Search Results (6)

Improving the restoration of skin defects of various etiologies continues to be an important medical challenge globally. This primarily applies to the treatment of chronic wounds and major burns, which create particularly complex and socially significant problems for surgery. In recent decades the progress in these fields has largely been associated with techniques for regenerative medicine, specifically, techniques based on the use of tissue-engineered constructs. Before their use in clinical practice, all such newly developed constructs require preclinical studies to confirm their safety and effectiveness in animal models. This paper presents the results of preclinical studies of the effectiveness of restoration of full-layer degloving wounds in pigs using grafts of either an original biopolymer hydrogel scaffold or a skin equivalent based on it, but seeded with autologous skin cells (ASCs). It is demonstrated that the scaffold itself integrates into the wound bed tissues, facilitating cell recruitment and the accumulation and early maturation of granulation tissue. Then, at later stages of regeneration, the scaffold accelerates the maturation of connective tissue and promotes the formation of tissues similar to those of healthy skin in terms of thickness and structure. Owing to the ASCs present in it, the skin equivalent demonstrates greater effectiveness than the scaffold alone, in particular, due to overall faster remodeling of the graft connective tissue. Therefore, the scaffold we have developed and the skin equivalent based on it have much potential as products for the repair of skin wounds. Full article

Background and Objectives: Traditionally, full-thickness skin defects (FTSDs) are covered with split-thickness skin grafts (STSGs). This usually provides an epidermal coverage but entails a high risk of hypertrophic scarring mainly due to the absence of the dermal layer. The Novosorb^® Biodegradable Temporising Matrix (BTM) is a novel synthetic dermal substitute that has been used for the reconstruction of various complex and/or large defects in our center. The aim of this article is to evaluate the clinical performance of the BTM as a synthetic dermal substitute for complex FTSD reconstruction in a European context. Materials and methods: This case series focused on the treatment of complex FTSDs with the BTM. After wound debridement, the BTM was applied according to a defined protocol. Once adequate vascularization was observed, the sealing membrane was removed and the neo-dermis was covered with STSGs. Patient demographics, comorbidities, wound defect localization and etiology, wound bed preparations, time of BTM application and removal, time to complete wound healing after STSG, complications, and HTS formation were recorded. Results: The BTM was used to treat FTSDs in six patients with complex wounds from degloving (3), burns (1), ulcerations (1), and necrotizing fasciitis (1). Successful integration occurred in five cases (83%), with one partial integration. The BTM remained in situ for an average of 20.7 days before delamination and STSG coverage. No major complications occurred, though one case had hypergranulation with secondary STSG infection. Two patients were lost to follow-up, while the remaining four had excellent aesthetic and functional outcomes with good-quality scars. Conclusions: Within the limits of this small and heterogeneous case series, the BTM appears to be a promising option for the reconstruction of complex FTSDs of varying etiologies. Its successful integration in most cases and limited complication rate support its clinical potential. However, given this study’s retrospective design and limited sample size, further prospective studies are required to validate these findings and assess long-term outcomes. Full article

