Wound Healing Complications Research Articles

The effect of the TNFα gene rs1800629 polymorphism on cytokine profile parameters in the complicated wound healing in combat trauma victims

Background. In the wound process, there is a high probability of complications in the form paratraumatic eczema (РТЕ), which determines the severity the course of wound repair. Genetic factors responsible for the regulation of cytokines a leading role in the etiopathogenesis of РТЕ. Aim — determine the relationship of TNFa gene rs1800629 with the development of РТЕ and IL-1ß, TNFα, IL-6. Materials and methods. The study included 162 patients after surgical interventions. Group I — 82 people with complications in the form PTE and II — 80 people without complications. The study rs1800629 TNFα gene was carried out by the poly- merase chain reaction method. The levels TNFα, IL-1β and IL-6 in the blood was determined by the enzyme immunoassay method. Results. A connection with PTE was established with of rs1800629 gene TNFα (p = 0.033 and p = 0.005). The genotypes GA (OR = 1.64; CI 0.83–3.24) and AA (OR = 2.94; CI 0.9–9.67), allele A (OR = 2.13; CI 1.26–3.6) rs1800629 influenced the increased chances of developing PTE. In group II the IL- 1β, TNFα, IL-6 indicators were increased (p < 0.001) in carriers of the AA genotype rs1800629. Conclusion. rs1800629 TNFα gene is associated with development of PTE. An increase in the levels IL-1β, TNFα, IL-6 was associated with the presence of a pathogenetic factor — AA genotype rs1800629 TNFα gene in development of complications.

Challenging frontiers in neuroplastic cranial reconstruction: addressing neurosurgical wound healing complications through interdisciplinary collaboration – an observational study

Background and objectivesAlthough rare, complications like skin dehiscence and necrosis after neurosurgery pose significant challenges by increasing the risk of infections spreading to the epidural, subdural, or intracerebral spaces. This retrospective, single-center study aims to assess the prior clinical courses, neuroplastic repair, and outcomes of patients with skin defects following cranial neurosurgical procedures, and to outline our interdisciplinary reconstructive protocol.MethodsA retrospective analysis was performed on cranial surgeries conducted at the Department of Neurosurgery, spanning from 2017 to 2023. Patients with skin defects requiring the combined expertise of neurosurgery and plastic surgery for effective treatment were included. The sizes of the skin defects were measured using intraoperative photographs analyzed with the freeware ImageJ software, version 2018. All patients provided informed consent for the surgeries. If informed consent was not possible due to neurological deterioration, consent was sought from adult representatives or next of kin except for acute circumstances. All patients admitted to our hospital agree to the pseudonymized use of their medical data and tissue specimens for research purposes in their treatment contract.ResultsA cohort of 24 patients experiencing wound healing complications after neurosurgical procedures underwent a total of 29 interdisciplinary surgeries for the reconstruction of skin, dural, and bone defects. After the neuroplastic surgery, 8 out of 24 patients (33.3%) developed surgical complications, with 6 of these requiring revision surgeries due to persistent cranial infection. In all cases, permanent wound closure was successfully achieved following adherence to the proposed treatment algorithm.ConclusionsOur study underscores the necessity of an integrated neurosurgical and plastic surgical approach to effectively manage wound healing complications in a single stage surgery. Key interventions include differentiation between necrosis and gaping lesions, alongside precise management of neurosurgical issues like cerebrospinal fluid fistulas and hydrocephalus. Plastic surgical expertise in assessing the possibilities and limitations of both local and free flap surgeries is essential.

Long-term result of unicompartmental knee arthroplasty in knee osteoarthritis secondary to chondrodysplasia

