6 Within the immediate cohort, flaps were associated with higher complication rates than reduction mammoplasty or mastopexy. A good to excellent outcome was achieved in 57% of patients that had a reduction mammoplasty and in 33% of patients having a flap-based reconstruction in the immediate setting. Munhoz and colleagues performed a similar comparison and showed a complication rate of 22.6% and 31.5% in the immediate and delayed cohorts, respectively.2 Skin necrosis was the most common complication in both cohorts and occurred in 7.5% and 18.4% of patients, respectively.
Drugs causing cutaneous necrosis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Prevention of contamination of the site and subsequent infections is pivotal in the management of acute skin necrosis. Empiric antibiotic therapy can be employed until definite culture results are obtained. The selection of antibiotics can further be modified based on the culture and sensitivity report. Culture reports obtained from superficial swabs are occasionally erroneous and should be avoided.
Trichothecenes
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
I. Malbrán, C.A. Mourelos, J.R. Girotti, G.A. Lori
Dermal contact develops symptoms that begins within minutes. These include burning skin pain, redness, tenderness, blistering, and progression to skin necrosis with leathery blackening and sloughing of large areas of skin.81,84 When the route of exposure is by ocular contact, tearing, eye pain, conjunctivitis, burning sensations about the eyes, and blurred vision for up to 1 week have been frequently reported. In severe cases, trichothecenes may cause eye injury that can lead to a marked impairment of vision.85,86
Utilization of Perifascial Loose Areolar Tissue Grafting as an Autologous Dermal Substitute in Extremity Burns
Published in Journal of Investigative Surgery, 2023
Burak Özkan, Burak Ergün Tatar, Abbas Albayati, Cagri Ahmet Uysal
Eleven PAT grafts were used for the upper extremity, and 5 PAT grafting procedures were performed for the lower extremity to cover exposed bones or tendons. Any tendon adhesion was not observed in the late postoperative period. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. The PAT graft failed to engraft in the ankle region in 1 patient. PAT and skin regrafting were performed 2 weeks later, with an uneventful healing. Partial skin graft necrosis was found in 4 patients, of whom 3 achieved healing with conservative wound care. The remaining patient required regrafting over the PAT graft. All patients older than 53 years (7/11 patients) had mild to severe comorbidities. Partial skin necrosis was found in 2 patients with diabetes mellitus. No complications were found in the patients with severe comorbidities such as chronic kidney failure and peripheral arterial disease. Seroma formation was found in 1 patient but was resolved within 1 month with a compression dressing.
Full-thickness dermal wound regeneration using hypoxia preconditioned blood-derived growth factors: A case series
Published in Organogenesis, 2023
Hadjipanayi Ektoras, Moog Philipp, Jiang Jun, Dornseifer Ulf, Machens Hans-Günther, Schilling Arndt F
Dermal tissue damage can occur as a result of mechanical trauma, burn injury (thermal/chemical), increased pressure (e.g. decubitus ulcers) and vasculopathy (e.g. diabetic ulcers),31,52 as well as autoimmune/inflammatory disease.53 Post-surgical wound healing complications can arise when increased skin tension is applied, a situation aggravated by cigarette smoking due to nicotine-induced vasoconstriction and endothelial dysfunction.41,42,54 Regardless of cause, skin necrosis removes the protective epidermal boundary which exposes the patient to infection. Thus, clinical difficulties increase significantly with wound surface area. In contrast to partial-thickness wounds, where the deep dermis remains intact and regeneration is possible from viable dermal appendages, full-thickness wounds present a much greater challenge since no dermal tissue is available from which repair can be initiated. Therefore, the mainstay treatment is aggressive surgical wound debridement to remove all necrotic tissue (up to well-perfused tissue layers), temporary wound coverage with application of vacuum-assisted closure (which aids wound contraction), and subsequent tissue reconstruction via skin grafting or local/free (microsurgical) tissue transfer.5,8,55
Predicting severity of periorbital necrotizing fasciitis
Published in Orbit, 2023
Michael I. Rothschild, Richard R. Pacheco, Edward J. Wladis
The study is a retrospective review of 10 consecutive patients with periorbital necrotizing fasciitis presenting at a single center, treated by one attending ophthalmic plastic surgeon between 2015 and 2020. The combination of features of an infectious process with overlying skin necrosis that crossed fascial planes and histologic confirmation of necrotizing fasciitis was used to definitively include patients. Demographic information and medical history were reviewed, and these were used to determine a CCI score for each patient. Other measured variables included presenting visual acuity in each affected eye, number of surgical debridements performed, infectious organism (if known), loss of eye, duration of follow-up, and visual acuity at last follow-up. If both eyes were involved, data were recorded for the more severely affected eye. Treating each case as a single patient, rather than treating each eye, simplified calculations as then the many systemic variables would not be counted twice. The visual acuities of enucleated eyes were considered to have no light perception.