Background/Objectives: Penile fractures are a rare urological emergency, defined as the traumatic rupture of the tunica albuginea. They are classically diagnosed on clinical grounds, requiring urgent operative repair, most commonly by penile degloving. Magnetic resonance imaging (MRI) has emerged as a promising tool in the management of penile fractures. Often recommended in the setting of equivocal clinical diagnoses, MRI can help diagnose, as well as localise, the site of injury. Furthermore, it also holds potential in differentiating penile fractures from mimicking conditions, thereby possibly preventing unnecessary surgical procedures. This study is aimed at evaluating the diagnostic accuracy of MRI for penile fractures. Furthermore, it seeks to explore MRI’s effectiveness in guiding the surgical approach through precise localisation of the injury site. Methods: The PubMed, Embase, and Cochrane databases were searched from January 1995 to December 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a total of 246 cases from 32 studies were identified. Results: Pooled results for MRI use in penile fracture diagnosis resulted in a positive predictive value of 97.8%, a negative predictive value of 87.0%, a sensitivity of 98.6%, and a specificity of 80%. MRI can accurately guide localised incisions, due to its ability to accurately identify the exact site of injury, with no additional reported complications or conversions to degloving. Considerable heterogeneity was observed within MRI parameters and protocols used in the studies identified. Conclusions: This review suggests that MRI is an accurate imaging modality for penile fractures and should be considered as a first-line investigation for equivocal cases. Its application may refine clinical management by avoiding unnecessary surgeries in cases mimicking penile fractures and improve pre-operative planning through precise injury localisation. This study is limited by heterogeneity in MRI protocols and the small sample sizes and retrospective nature of many included studies. The future standardisation of MRI protocols could enhance its utility and reliability in the clinical setting. Additionally, further research is needed to evaluate the long-term outcomes following the repair of small fractures detected on MRI and following MRI-guided localised incisions during surgical repair. Level of Evidence: 2. Full article

Morel-Lavallée lesions (MLLs) in the knee are rare. This article presents one of the largest documented cases (13.46 × 12.73 × 3.03 cm), successfully managed non-operatively with clinical and sonographic follow-up. The patient was a 19-year-old male who sustained a bike accident, presenting with immediate gross swelling over the anterior knee, along with bruising and skin abrasions. He was unable to walk and was admitted to the orthopedic ward. A bedside handheld ultrasound examination revealed a large pre-patellar MLL, primarily filled with blood clots. Ultrasound-guided aspiration resulted in a dry tap. The diagnosis was confirmed through magnetic resonance imaging, and conservative management was implemented. At four weeks post-injury, the patient showed significant improvement. He achieved full range of knee motion seven weeks post-injury. Ultrasound imaging revealed a significantly reduced lesion size, with a sub-centimeter thickness. This case highlights the pivotal role of portable ultrasound in the acute diagnosis and follow-up of MLLs. It also demonstrates that, even with a lesion of substantial size, non-operative treatment can be highly effective. These findings provide valuable insights for developing treatment protocols for this rare condition. Full article

Segmental posthetomy, also referred to as circumcision, reefing or posthioplasty, consists of removing a circumferential segment of the internal preputial lamina (internal preputial fold) followed by end-to-end anastomosis of skin edges. The purpose of this case series is to describe the successful outcome of segmental posthetomy for treating different diseases involving the internal or/and external preputial fold, while restoring the normal telescopic function. In this paper, we report the first case of complete degloving injury of the equine penis in the literature (case 1) and describe three different common lesions of the equine prepuce/penis (preputial scar tissue in case 2, preputial sarcoid in case 3 and penile/preputial wound in case 4). The amount of prepuce (safe minimums) that can be removed from a stallion without disrupting the proper telescopic function of the internal/external preputial fold and normal copulatory ability, has not been established. In this case series, all Equidae stallions maintained the telescopic function after preputial surgical resection. However, the surgeon must carefully evaluate every single case, especially when performing the Adam’s procedure. Full article

No report to date describes the added risk traumatic, degloving injuries of the oral cavity may pose when treating fractures of the mandible. The authors describe the oral degloving injury, characterized by separation of periosteum and soft tissue of the anterior floor of the mouth from the inner cortex of the anterior segment. Vascular anatomy of the floor of the mouth is reviewed as a prelude to a description of pathomechanics of the injury and a case report. The higher incidence of oral degloving in youth and in young adulthood and parallels in elective, orthognathic surgery are identified. When this unusual clinical presentation occurs, and when open reduction of fractures of the anterior segment is chosen, a vestibular incision is best avoided. Instead, a submental or upper neck incision is chosen for sufficient exposure to allow reduction and the application of appliances. Meticulous closure of the intraoral void is achieved using one of two techniques, depending on the level of degloving. Full article