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Radiotherapy for cancer treatment is often associated with skin damage that can lead to incapacitating hard-to-heal wounds. No permanent curative treatment has been identified for radiodermatitis. This study provides a detailed characterization of the dose-dependent impact of ionizing radiation on skin cells (45, 60, or 80 grays). We evaluated both early and late effects on murine dorsal skin with a focus on the healing process after two types of surgical challenge. The irradiated skin showed moderate to severe damage increasing with the dose. Four weeks after irradiation, the epidermis featured increased proliferation status while the dermis was hypovascular with abundant α-SMA intracellular expression. Excisional wounds created on these tissues exhibited delayed global wound closure. To assess potential long-lasting side effects of irradiation, radiodermatitis features were followed until macroscopic healing was notable (over 8 to 22 weeks depending on the dose), at which time incisional wounds were made. Severity scores and biomechanical analyses of the scar tissues revealed that seemingly healed irradiated skin still displayed altered functionality. Our detailed investigation of both the acute and chronic repercussions of radiotherapy on skin healing provides a relevant new in vivo model that will instruct future studies evaluating the efficacy of new treatments for radiodermatitis.

Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery (BCS). It has become increasingly popular in Europe; however, it has not yet been widely accepted in North America. This study aims to describe the experience with OPS at a Canadian tertiary care centre. Methods: This study is a retrospective case series consisting of consecutive OPS cases at a single Canadian centre, the Royal Victoria Regional Health Centre in Barrie, Ontario, between 2009 and 2015. Results: A total of 275 women who consecutively underwent OPS were included. The average size of the tumour was 17 mm (standard deviation [SD] 13 mm; range 0-110 mm). The average specimen weight was 155 g (SD 146 g; range 15-1132 g). Invasive ductal carcinoma was the most common diagnosis (237 patients, 86.2%), followed by ductal carcinoma in situ (18 patients, 6.6%) and then invasive lobular carcinoma (15 patients, 5.5%). A positive margin was recorded in 37 (13.5%) patients. Immediate postoperative complications included seroma and edema (32.7%), wound infection (13.1%), hematoma (8.7%) and delayed wound healing (6.5%). A delay to adjuvant therapy due to postoperative complications occurred in 7 of 217 (3.2%) patients. The median follow-up was 18 months. There were local and distant recurrences in 9 (3.3%) and 2 (0.7%) patients, respectively. Overall survival was 99.3%. Conclusion: The findings of this study are comparable to results in the literature on OPS and demonstrate that OPS is an attractive alternative to standard lumpectomy for Canadian general surgeons who treat breast cancer. Contexte : La chirurgie oncoplastique (COP) est en passe de devenir la nouvelle norme pour la chirurgie conservatrice du sein (CCS). Elle est de plus en plus populaire en Europe, mais elle n'a pas encore ete largement adoptee en Amerique du Nord. Cette etude vise a decrire l'experience d'un etablissement de soins tertiaires au Canada en matiere de COP. Methodes : Cette etude repose sur une serie retrospective de cas de COP dans un etablissement canadien, le Centre regional de sante Royal Victoria de Barrie, en Ontario, entre 2009 et 2015. Resultats : En tout, 275 cas consecutifs de COP ont ete inclus. La taille moyenne des tumeurs etait de 17 mm (ecart-type [E.-T.] 13 mm; eventail 0-110 mm). Le poids moyen des specimens etait de 155 g (E.-T. 146 g; eventail 15-1132 g). Le diagnostic le plus frequent etait le carcinome canalaire invasif (237 patientes, 86,2 %), suivi du carcinome canalaire in situ (18 patientes, 6,6 %), puis du carcinome lobulaire invasif (15 patientes, 5,5 %). Une marge positive a ete enregistree chez 37 patientes (13,5 %). Parmi les complications postoperatoires immediates, mentionnons serome et oedeme (32,7 %), infection de plaie (13,1 %), hematome (8,7 %) et retard de cicatrisation de la plaie (6,5 %). Un retard du traitement adjuvant du a des complications postoperatoires est survenu chez 7 patientes sur 217 (3,2 %). Le suivi median a ete de 18 mois. On a note des recurrences locales et a distance chez 9 (3,3 %) et 2 (0,7 %) patientes, respectivement. La survie globale a ete de 99,3 %. Conclusion : Les conclusions de cette etude se comparent aux resultats recenses dans la litterature au sujet de la COP et demontrent que cette derniere est une solution de rechange attrayante a la tumorectomie standard pour les chirurgiens generaux qui soignent le cancer du sein au Canada., Oncoplastic surgery (OPS) was developed in the 1980s in an attempt to improve upon the original surgical techniques used in standard breast-conserving surgery (BCS). (1-4) Breast conservation consists of partial [...]

Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and in the community. Moreover, pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and skills to implement pressure ulcer prevention strategies and to effectively treat pressure ulcers in their patients. This continuing medical education article focuses on pressure ulcer prevention and management, with an emphasis on the evidence for commonly accepted practices. [ABSTRACT FROM AUTHOR]

This article examines the treatment of facial wounds in early modern Britain through a close study of the casebook of St Bartholomew's Hospital surgeon Joseph Binns (d. 1664). It explores surgeons' and related practitioners' special attention to the care and infliction of facial wounds and scarring in their practice, including impairments to facial movement and expression, the use of specific suturing techniques and the reduced use of stitches, and the development of agglutinative medicaments. The face was recognised as a site of immense vulnerability and exposure, requiring particular care, and this vulnerability was mirrored in the capacity for facial scarring to detrimentally advertise a practitioner's skill. This essay reads Binns' unpublished notes against the cases and theoretical ideals set out in published texts from surgeons such as the Scottish Alexander Read, the East India Company surgeon John Woodall, and the London surgeon and physician Daniel Turner. I argue that both the textbooks and Binns' practice demonstrate awareness of the special role of the face in the early modern period, and that this guided the medical approach to disfiguring injuries and conditions. [ABSTRACT FROM AUTHOR]

The Department of Plastic Surgery within Barts Health NHS Trust introduced a pathway to treat complex plastic surgery wounds using a single-use, negative-pressure wound therapy (NPWT) device. The pathway was developed in a response to the lack of acute beds. Methods: A retrospective review was conducted per financial year from 2012 to 2017, on all wounds within the department, treated using the pathway. The number of bed days released was calculated according to admission type. Results: 213 wounds were reviewed. Median patient age was 50 years, with an even gender divide. Total calculated bed management efficiency, across five financial years, was £76,591.60. A total of 367 bed days were released during this period. [ABSTRACT FROM AUTHOR]

Purpose: Following its renaissance in ophthalmology during the 1990s, preserved human amniotic membrane (HAM) has become an attractive biomaterial for all surgical disciplines. This article reviews the current and potential use of HAM in oral and maxillofacial surgery, its postulated properties and common preservation techniques. Methods: Literature was identified by an electronic search of PubMed in July 2012; this was supplemented from the reference lists of the consulted papers. Results: HAM has been used in the field of oral and maxillofacial surgery from 1969 onwards because of its immunological preference and its pain-reducing, antimicrobial, mechanical and side-dependent adhesive or anti-adhesive properties. The effects of HAM on dermal and mucosal re-epithelialisation have been highlighted. Typically, HAM is applied after being banked in a glycerol-preserved, DMSO-preserved or freeze-dried and irradiated state. Whereas the use of HAM in flap surgery and in intra-oral and extra-oral lining is reported frequently, novel HAM applications in post-traumatic orbital surgery and temporomandibular joint surgery have been added since 2010. Tissue engineering with HAM is a fast-expanding field with a high variety of future options. Conclusions: Preserved HAM is considered to be a safe and sufficient biomaterial in all fields of oral and maxillofacial wound healing. Recently published novel indications for HAM application lack a high level of evidence and need to be studied further. [ABSTRACT FROM AUTHOR]

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Objective To report the design and benefits of a rigid polyethylene cover 'shell' for the protection of dorsal torso wounds and tube fixation in pigs. Methods Open C-shaped polyethylene shells were designed to protect wounds and dressings on the dorsum of pigs used in research into negative pressure dressing-assisted wound healing. The shells were designed to resist trauma and contamination, to be comfortable and expansible, and to facilitate tube fixation and management. Strap fixation was optimised during experimentation. Efficacy was assessed by direct observation of dressing and wound protection, tube integrity and by macroscopic and microscopic assessments of wound healing. Results The shells effectively protected the wounds against blunt and sharp trauma, were simple to remove and reapply, were well tolerated and allowed for growth of the pigs. Circumferential neck straps attached by lateral straps to the shells proved critical. There was no wound infection or inflammation underlying the shells. Porting tubing via mid-dorsal holes in the shells and affixing the tubing just cranial to these holes prevented tube damage and traction, permitted tube management from outside the cages and allowed the pigs to move freely without becoming entangled. Conclusion These shells effectively protected dorsal skin wounds and dressings, prevented tube damage and facilitated tube management in pigs. Similar systems may be useful for other production animals for wound management and for tube management with negative pressure wound healing, drain tubes or the delivery of nutrition, fluids or medications. [ABSTRACT FROM AUTHOR]