Functional Morbidity Research Articles

33303 The Sarcoidosis app: A mobile app study of impact of disease on quality of life and physical activity

Background: Sarcoidosis, a multisystem granulomatous disease affecting lungs and skin, often causes substantial functional morbidity. Clinical and epidemiologic knowledge is incomplete given its rarity and variable presentation. As 85% of American adults own smartphones, we developed the Sarcoidosis App (SA), a mobile app to study quality of life (QoL) and physical activity (PA).

ENHANCED RECOVERY AFTER SURGERY(ERAS)PROTOCOLS VS. STANDARD CARE IN PATIENTS WITH PEPTIC ULCER PERFORATION

Objectives: To compare the efficacy of Enhanced recovery after surgery(ERAS) protocol vs standard care in patients with perforated peptic ulcer (PPU). Materials and Methods: This single-center, retrospective, cross-sectional study was carried out from January 2021 to January 2022. Patients with PPU undergoing Grahams repair were divided into standard care and ERAS group. Primary outcome was the duration of stay. Secondary outcomes were functional recovery parameters and morbidity. Results: A total of 120 cases of PPU were admitted in our hospital, among which 60 patients each were included in standard care and ERAS group, respectively. Patients in ERAS group had a significantly early functional recovery for the time to first flatus (1.41 vs 2.38 p < 0.001), first stool (2.65 vs 3.78 p < 0.001), first fluid diet (2.75 vs 6.1 p < 0.001), and solid diet (4.08 vs 7.11 p < 0.001). Duration of stay in ERAS group was significantly shorter (6.2 vs 8.53 p < 0.001). There was a significant reduction in postoperative morbidity such as postoperative nausea and vomiting (RR 0.43, p value = 0.005), superficial SSI (RR 0.4, p = 0.005) and pulmonary complications (RR 0.45, p = 0.002). Result : ERAS group showed better primary and secondary outcomes. Conclusion: In conclusion, ERAS protocols, are feasible and safe for application in selected patients undergoing Grahams repair of perforated peptic ulcer without an increase in the rate of complications.

Hip Fracture in the Elderly: An Overview

In this paper, the available information about hıp fracture ın the elderly is briefly reviewed. Intracapsular and extracapsular hip fractures, which usually occur due to low energy trauma in elderly patients, are one of the most important causes of functional disability, morbidity and mortality. Treatment of hip fractures; it requires the management of a broad spectrum from prevention to surgery and post-operative care. It is important to mobilize elderly patients with hip fractures as soon as possible by treating them with the appropriate method and to avoid systemic complications that may occur due to immobility.

Current status and evolution of microsurgical tongue reconstructions, part I.

Reconstructive surgery in the management of head and neck cancer has evolved to include structure-specific approaches in which organ-specific treatment algorithms help optimize outcomes. Tongue cancer management and reconstruction are surgical challenges for which well-executed reconstructive plans should be completed promptly to avoid delaying any subsequently planned oncologic treatment. Crucial considerations in tongue cancer resection are the significant functional morbidity associated with surgical defects, particularly in terms of speech and swallowing, and the consequent negative impact on patients’ quality of life. With the evolution of microsurgical techniques and the development of the perforator flap concept, flap options can be tailored to the characteristics of various tongue defects. This has allowed the implementation of pliable flaps that can help restore tongue mobility and yield subsequent functional outcomes. Using an evolutional framework, we present this series of reviews related to tongue reconstruction. The first part of the review summarizes flap options and flap-related factors, such as volume and tissue characteristics. Related functional aspects are also presented, including tongue mobility, speech, and swallowing, as well as ways to evaluate and optimize these outcomes.

