Search

Background: Surgical debridement and split thickness graft is the most common treatment for acute burn patients that require surgery. However, there is a relevant minority that will require more complex reconstructive options. Microsurgery has evolved as a valuable tool in the acute setting allowing early closure of complex wounds in order to avoid infection, maintain function and even for limb salvage in one stage reconstruction. We present our experience in the management of severely acute burned patients with free flaps, flap survival rate and complications in Chile’s National Health service. Method: We performed a retrospective analysis of all major burn patients admitted in our unit who received a microsurgical flap in the period between april 2019 and march 2023. Data was collected on patient sex, age, mechanism of injury, total burned surface area (TBSA), location of the defect, days to reconstruction, flaps used, operatory time, flap survival and complications. Results: In the study period we had 925 admissions. A total of 36 patients had 42 free flaps (5,1%). All but two patients were male (95 %), mean age 46 years (range 20–––76 years). Total body surface area burned averaged 14 % (range 1–64 %). The majority of injuries were caused by high voltage electricity (59 %) and fire (33 %). 59 % compromised lower limbs and 31 % upper limbs. In 81 % of the cases anterolateral thigh flaps were used. Mean time to reconstruction was 39 days(range 1–64 days), we had 9 complications (21 %) and only one flap was lost (2,9%). Discussion: The introduction of free flaps in the burn reconstruction field was first described in sequelae management. In the acute phase it has also proven to be safe and feasible with a surgical indication of 1,5% to 2% of the admissions in different series. In our unit, 5,1% of our admissions required it, with a low flap loss rate. The increased confidence for its use in the acutely burned setting allowed us to achieve complex coverage while maintaining surgical risk and an internationally acceptable rate of losses and complications. Free flaps cpnstitute an active approach in the classical treatment of this pathology pushing the boundaries in the local environment.

Background: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent disease that threatens patients with texturized breast implants. Major concerns about the safety of these implants are leading to global changes to restrict the utilization of this product. The principal alternative is to perform breast augmentation utilizing smooth implants, given the lack of association with BIA-ALCL. The implications and costs of this intervention are unknown.Objectives: The authors of this study determined the cost-effectiveness of smooth implants compared with texturized implants for breast augmentation surgery.Methods: A tree decision model was utilized to analyze the cost-effectiveness. Model input parameters were derived from published sources. The capsular contracture (CC) rate was calculated from a meta-analysis. Effectiveness measures were life years, avoided BIA-ALCL, avoided deaths, and avoided reoperations. A sensitivity analysis was performed to test the robustness of the model.Results: For avoided BIA-ALCL, the incremental cost was $18,562,003 for smooth implants over texturized implants. The incremental cost-effectiveness ratio was negative for life years, and avoided death and avoided reoperations were negative. The sensitivity analysis revealed that to avoid 1 case of BIA-ALCL, the utilization of smooth implants would be cost-effective for a risk of developing BIA-ALCL equal to or greater than 1:196, and there is a probability of CC with smooth implants equal to or less than 0.096.Conclusions: The utilization of smooth implants to prevent BIA-ALCL is not cost-effective. Banning texturized implants to prevent BIA-ALCL may involve additional consequences, which should be considered in light of higher CC rates and more reoperations associated with smooth implants than with texturized implants. [ABSTRACT FROM AUTHOR]

Background  The superficial circumflex iliac artery perforator flap (SCIP) is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. Different planning methods have been described, but these are not yet standardized like in other flaps. The aim of this study is to present a fast, effective, and reliable method for SCIP flap planning using computed tomography angiography (CTA). Patients and Methods  Between October 2017 and September 2018, CTA was performed on 40 patients. Preoperative planning of SCIP flaps based on the medial branch was performed analyzing CTA images. The perforating sites of the medial branch on the deep (point D) and superficial fascia (point S) were identified. Distances to those points, from the center of the umbilicus in the "y-axis" and the midline perpendicularly in the "x-axis," were measured. These measurements were transferred to the patient's skin as a guide for dissection. Results  Eighty areas were studied identifying points D and S in CTA. Forty-three SCIP flaps were performed using this planning method. In 100% of the flaps, points D and S matched perfectly with handheld Doppler and surgical findings. Conclusion  Points D and S method for medial branch based SCIP planning with CTA is an easy to learn, efficient, fast, and reliable technique for preoperative planning, allowing a safe and predictable elevation of the flap. [ABSTRACT FROM AUTHOR]