Background. In determining the indications for unicondylar endoprosthesis of the knee joint the literature practically does not cover the results of such interventions in knee osteoarthritis in patients with chondrodysplasia. The purpose of our report was to publish our observation of the long-term results of unicondylar endoprosthesis of the knee joint in a patient with knee osteoarthritis due to chondrodysplasia. Material and methods. We operated on a patient with chondrodysplasia who came to the clinic at the age of 28 with complaints of pain in the right knee joint during walking, “clicking” and joint swelling. The radiological and magnetic resonance examination results of the right knee determined the presence of an area of aseptic necrosis of the medial femoral condyle. Considering the concordance of lower limb axis disorders, it was decided to perform unicondylar arthroplasty with preservation of the preoperative varus deformity to maintain the motor stereotype's compensation state. Results. In the postoperative period, there were no complications in wound healing, the rate of recovery of movements corresponded to similar indicators in patients with knee osteoarthritis of other etiologies after similar interventions, and the patient was discharged from the hospital on the sixth day after surgery with the preoperative range of motion in the operated joint. At the examination 10 years after the operation there were no complaints from the operated knee joint, the movements in the operated joint remained in the same range, and the patient moved without additional support with full load on the operated limb. Conclusions. Our results indicate the appropriateness of unicompartmental knee arthroplasty in patients with knee osteoarthritis secondary to.

Facilitation of diabetic wound healing by far upstream element binding protein 1 through augmentation of dermal fibroblast activity.

Diabetes mellitus (DM) often leads to wound healing complications, partly attributed to the accumulation of advanced glycosylation end products (AGEs) that impair fibroblast function. Far Upstream Element Binding Protein 1 (FUBP1) regulates cell proliferation, migration, and collagen synthesis. However, the impact of FUBP1 on diabetic wound healing remains unknown. This study is designed to explore the function and mechanisms of FUBP1 in diabetic wound healing. Eighteen Sprague-Dawley rats (weighing 220-240g) were randomly assigned to three groups (n = 6): a control group (NC) of healthy rats, a model group (DM) of untreated diabetic rats, and a treatment group (DM + FUBP1) of diabetic rats accepting FUBP1 treatment. A 10mm diameter circular full-thickness skin defect was created on the back of each rat. On days 1 and 7, rats in the treatment group received local injections of 5µg FUBP1 protein at the wound site, whereas the control group and model group were administered saline. Wound healing was documented on days 0, 3, 7, 10, and 14, with tissue samples from the wound areas collected on day 14 for histological analysis, including H&E staining, Masson's trichrome staining, and immunohistochemistry. Western blot analysis was utilized to assess the expression of GSK-3β, Wnt3a, and β-catenin. In vitro, the effects of various concentrations of AGEs on cell viability and FUBP1 expression were examined in human dermal fibroblasts (HDF). Cells were genetically modified to overexpress FUBP1 using lentiviral vectors and were cultured for 48h in media with or without AGEs. The impacts on fibroblast proliferation, migration, and Wnt/β-catenin signaling were evaluated using CCK-8, scratch assays, and Western blot analysis. Animal investigation revealed that from day 7 onwards, the wound healing rate of the treatment group was higher than that of the model group but lower than the control group. On day 14, the wound healing rates were as follows: control group (0.97 ± 0.01), model group (0.84 ± 0.03), and treatment group (0.93 ± 0.01). These differences were statistically significant. Histological analysis indicates that FUBP1 promotes granulation tissue formation, re-epithelialization, and collagen deposition in treatment group. Additionally, FUBP1 protein expression decreased in dermal fibroblasts when exposed to AGEs. Overexpression of FUBP1 significantly enhanced fibroblast proliferation and migration, activating the Wnt/β-catenin pathway and mitigating the inhibitory effects of AGEs. Our results suggest that FUBP1 can be a promising therapeutic target for diabetic wound healing, potentially counteracting the detrimental effects of AGEs on dermal fibroblasts through the Wnt/β-catenin pathway.

Intraoperative Hypothermia Versus Normothermia in Breast Reconstruction: A Systematic Review and Meta-Analysis.