Donor-Site Morbidity and Quality of Life after Autologous Breast Reconstruction with PAP versus TMG Flap

The transverse myocutaneous gracilis (TMG) and the profunda artery perforator (PAP) flap are both safe choices for autologous breast reconstruction originating from the same donor region in the upper thigh. We aimed to compare the post-operative outcome regarding donor-site morbidity and quality of life. We included 18 patients who had undergone autologous breast reconstruction with a PAP flap (n = 27 flaps). Prospective evaluation of donor-site morbidity was performed by applying the same questionnaire that had already been established in a previous study evaluating TMG flap (n = 25 flaps) outcome, and results were compared. Comparison of the two patient groups showed equivalent results concerning patient-reported visibility of the donor-site scar and thigh symmetry. Still, the TMG group was significantly more satisfied with the scar (p = 0.015) and its position (p = 0.001). No difference was found regarding the ability to sit for prolonged periods. Donor-site wound complications were seen more frequently in the PAP group (29.6%) than in the TMG group (4.0%). Both groups expressed rather high satisfaction with their quality of life. Both flaps show minimal functional donor-site morbidity and high patient satisfaction. To minimize wound healing problems in PAP patients, thorough planning of the skin paddle is necessary.

Association of Pathogen Type With Outcomes of Children Encountering Community-Acquired Pediatric Septic Shock.

To determine the association of pathogen type with mortality, functional status, and health-related quality of life (HRQL) among children at hospital discharge/1 month following hospitalization for septic shock. Secondary database analysis of a prospective, descriptive cohort investigation. Twelve academic PICUs in the United States. Critically ill children, 1 month to 18 years old, enrolled from 2013 to 2017. None. Association of clinical outcomes with pathogen type was assessed for all patients and separately for surviving patients enrolled in the primary Life After Pediatric Sepsis Evaluation (LAPSE) investigation. For this secondary analysis, we predicted that age would be associated with pathogen type and outcomes, and accordingly, it was incorporated as a confounding variable in primary analyses. Among 389 children enrolled with septic shock, at 1 month/hospital discharge, we observed no statistically significant differences in relation to pathogen types for the composite outcome mortality or substantial new functional morbidity: no causative organism identified (27% [28/103]), pure viral infections (26% [24/91]), pure bacterial/fungal infections (25% [31/125]), and bacterial/fungal+viral coinfections (33% [23/70]). Similarly, we observed no statistically significant differences in relation to pathogen types for the composite outcome, mortality, or persistent serious deterioration of HRQL: no causative organism identified (43% [44/103]), pure viral infections (33% [30/91]), pure bacterial/fungal infections (46% [57/125]), and bacterial/fungal+viral coinfections (43% [30/70]). However, we did identify statistically significant associations between pathogen type and the outcome ventilator-free days ( p = 0.0083) and PICU-free days (0.0238). This secondary analysis of the LAPSE database identified no statistically significant association of pathogen type with composite mortality and morbidity outcomes. However, pathogen type may be associated with PICU resources employed to treat sepsis organ dysfunction. Ultimately, pediatric septic shock was frequently associated with adverse patient-centered, clinically meaningful outcomes regardless of infectious disease pathogen type.

Early Developmental Trajectories in Infants With Neurofibromatosis 1.

ObjectiveTo examine the trajectories of cognitive, motor and behavioural development in infants with NF1 compared to infants without a family history of neurodevelopmental difficulties.Study designInfants with NF1 and low-risk controls were recruited from 5 months of age and followed longitudinally. Data from standardised tests was gathered at 5, 10 and 14 months and developmental trajectories of motor, language, behaviour, sleep, social development and parent–infant interaction were examined. Linear mixed modelling was used to estimate group differences in cognitive and behavioural measures over time.ResultsNo group differences were observed on Mullen Scale of Early Learning, overall adaptive functioning, temperament or behavioural measures. There were no group differences observed on measures of social communication or parent–infant interaction. Over the course of development, the NF1 group slept less and took more time to settle to sleep as compared to the control group. Maternal education was significantly associated with cognitive and behavioural developmental outcomes in both groups.ConclusionCognitive, social and behavioural impairments are a cause of significant functional morbidity in children with NF1. This report is the first study to investigate the trajectories of cognitive, motor and behavioural development in infancy in NF1. Our results demonstrate that overall cognitive and behavioural developmental trajectories of the NF1 group in the infancy period are similar to controls. Given previous reports of delayed development in the NF1 cohort by 40 months, early clinical interventions strategies to promote sleep hygiene may be beneficial to optimise developmental outcomes.

Clinical Consequences of Metabolic Acidosis-Muscle.

Metabolic acidosis is common in people with chronic kidney disease and can contribute to functional decline, morbidity, and mortality. One avenue through which metabolic acidosis can result in these adverse clinical outcomes is by negatively impacting skeletal muscle; this can occur through several pathways. First, metabolic acidosis promotes protein degradation and impairs protein synthesis, which lead to muscle breakdown. Second, metabolic acidosis hinders mitochondrial function, which decreases oxidative phosphorylation and reduces energy production. Third, metabolic acidosis directly limits muscle contraction. The purpose of this review is to examine the specific mechanisms of each pathway through which metabolic acidosis affects muscle, the impact of metabolic acidosis on physical function, and the effect of treating metabolic acidosis on functional outcomes.

The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature.

Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin cancer (NMSC) is rising. The management of NMSC is difficult and necessitates a multidisciplinary team (i.e., pathologists, dermatologists, medical oncologists, surgeons, and radiation oncologists). When surgery is not an option or will cause unacceptably functional morbidity, radiation therapy (RT) may be a preferable tissue-preserving option. Whether used alone or in conjunction with other treatments, RT has been shown to be quite effective in terms of cosmetic results and local control. Contact hypofractionated RT, brachytherapy, and electronic brachytherapy are all promising new treatments. However, rigorous, randomized trials are missing, explaining the disparity in dose, fractionation, and technique recommendations. Therefore, it is essential that interdisciplinary teams better understand RT modalities, benefits, and drawbacks. Our review will provide the role and indications for RT in patients with NMSC.

Prevention and management of post-deep inferior epigastric perforator flap abdominal bulge: A 5-year single-surgeon series

Abdominal bulge in the absence of a hernia is a known complication following free abdominal flap breast reconstruction and can be associated with significant aesthetic and functional morbidity. This study aims to review the impact of permanent subrectus mesh placement on the incidence of post-DIEP bulge. All patients over a 5-year period who underwent unilateral or bilateral DIEP breast reconstruction were included in the study. The cohort was divided into a "permanent mesh" (PM) and "no permanent mesh" (NPM) groups. Those in the PM group underwent placement of a permanent Bard™ Soft Polypropylene Mesh, and the NPM group comprised of patients who had a semi-permanent subrectus VyproⓇ mesh or no mesh. The primary outcome of the study was the development of post-DIEP abdominal bulge or hernia. The secondary outcome was the incidence of other donor site complications such as infection. Post-operative follow-up was conducted for a minimum of 6 months. The study included 276 patients, 134 of whom were in the NPM group and 142 in the PM group. Demographics including mean age, median BMI, incidence of pre-operative chemotherapy, radiotherapy, and prior abdominal surgery were comparable between the two groups. The incidence of post-operative abdominal bulge or hernia was lower in the PM group (PM= 0.7% vs. NPM=5.2%, p<0.05). There was no significant difference in the incidence of donor site infection between the two groups (PM=3.5 vs. NPM=2.2%, p=0.53). Our study demonstrates that a low rate of abdominal morbidity can be achieved with the placement of a permanent subrectus mesh.

MOTION: A randomized, phase 3, placebo-controlled, double-blind study of vimseltinib (DCC-3014) for the treatment of tenosynovial giant cell tumor.