Despite advancements in breast reconstruction, the precise impact of intraoperative hypothermia on postoperative complications remains unclear. Recent literature suggests that intraoperative hypothermia is a risk factor for impaired wound healing and increases the incidence of surgical site infections. This study examines the effect of intraoperative hypothermia on postoperative outcomes in breast reconstruction. We searched PubMed, Embase, and Cochrane Library for studies comparing hypothermia with normothermia in breast reconstruction. A meta-analytical method was employed to estimate the risk of postoperative complications among patients undergoing breast reconstruction. Data synthesis employed the random-effects models, presenting the results as risk ratio (RR) with corresponding 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration), and heterogeneity was assessed using I2 statistics. Four studies meeting our inclusion criteria were included in the meta-analysis, comprising 871 participants. The average age and body mass index were 52.98 years and 27.76 kg/m2, with a follow-up duration of 3-6 months. In our analysis, intraoperative hypothermia was associated with an increase in the incidence of wound healing complications in breast reconstruction (RR 1.68; 95% CI 1.24 to 2.27; p = 0.0008). Despite lower incidence of infection, hematoma, seroma, and necrosis in the hypothermia group, no significant differences were observed. Our meta-analysis assessing intraoperative hypothermia in breast reconstruction indicates that hypothermia is a significant risk factor for wound healing complications.

Unveiling advanced strategies for therapeutic stem cell interventions in severe burn injuries: a comprehensive review.

This comprehensive review explores the complex terrain of stem cell therapies as a potential therapeutic frontier in the healing of complicated burn wounds. Serious tissue damage, impaired healing processes, and possible long-term consequences make burn wounds a complex problem. An in-depth review is required since, despite medical progress, existing methods for treating severe burn wounds have significant limitations. Burn wounds are difficult to heal because they cause extensive tissue damage. The challenges of burn injury-induced tissue regeneration and functional recovery are also the subject of this review. Although there is a lot of promise in current stem cell treatments, there are also some limitations with scalability, finding the best way to transport the cells, and finding consistent results across different types of patients. To shed light on how to improve stem cell interventions to heal severe burn wounds, this review covers various stem cell applications in burn wounds and examines these obstacles. To overcome these obstacles, one solution is to enhance methods of stem cell distribution, modify therapies according to the severity of the burn, and conduct more studies on how stem cell therapy affects individual patients. Novel solutions may also be possible through the combination of cutting-edge technologies like nanotechnology and biotechnology. This review seeks to increase stem cell interventions by analyzing present challenges and suggesting strategic improvements. The goal is to provide a more effective and tailored way to repair serious burn wounds.

Impact of Early Dressing Removal After Cesarean Section on Wound Healing and Complications: A Systematic Review.

The global increase in cesarean section (C-section) births has heightened concerns about surgical site infections (SSIs), a significant risk associated with this common obstetric procedure. This literature review evaluates the impact of early dressing removal after C-sections, drawing from randomized controlled trials and clinical studies to assess potential benefits and risks. The review found no definitive evidence favoring a specific timing for dressing removal to reduce SSIs. However, earlier removal before hospital discharge generally enhances patient comfort. Factors such as high BMI, urgent C-sections, preterm premature rupture of membranes (PPROM), and chorioamnionitis are linked to higher wound healing complications, irrespective of when the dressing is removed. Removing staples before discharge is advised for convenience, with close monitoring recommended for high-risk patients. The findings emphasize the need for further research to optimize wound healing protocols, particularly for high-risk groups, to improve patient outcomes and minimize complications. A personalized approach to postoperative care, tailored to individual risk factors, may offer the best strategy for reducing SSIs and enhancing recovery after C-sections.

Outcomes of free flap breast reconstruction in patients aged 70 years and over: A single-centre experience

BackgroundChronological age is an important factor in determining whether a patient is offered reconstruction following breast cancer surgery. Free flap breast reconstruction is considered by many as the gold standard but is seldom offered to older patients, as the risks are considered too high. This study aims to examine the outcomes of free flap breast reconstruction in patients aged 70 and above treated in our unit. MethodsWe conducted a retrospective review examining the outcomes of consecutive patients aged 70 and above undergoing autologous free flap breast reconstruction at a single centre between January 2015 and December 2023. Logistic regression was used to determine the relationship between increasing age and comorbidities, and four primary outcome variables – all complications, readmission, return to theatre, and length of stay. ResultsWe identified 71 patients with a mean age of 72.3 years (70-78). 63.4% had one or more comorbidities, with the most common being hypertension and hypercholesterolaemia. Most patients were ASA grade 1 or 2 (91.5%). The overall complication rate was 36%, the majority of which were minor wound healing complications (22.5%). There were no episodes of flap loss, either partial or complete. The rates of severe complications (14%), readmission (8.4%) and return to theatre (7%) were low and comparable to those previously published for our general patient cohort. There was no relationship between increasing age beyond 70 years and any of the four primary adverse outcome measures. ConclusionsFree flap breast reconstruction in patients aged 70 and above can be very successful and safe and should be considered as an option in all fit, surgically optimised patients, independently of age.

Neo-Omphaloplasty within a Vertical Scar: The Double Trapezium Flap Technique

Background: Various techniques for neo-omphaloplasty (or umbilicoplasty/umbiliconeoplasty) have been established in recent decades. However, when the omphaloplasty must be integrated into a vertical scar, most of these techniques are unsuitable. Method: We established a technique comprising two “cross-border” trapezium flaps that come together in a key-lock fashion to be applicable for umbilical reconstruction in vertical scars. Between 2020 and 2023, we performed the double trapezium flap technique in 11 patients requiring abdominal wall correction due to previous operations resulting in the loss of the original navel and a vertical midline scar. The follow-up period was 12 months. Results: We encountered two minor wound healing disorders not involving the omphaloplasty. One patient experienced a more severe wound healing complication involving the vertical scar and the lower flap of the neo-umbilicus. No cases of umbilical flattening or detachment of the anchorage stitches were detected. Patients ranked the aesthetic outcomes as “excellent” (n = 9) or “good” (n = 2). Physicians ranked the results as “excellent” (n = 7), “good” (n = 4), and “average” (n = 1). Conclusions: For the selected patients, this technique appears to be a good and reliable option to create a natural looking neo-umbilicus, creating sufficient umbilical depth with minimal scarring. While a study population of 11 patients is hardly enough to endorse a new technique, appropriate cases are comparatively rare and very specific.

Essential oils: a potential alternative with promising active ingredients for pharmaceutical formulations in chronic wound management.

Chronic wound is a major clinical challenge that complicates wound healing, mainly associated with bacterial biofilms. Bacterial burden damages tissue and persists inflammation, failing to granulate, leading to morbidity and mortality. Various therapeutic strategies and approaches have been developed for chronic wound healing in clinical practice. As treating biofilm infection is crucial in chronic wounds, a potent antibiofilm agent, essential oils have been explored extensively for their therapeutic properties and as a replacement for antibiotic therapy. Currently, several studies on essential oils and their active compounds in therapeutics, such as adjunctive therapies, nanotechnology-based treatment and their drug delivery systems, help heal chronic wounds. The antimicrobial, anti-inflammatory and antioxidant properties of essential oils make them distinct and are renowned as natural remedies to improve the healing of infected chronic wounds. Consequently, it accelerates wound closure by reducing inflammation, increasing angiogenesis and tissue regeneration. This review focuses on different essential oils and their active compounds that are exploited for the treatment of biofilm infection, chronic inflammation and wound healing. Thus, an effective novel treatment can be developed to improve the current treatment strategy to overcome multidrug resistance bacteria or antibiotic resistance in various chronic wound infections that support wound healing.

The Use of Cryopreserved Umbilical Tissue as an Adjunctive Therapy in Immediate Breast-Reconstruction Patients at High Risk for Wound-Healing Complications: Case-Report Series and Preliminary Results

The Use of Cryopreserved Umbilical Tissue as an Adjunctive Therapy in Immediate Breast-Reconstruction Patients at High Risk for Wound-Healing Complications: Case-Report Series and Preliminary Results

Outcome of perioperative immune enhancing nutrition in patients undergoing radical cystectomy