TPS11590 Background: Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm that occurs in the synovium of joints, bursae, or tendon sheaths. TGCT is caused by upregulation of the colony-stimulating factor 1 (CSF1) gene, resulting in aberrant CSF1 expression and the recruitment of CSF1 receptor (R)-dependent inflammatory cells. Resection is the primary treatment, but nonsurgical treatment options are necessary for patients with symptomatic TGCT not amenable to surgical resection. Vimseltinib is an oral switch control TKI specifically designed to selectively and potently inhibit CSF1R. In a Phase 1/2 study in patients with TGCT, vimseltinib showed encouraging antitumor activity with an overall objective response rate (ORR) of 42% in the cohort receiving 30 mg twice weekly (recommended phase 2 dose; Gelderblom et al, ESMO 2021 Poster). Vimseltinib was also well tolerated, and the majority of the common (≥15%) treatment-emergent adverse events (TEAEs) were Grades 1–2. Among these common TEAEs, the only Grade 3–4 event in the Phase 2, twice-weekly, 30-mg cohort was increased blood creatine phosphokinase (CPK); however, this elevated CPK was not associated with any symptoms (Gelderblom et al, ESMO 2021 Poster). Phase 1/2 efficacy and safety data support further development of vimseltinib; here, we describe the ongoing Phase 3 study for patients with TGCT not amenable to surgical resection. Methods: MOTION (NCT05059262) is a Phase 3, randomized, placebo-controlled, double-blind study that aims to evaluate the efficacy and safety of vimseltinib for the treatment of TGCT not amenable to surgical resection. Participants must be at least 18 years of age and have histologically confirmed and symptomatic TGCT for which surgical resection will potentially cause worsening functional limitation or severe morbidity. Prior CSF1R therapy is not permitted (previous imatinib and nilotinib is allowed). In Part 1 of the study, eligible participants will be randomized 2:1 to receive either vimseltinib 30 mg twice a week or matched placebo for 24 weeks. The primary outcome measure is ORR assessed by central read using Response Evaluation Criteria in Solid Tumors version 1.1 at 25 weeks. Secondary outcome measures include ORR per tumor volume score, range of motion, and patient-reported outcomes. Participants assigned to placebo in Part 1 will have the option to receive vimseltinib in Part 2, a long-term treatment phase in which participants will receive open-label vimseltinib. This international study plans to randomize 120 participants and is currently enrolling. Clinical trial information: NCT05059262.

Novel technique to prevent or correct open-mouth deformity after bilateral mandibular resection: Use of tensor fascia lata slings.

Open-mouth deformity after mandibular resection presents a challenge for surgeons and patients, contributing to significant functional and cosmetic morbidity. We present an innovative surgical technique to prevent or correct open-mouth deformity. Tensor fascia lata slings were utilized in combination with maxillomandibular fixation to surgically correct or prevent open-mouth deformity in four patients who had previously undergone mandibulectomy or at the time of a contralateral mandibulectomy following prior hemimandibulectomy and reconstruction. Two patients achieved favorable outcomes, including oral competence and improved resting jaw position, while open-mouth deformity could not be corrected for one patient. Another patient remains in the early postoperative period following a secondary procedure to correct open-mouth deformity. Open-mouth deformity is a functional/aesthetic problem that has not been addressed in the literature. Use of tensor fascia lata slings to suspend the mandible is a novel approach to the surgical management of open-mouth deformity.

Postural disorders of neurological genesis in elderly patients: pathogenesis and features of diagnostics (literature review)

Walking and balance disorders in elderly patients are the most common manifestations of various diseases of the nervous system. Balance imbalance is the leading cause of injuries in the elderly, leading to a limitation of both the patient’s ability to work and communication in the social environment, which in particular cases leads to a loss of independence, reducing the quality of life. Walking disorders are an important, difficult to resolve medical and social problem. The aim of the study was to identify the physiological and clinical aspects of age-related gait disorders with an emphasis on neurological pathogenetic causes. A detailed study of modern foreign medical literature and current international clinical guidelines was carried out with further systematization of the data obtained. Falls in the elderly are a common and major factor that threatens the independence of older people. The frequency of falls increases with age. Treatment for fall injuries does not always include identifying the cause of the fall. In the elderly, loss of balance is most commonly due to multiple causes, including impending threat to the homeostatic mechanisms that maintain postural stability combined with age-related impairments in balance, gait stability, and cardiovascular function. Gait disorders are a major cause of functional impairment and morbidity in the elderly. Most gait disorders in the elderly are multifactorial and have neurological components. In developed countries, there is a trend towards aging of the population: the percentage component of the elderly part of the population is growing. It is violations of balance, stability and walking, to a large extent, that lead to the inability of the patient to provide his quality of life at a satisfactory level on his own, to disability and failure in the workplace. Early diagnosis of gait disorders can prevent premature disability and limit the independence of elderly patients. It is important to note that a history of falls is a predictor of the risk of new falls.

MP25-08 URINARY TRACT RECONSTRUCTION WITH ENTEROCYSTOPLASTY AFTER RADIATION FOR PELVIC CANCER

You have accessJournal of UrologyCME1 May 2022MP25-08 URINARY TRACT RECONSTRUCTION WITH ENTEROCYSTOPLASTY AFTER RADIATION FOR PELVIC CANCER Sender Herschorn, and Jenn Locke Sender HerschornSender Herschorn More articles by this author , and Jenn LockeJenn Locke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation (RT) for pelvic cancer may compromise the urinary tract. Reconstruction can be challenging especially at the time of surgical removal of the tumor. As an alternative to cystectomy, enterocystoplasty (EC) +/- ureteral reimplantation or continent catheterizable channel (CCC) brings the potential benefits of preserving the LUT. We report our experience in a series of patients, all of whom had RT, to assess outcomes and complications. METHODS: This is a retrospective case series of all post-RT patients who underwent EC to reconstruct the LUT between 1994 and 2021 from one institution. Complications and functional results were recorded. RESULTS: 36 patients (18 women,18 men) who had prior RT for treatment of advanced or recurrent pelvic cancer were identified. 10 patients, post chemo-RT for colorectal cancer, underwent immediate reconstruction after tumour excision, which included part of the bladder +/- ureter(s) (group 1) and 26 after RT for prostate (7), gynecologic (13), colorectal (5) and liposarcoma (1) had surgery due to RT complications (group 2). Mean age at surgery was 58 yrs (median 58.5; range 33-76). All patients underwent EC and 24 (67%) had simultaneous ureteral reimplants either into an afferent intestinal limb (17) or into the bladder (7) with 16 undergoing bilateral reimplants. Reimplants were done for obstruction due to tumor (group 1) or post-RT (group 2). 8 patients in group 2 had simultaneous CCC due to devastated urethras. The median postop length of stay (LOS) was 9 days (4-25) and was significantly shorter in group 2 vs. group 1; 8 (IQR 6-10) vs. 13 (IQR 10-14) (p=0.0039). No early (within 30 days) surgical reintervention was prompted by the LUT reconstruction. After a median follow-up of 38.5 mo. (range 2-195), 9 patients (29%) required reinterventions including 4 open operations (1 parastomal hernia, 1 vesicovaginal, 2 vesico-cutaneous fistulae), 2 ureteral intestinal anastomotic stricture dilations, and 3 endoscopic bladder stone removals. Reintervention rate was similar in the groups. Renal function was preserved. 23/28 non-stoma patients void spontaneously, 3 perform intermittent catheterization (IC), and 2 have indwelling catheters. 7/8 stoma patients do IC and one is awaiting persistent vesicocutaneous fistula repair with an indwelling catheter. At last follow-up, 32/36 patients considered their LUT management to be successful. CONCLUSIONS: Prior pelvic RT is not a contraindication to EC with or without ureteral reimplantation and/or CCC. Longer LOS was seen in the extirpative group. Acceptable functional outcomes and morbidity can be achieved. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e430 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sender Herschorn More articles by this author Jenn Locke More articles by this author Expand All Advertisement PDF DownloadLoading ...

P34. CONTINUOUS NEGATIVE PRESSURE WOUND THERAPY REGULATES HEALING AND FIBROSIS IN MURINE EXCISIONAL WOUNDS

PURPOSE: Hypertrophic scarring is a fibroproliferative disorder that can occur post-operatively resulting in significant functional and esthetic morbidity. Mechanical forces are known to modify the wound microenvironment and influence cellular behavior and organization. The potential effects of micromechanical force application through Negative Pressure Wound Therapy (NPWT) on skin scarring have not yet been explored in vivo. Here we investigate the application of continuous NPWT in a murine excisional wound model. METHODS: 20 obese and diabetic (db/db) mice received a 1×1 cm2 full thickness excisional dorsal skin wound and were separated into two groups, treated either with occlusive covering (Control, n=10), or NPWT (continuous, -125 mmHg, 7 days; NPWT, n=10). The wounds were photographed on days 0, 7, and 10, and the animals sacrificed and tissue harvested on day 10 for histological and molecular analysis. RESULTS: Although use of NPWT was shown to significantly increase Yes-associated protein (YAP), Engrailed-1 (En1) was significantly decreased. Use of NPWT significantly increased fibronectin deposition and improved collagen deposition and organization. Western blotting showed significantly increased RhoA and YAP and decreased Caspase-3 in the NPWT group. CONCLUSION: Taken together, our findings indicate that the mechanotransduction forces exerted by NPWT uncouple YAP, a mechanical signaling protein, from En1. Fibroblasts of an En1 lineage are known to mediate fibrotic processes that lead to scarring, while increased expression of caspase-3 has been linked to keloid formation. Therefore, through its actions on fibroblast proliferation and apoptosis, NPWT may play a significant role in final scar appearance.

Discharge Planning for Children With Critical Bronchiolitis.

Discharge Planning for Children With Critical Bronchiolitis.

Specific characteristics and current diagnostic and treatment modalities performance of super refractory status epilepticus in children: A comparative study

Super-refractory status epilepticus (SRSE) is associated with significant morbidity and mortality in children. We explored the clinical spectrum, specific characteristics, and outcome in SRSE patients admitted in a pediatric intensive care unit (PICU) and investigated how well current diagnostic or treatment modalities perform compared to Status Epilepticus (SE) and Refractory SE (RSE) patients. Retrospective analysis of PICU patients admitted with convulsive SE during 2009-2019. Eighty-six patients were classified as SE, RSE, and SRSE. New-onset RSE (NORSE) and febrile infection-related epilepsy syndrome (FIRES) were also identified. Functional outcome was evaluated by the modified Rankin scale. Patients with SRSE (n=20) had longer weaning off anesthetics (p=0.014), length of stay, mechanical ventilation duration, higher illness severity scores, and poorer outcome compared to SE (n=13) or RSE (n=53) patients (all p<0.001). Diagnosis, mainly expressed by high prevalence of NORSE (n=13) and FIRES (n=9), was independently associated with SRSE (p=0.024). Abnormal MRI findings (p=0.005), and epilepsy-related pathogenic variants identified by whole-exome sequencing (WES) were mostly found in SRSE patients. Compared to intravenous immunoglobulins and steroid pulses, plasmapheresis and ketogenic diet, more often used in SRSE (p<0.01), contributed better to seizure control. Only SRSE (AUROC > 0.80, 95% CI=0.68-0.94, p<0.001) and diagnosis (AUROC > 0.70, 95% CI=0.55-0.83, p=0.02) could predict a poor outcome. The majority of SRSE patients are characterized by considerable functional decline and morbidity. WES analysis may reveal epilepsy-related pathogenic variants while early aggressive immunotherapy and/or ketogenic diet might prove beneficial. Multicenter studies for prediction models of outcome are needed.

The effect of stromal vascular fraction in an experimental frostbite injury model

BackgroundDespite current treatment modalities, frostbite remains an injury with a poor prognosis which may cause functional morbidities. Several experimental and clinical studies have demonstrated that stromal vascular fraction is an autologous mixture, which can improve wound healing and vasculogenesis. The aim of this study was to show the beneficial effects of stromal vascular fraction on experimental frostbite healing. Material and methodsStromal vascular fraction (SVF) was harvested from 5 rats after excision of the inguinal fat pads. Another 20 rats were separated into 2 groups of 10 as the SVF group and the control group. A frostbite injury was created on each rat using a cryoprobe frozen with liquid nitrogen (−196 °C). SVF was applied to the SVF group and phosphate-buffered saline to the control group. All injections were performed subcutaneously within the frostbite injury area. Biopsies were performed on days 5 and 14 for histopathological and immunochemical evaluations. The tissue perfusion rates of both groups were assessed on day 14 using indocyanine green angiography (SPY system). ResultsThe increase in mean tissue perfusion was 373.3% ( ± 32.1) in the SVF group and 123.8% ( ± 16.3) in the control group (p < 0.001). The macroscopic wound reduction rates of the SVF and control groups were 25.5% ( ± 19.1) and 18.0% ( ± 5.9), respectively on day 5%, and 78.2% ( ± 9.2) and 57.3% ( ± 16.7) on day 14 (p = 0.007; p = 0.003). Acute inflammation and the fibrosis gradient were significantly decreased in the SVF group compared to the control group (p = 0.004, p = 0.054 respectively on day 14). Granulation tissue amount, re-epithelialization score and neovascularization were significantly increased in the SVF group (p = 0.006, p = 0.010 and p = 0.021, respectively on day 14). ConclusionsThe study results demonstrated that SVF increases frostbite wound healing by increasing tissue perfusion rate, neovascularization and re-epithelialization, and modulating acute inflammation and fibrosis.

Optimizing Aesthetics in Reconstructive Breast Surgery Using Muscle-Sparing Latissimus Dorsi Flap in Radiated and Nonradiated Patients.

The latissimus dorsi musculocutaneous flap (LDMF) has been a workhorse for breast reconstruction. Its high rate of donor-site morbidity has led to the advent of the muscle-sparing latissimus dorsi flap (MSLDF). However, there are very limited reports using the MSLDF in irradiated patients. Prior studies of MSLDF have either precluded previously radiated patients from receiving MSLDF or have included them as part of their larger MSLSDF cohort without specifically analyzing their outcome as a separate group or comparing them to the traditional LDMF group. We describe the technique and outcome of MSLDF in both radiated and nonradiated patients and compare the outcome to our LDMF patients. A retrospective chart review of patients undergoing breast reconstruction between 2003 and 2020 using either a pedicled MSLDF or LDMF with a transverse skin paddle was conducted. All patients underwent a 2-stage reconstruction with the flap and tissue expander placement done during the first stage, and replacement with implant and, if needed, fat grafting to enhance soft tissue during the second stage. Complications, subjective functional morbidity, and aesthetic outcomes were reviewed. A total of 35 MSLDFs and 40 LDMFs were performed: 24 MSLDFs (69%) and 25 LDMFs (63%) were inset into a previously irradiated field. There were 2 cases of infection requiring explantation in both MSLDF (8.3%) and LDMF (8.0%) radiated cohorts. There were no cases of donor-site seroma in the MSLDF cohorts versus 12 (30%) in the LDMF cohorts. Minor distal tip superficial epidermolysis was seen in 5 MSLDFs (14.3%), 3 of which were in the radiated cohort, and in 1 LDMF (2.5%) radiated cohort with no cases of flap loss. Functional and aesthetic outcomes were satisfactory. Four patients who had a unilateral MSLDF had a completion upper back lift. This is the largest series to date demonstrating the use of the MSLDF in both nonradiated and radiated patients and comparing it to a standard LDMF for breast reconstruction by the same surgeon. The pedicled MSLDF is a versatile option for breast reconstruction in radiated patients, and radiation should not be considered a contraindication for its use.

Functional Outcomes and Morbidity in Pediatric Sepsis Survivors: A Tanzanian Experience.

Pediatric sepsis remains a significant cause of childhood morbidity and mortality, disproportionately affecting resource-limited settings. As more patients survive, it is paramount that we improve our understanding of post-sepsis morbidity and its impact on functional outcomes. The functional status scale (FSS) is a pediatric validated outcome measure quantifying functional impairment, previously demonstrating decreased function following critical illnesses, including sepsis, in resource-rich settings. However, functional outcomes utilizing the FSS in pediatric sepsis survivors have never been studied in resource-limited settings or in non-critically ill septic children. In a Tanzanian cohort of pediatric sepsis patients, we aimed to evaluate morbidity associated with an acute septic episode using the FSS modified for resource-limited settings. This was a prospective cohort study at an urban referral hospital in Tanzania, including children with sepsis aged 28 days to 14 years old over a 12-month period. The FSS was adapted to the site's available resources. Functional status scale scores were obtained by interviewing guardians both at the time of presentation to determine the child's baseline and at 28-day follow-up. The primary outcome was “decline in functional status,” as defined by a change in FSS score of at least 3. In this cohort, 4.3% of the 1,359 surviving children completing 28-day follow-up had a “decline in functional status.” Conversely, 13.8% of guardians reported that their child was not yet back to their pre-illness state. Three-quarters of children reported as not fully recovered were not identified via the FSS as having a decline in functional status. In our cohort of pediatric sepsis patients, we identified a low rate of decline in functional status when using the FSS adapted for resource-limited settings. A higher proportion of children were subjectively identified as not being recovered to baseline. This suggests that the FSS has limitations in this population, despite being adapted for resource-limited settings. Next steps include developing and validating a further revised FSS to better capture patients identified as not recovered but missed by the current FSS.