BackgroundSince radical cystectomy is associated with relatively high perioperative morbidity and mortality, this study was conducted to evaluate the efficacy of perioperative immune nutrition in radical cystectomy patients on postoperative outcomes including wound healing, postoperative complications, either infectious or non-infectious, and length of hospital stay.Patients and methodsThis prospective, randomized controlled study was conducted between June 2022 and November 2023. Forty-two patients who had undergone radical cystectomy with ileal conduit were randomized into two groups: the immune nutrition group, which received perioperative immune nutrition, and the conventional group, which did not receive immune nutrition. Patients were followed up for 30 days postoperatively to assess wound healing, infectious and non-infectious complications, and the length of hospital stay.ResultsPatients who received immune nutrition had significantly lower postoperative infectious complications (19.0 vs 61.9%; P = 0.004), shorter hospital stay (16.57 ± 3.74 vs 20.38 ± 5.97; P = 0.01) and shorter ICU stay (2.60 ± 1.07 vs 7.09 ± 7.50; P = 0.029). The proper wound healing was significantly higher in the immune nutrition group (90.5 vs 52.4%; P = 0.006). However, there was no significant difference between both groups in the rate of non-infectious complications (28.5% vs. 57.1%, P = 0.061).ConclusionPerioperative immune nutrition is associated with improved wound healing, reduced infectious complications, and reduced length of hospital stay.Trial registration clinicaltrials.gov, NCT05822518. Registered 1 April 2023—Retrospectively registered, https://clinicaltrials.gov/study/NCT05822518.

Multifunctional Silver‐Enzyme Nanogels Assembly with Efficient Trienzyme Cascades for Synergistic Diabetic Wound Healing

AbstractDiabetic wound healing presents a persistent clinical challenge, often characterized by prolonged healing times, and can be particularly difficult to achieve in a hyperglycemic environment. In this study, a multi‐functional silver‐enzyme nanogels assembly (Ag‐nGHC) is designed by focusing on the complex diabetic wound environment. Glucose oxidase (GOX), horseradish peroxidase (HRP), and catalase (CAT) are modified within polymeric nanogel layers and assembled into a large enzyme cluster with silver ions. The close attachment of three enzymes ensures fast and continuous consumption of a high level of glucose, generation of oxygen, and hydroxyl radicals (•OH) around the wound site. Meanwhile, the silver ions within the Ag‐nGHC assembly act as an effective agent to kill bacteria. This cascade enzyme system significantly improves the microenvironment of the wound site by reducing bacterium infection and alleviating hypoxia as well as hyperglycemia. Sequentially, the improved environment facilitates the later processes including anti‐inflammatory, re‐epithelialization, and angiogenesis, evidenced by enhancing polarization toward M2 macrophages and increasing CD31 signals in this study. Overall, the Ag‐nGHC materials are proven to achieve multifunctional properties toward complicated diabetic wound healing processes (attributes such as adaptability, hypoxia‐alleviated, anti‐hyperglycemic, antimicrobial, anti‐inflammatory, and angiogenic) and showed great potential for the treatment of chronic diabetic wound.

Enhanced Targeted Drug Delivery for Scar Prevention: Clathrin‐Coated Solid Lipid Nanoparticles for Model Drug Encapsulation

AbstractExcessive scar formation is a major complication of wound healing. Premature release of anti‐scarring drugs can negatively impact healing. This study aims to develop a targeted delivery system for the controlled release of anti‐scarring drugs during the scar formation stage. Solid lipid nanoparticles (SLNs) coated with Clathrin, a cage‐like protein, to prevent premature drug release is developed. Insulin‐like growth factor (IGF) is conjugated to the SLNs for targeted delivery via its affinity for connective tissue growth factor (CTGF), a protein overexpressed during scar formation. The IGF‐Clathrin‐SLNs exhibited a size of 300 ± 20 nm and a zeta potential of 9.23 ± 0.4 mV. In vitro studies demonstrated sustained release of the encapsulated drug‐ kynurenic acid; less than 10% of kynurenic acid is released within three days, while over 50% is released within 10 h upon Clathrin removal using a surfactant at pH 8. Cellular uptake studies confirmed targeting efficacy. Fibroblasts with low CTGF expression displayed low uptake (<10%), whereas MCF7 cells with high CTGF expression showed significantly higher uptake (80%). This work demonstrates a promising targeted delivery platform for the controlled release of anti‐scarring drugs during scar formation.

Effect of concentrated growth factor on wound healing, side effects, and postoperative complications following third molar surgery

BackgroundThird molar surgery often results in postoperative complications such as pain, trismus, and facial swelling due to surgical trauma. Concentrated Growth Factor (CGF), a third-generation platelet concentrate, is believed to enhance wound healing due to its rich content of growth factors and fibrin. MethodsThis systematic review followed PRISMA guidelines and included a search of PubMed, Embase, and Cochrane Library up to April 18, 2024. Randomized controlled trials involving CGF-treated versus non-CGF-treated patients undergoing third molar surgery were included. Risk of bias was assessed using the Cochrane Collaboration RoB 2.0. ResultsTen studies were included. CGF significantly improved wound healing, with enhanced soft and hard tissue recovery. Pain relief was notable on postoperative days 3 and 7, although results varied. CGF reduced facial swelling significantly on days 3 and 7 post-surgery. Trismus outcomes were mixed, with some studies reporting significant alleviation and others showing no advantage. CGF showed potential in reducing dry socket incidence, though evidence was not robust. ConclusionsCGF appears to promote wound healing and reduce postoperative complications such as pain and swelling after third molar surgery. However, its effects on trismus and dry socket incidence remain controversial. Further research with standardized measures is needed to confirm these findings.

Downstaging with atezolizumab-bevacizumab: a case series.

Hepatocellular carcinoma (HCC) is generally diagnosed at an advanced stage, which limits curative treatment options for these patients. Locoregional therapy (LRT) is the standard approach to bridge and downstage unresectable HCC for liver transplantation (LT). Atezolizumab-bevacizumab (atezo-bev) can induce objective responses in nearly one-third of patients; however, the role and outcomes of downstaging using atezo-bev remains unknown. In this retrospective single-center study, we included consecutive patients between November 2020 and August 2023, who received atezo-bev with or without LRT and were subsequently considered for resection/LT after downstaging. Of the 115 patients who received atezo-bev, 12 patients (10.4%) achieved complete or partial response and were willing to undergo LT; they (age, 58.5 years; women, 17%; Barcelona Clinic Liver Cancer stage system B/C, 5/7) had received 3-12 cycles of atezo- bev, and four of them had received prior LRT. Three patients died before LT, while three were awaiting LT. Six patients underwent curative therapies: four underwent living donor LT after a median of 79.5 days (range, 54-114) following the last atezo-bev dose, one underwent deceased donor LT 38 days after the last dose, and one underwent resection. All but one patient had complete pathologic response with no viable HCC. Three patients experienced wound healing complications, and one required re-exploration and succumbed to sepsis. After a median follow-up of 10 months (range, 4-30), none of the alive patients developed HCC recurrence or graft rejection. Surgical therapy, including LT, is possible after atezo-bev therapy in well-selected patients after downstaging.

Focused Perioperative Nutritional Supplementation Reduces Wound Complications in Patients Undergoing Spinal Fusion Surgery.

Retrospective cohort study. To evaluate intensive postoperative nutritional supplementation on wound healing complications and outcomes after spinal fusion surgery. Poor nutritional status leads to inferior postoperative outcomes by increasing mortality and predisposing patients to infection and wound healing complications. While perioperative nutritional supplementation has shown promise in mitigating these risks, there is a paucity of literature regarding specific nutritional routines in spinal fusion surgery. A retrospective analysis was conducted on patients who underwent spinal fusion surgery between 2019 and 2022. Demographic and nutritional data, including preoperative prealbumin levels (PAB) and postoperative supplemental diet, were examined. Primary endpoints included wound complications, with secondary outcomes assessing Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Health (PH) scores. Statistical analyses included unpaired t-tests and Chi-squared/Fischer's exact tests with significance set at P<0.05. Patients receiving the supplemental diet (n=229) demonstrated fewer wound complications (7% vs. 21%, P=0.004) and reoperations (3% vs. 11%, P=0.016) compared to those without supplementation (n=56). No significant differences were observed in preoperative or postoperative PROMIS PH or ODI scores. Patients with normal preoperative PAB had more wound complications without the supplemental diet (5% vs. 18%, P=0.025). A similar trend was seen in the patients with low preoperative PAB (12% vs. 26%, P=0.12). Postoperative nutritional supplementation significantly reduces wound complications after spinal fusion surgery in a cost-effective manner. This study underscores the modifiability of certain perioperative risk factors and suggests that nutritional strategies can mitigate potential complications.

Understanding healing complications in implant-based breast reconstruction using novel metrics for indocyanine green angiography

IntroductionIndocyanine green (ICG) angiography for the intraoperative evaluation of tissue perfusion is commonly used in implant-based breast reconstruction (IBR). The assessment of ICG images depends on the surgeon’s interpretation and is qualitative or semiqualitative in nature. To quantify ICG metrics, this study aimed to apply a novel assessment of fill-rate dynamics to predict wound-healing complications and provide pragmatic assessment tools in IBR. MethodsThis was a retrospective cohort study of patients who underwent IBR with ICG using the photodynamic eye (PDE-Neo II) qualitative imaging system between April 2021 and September 2023. ICG recordings were reviewed to quantify the relative surface area and fluorescence intensity of visual perfusion deficits using ImageJ. The primary outcome was the incidence of wound-healing complications. t-tests and logistic regression were performed for statistical testing. ResultsA total of 112 patients (201 breasts) were included. The incidence of wound-healing complications was 12.9%. A higher relative surface area of ischemic regions was significantly associated with wound-healing complications (3.3% vs. 0.90%; p = 0.001). The rate of change in the surface area of ischemic regions was significantly associated with wound-healing complications (0.35% per second vs. 1.29% per second; p = 0.003%). On average, the duration of transient ischemic areas was significantly longer in breasts with wound-healing complications (46.0 s vs. 36.0 s, p = 0.01). ConclusionA transient ischemic area of > 5% of the breast and/or failure to resolve transient ischemic areas after 60 s may predict wound-healing complications and inform surgical reconstructive decision-making in IBR.

Navigating Brain Metastases: Unveiling the Potential of 3-Tesla Intraoperative Magnetic Resonance Imaging.

Intraoperative magnetic resonance imaging (iMRI) has witnessed significant growth in the field of neurosurgery, particularly in glioma surgery, enhancing image-guided neuronavigation and optimizing the extent of resection (EOR). Despite its extensive use in the treatment of gliomas, its utility in brain metastases (BMs) remains unexplored. This study examined the effect of iMRI on BM resection. This retrospective study was conducted at the neurosurgical center of the University Hospital of the Technical University of Munich and involved 25 patients with BM who underwent resection using 3-Tesla iMRI between 2018 and 2022. Volumetric measurements of the resected contrast-enhancing metastases were performed using preoperative, intraoperative, and postoperative MRI images. The Karnofsky Performance Score (KPS) and neurological status of the patients were assessed pre- and postoperatively. Local recurrence and in-brain progression were reported in patients who underwent follow-up MRI at 3 and 6 months postoperatively. In this cohort (n = 25, mean age 63.6 years), non-small-cell lung cancer (NSCLC) was the most common origin (28%). The mean surgical duration was 219.9 min, and that of iMRI was 61.7 min. Indications for iMRI were primarily associated with preoperative imaging, suggesting an unclear entity that is often suspicious for glioma. Gross total resection (GTR) was achieved in 21 patients (84%). Continued resection was pursued after iMRI in six cases (24%), resulting in an improved EOR of 100% in five cases and 97.6% in one case. Neurological status postoperatively remained stable in 60%, improved in 24%, and worsened in 16% of patients. No wound healing or postoperative complications were observed. Among the thirteen patients who underwent follow-up MRI 3 months postoperatively, one patient showed local recurrence at the site of resection, and seven patients showed in-brain progression. Of the eight patients who underwent a 6-month follow-up MRI, two showed local recurrence, while three exhibited in-brain progression. The observed favorable profiles of GTR, coupled with the notable absence of wound-healing problems and acute postoperative complications, affirm the safety and feasibility of incorporating iMRI into the neurosurgical workflow for resecting BM with specific indications. The real-time imaging capabilities of iMRI offer unparalleled precision, aiding meticulous tumor delineation and informed decision-making, ultimately contributing to improved patient outcomes. Although our experience suggests the potential benefits of iMRI as a safe tool for enhancing EOR, we acknowledge the need for larger prospective clinical trials. Comprehensive investigations on a broader scale are imperative to further elucidate the specific indications for iMRI in the context of BMs and to study its impact on survival. Rigorous prospective studies will refine our understanding of the clinical scenarios in which iMRI can maximize its impact, guiding neurosurgeons toward more informed and tailored decision-making.

Treatment of the Distal Forearm Fracture by Volar Dual Window Approach.

Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: -0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity.