Skin Coverage Research Articles

Delayed breast reconstruction with the thoracodorsal flap and endoprosthesis after complex treatment of breast cancer

Breast reconstruction with a thoracodorsal flap (TDF) in combination with a tissue expander/implant is a wellestablished technique.The purpose of the study was to present current data on the results of delayed breast reconstruction with thoracodorsal flap and tissue expander after combined/complex treatment in patients with breast cancer.Material and methods. The search for relevant sources was carried out in the PubMed, Cochrane Library, E-library systems, publications from 2014 to 2022 were studied. Delayed breast reconstruction using TDF in combination with a tissue expander/implant is a reliable method of reconstruction for the group of patients who have previously undergone radical mastectomy or adjuvant external beam radiation therapy in terms of combined/complex treatment of breast cancer, allowing to achieve good and excellent aesthetic results with a low incidence of surgical complications.Results and discussion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, high patient satisfaction. Patients with a low body mass index or obesity, a history of abdominal surgery, including abdominoplasty, are not candidates for reconstruction using anterior abdominal wall flaps, and therefore the only possible method of breast reconstruction for them is the method using the TDF. In addition, the use of the TDF may be most appropriate for women who are planning a pregnancy in the future and for whom the use of anterior abdominal wall flaps will not be an optimal method of reconstruction due to reduced abdominal wall compliance. Other reasons why the use of TDF is the method of choice for many surgeons are the possibility of closing the donor site regardless of the size of the skin flap taken, the possibility of closing such defects of the mammary gland as extrusions, protrusions, in case of insufficiency of the skin cover after skin-preserving mastectomies.Conclusion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, a high degree of patient satisfaction.

Extracellular matrix-based biomaterials in burn wound repair: A promising therapeutic strategy.

Burns are common traumatic injuries affecting many people worldwide. Development of specialized burn units, advances in acute care modalities, and burn prevention programs have successfully reduced the mortality rate of severe burns. Autologous skin grafting has been considered as the gold standard for wound coverage after the removal of burned skin. For full-thickness burns of a larger scale, however, the autograft donor site may be quickly exhausted, so that alternative skin coverage is necessary. Although rapid progress has been made in the development of skin substitutes for burn wounds during the last decade, no skin substitute has fulfilled the criteria as a perfect replacement for the damaged skin. Extracellular matrix (ECM) derived components have emerged as a source for the engineering of biomaterials capable of inducing desirable cell-specific responses and one of the most promising biomaterials for burn wound healing. Among these, acellular dermal matrix, small intestinal submucosa, and amniotic membrane have been applied to treat burn wounds with acceptable outcomes. This review has explored the use of biomaterials derived from naturally occurring ECM and their derivatives for approaches aiming to promote burn wound healing, and summarized the ECM-based wound dressings products applicable in burn wound and postburn scar contracture to date.

Correlation Analysis of Subjective and Objective Texture Properties: Color and Heterocyclic Amine Content of Grilled Chicken Breast Fillet

The present study discusses the technofunctional properties (color, texture) of grilled chicken with both objective (colorimeter, texture profile) analysis and subjective (sensory) analysis. Besides them, the total content of potentially carcinogenic heterocyclic amines (HCAs) was also monitored by the applied grilling time–temperature combinations. The same samples were analyzed during the heat treatment of chicken breast samples for 5–15 min at 150–230 °C on an electric contact grill. The grilling variables included the effect of skin cover. Among the structural parameters, hardness exhibited a significant difference between the groups of skin-covered and not-covered ones, and in this case, a linear connection was also found with the time and temperature values, respectively. The structural parameters obtained by sensory and instrumental analysis were compared to each other. In addition, the structural parameters were compared to the color ones (sensory, color according to the CIELAB system: brightness, redness, and yellowness) and to the total HCA content. In the case of closed grilling, sensory-evaluated parameters such as juiciness and tenderness showed a strong negative correlation to instrumentally measured hardness (R = −0.879; −0.749) and chewiness (R = −0.872; −0.718) due to the water loss from the increase in grilling temperature and time. The total HCA content positively correlated to chewiness (R = 0.789). The sensory color parameter and the brightness had a strong connection with juiciness (R = 0.738; 0.723), hardness (R = −0.795; −0.706), and chewiness (R = −0.843; −0.818); redness showed positive correlation to cohesiveness (R = 0.764) and chewiness (R = 0.829). Accordingly, juiciness and chewiness showed a connection to the total HCA levels, which makes it possible to carry out further research on instrumental and sensory parameters that may predict the formation of hazardous amounts of carcinogenic heterocyclic amines.

Clinical characteristics, treatment and efficacy of calcaneal osteomyelitis: A systematic review with synthesis analysis 1118 reported cases.

Calcaneal osteomyelitis (CO) still poses great challenges to orthopaedic surgeons due to unique anatomic and functional features of the calcaneus. This study summarized the current data regarding clinical characteristics, treatment and efficacy of CO, based on an analysis of literature-reported cases. We searched the PubMed, Embase, and Cochrane Library databases to find English and Chinese studies reporting on CO patients between 2000 and 2021, with available data for synthesis analysis. The quality of the included studies was evaluated by the National Institutes of Health (NIH) assessment scale. Effective data were extracted and pooled for analysis. Altogether 198 studies involving 1118 patients were included, with a male-to-female ratio of 2.3 (724 males and 310 females). The median age at CO diagnosis was 46 years, with a median symptom duration of 3 months. Injury-related infections (524 cases) and diabetic foot infections (336 cases) were the two most common causes, with ulcer (468 cases) and wound sinus or exudation (209 cases) being the predominant symptoms. The overall positive culture rate was 80.2%, with polymicrobial infections accounting for 18.1%. Staphylococcus aureus was the most frequently detected pathogen (42.7%), with fungal-related infections isolated in 17 cases. Although most patients received surgical interventions (96.9%), the recurrence rate was 20.1%. The incidence of infection relapse following partial calcanectomy, total calcanectomy, debridement with implantation of local antibiotics, and debridement with or without flap or skin coverage were 31.7%, 45.0%, 16.8%, and 15.1%, respectively. The overall incidence of limb amputation was 12.4%, with all-cause and CO-related mortalities of 2.8% and 0.2%, separately. CO shared similar characteristics with extremity chronic osteomyelitis, primarily affecting young males, with trauma and diabetic foot as the leading causes and Staphylococcus aureus as the most frequently detected pathogen. Despite surgery being the primary treatment modality, clinical outcomes remained unsatisfactory, marked by high rates of infection recurrence and limb amputation.

Dorsal Carpal Artery Perforator Flaps: An Anatomical and Clinical Study.

Hand injuries pose challenges due to complexity and aesthetic-functional concerns. Dorsum of hand injuries are difficult to treat due to thin skin cover and increased propensity to exposure of underlying structures. Perforator-based flaps can provide better outcomes with minimal donor site morbidity. This study aims to bridge the gap in anatomical knowledge and explore the potential benefits of dorsal carpal artery perforator flap. A prospective study was done from July 2021 to June 2023, focused on study of dorsal carpal artery perforators on 12 fresh frozen cadaveric hands. Anatomical study involved injection of red latex into arteries at the wrist, followed by dissection and measurements. During the clinical phase, we used the inferences gained from the anatomical study to identify and mark perforator of dorsal carpal arteries. We performed V-Y advancement flap based on the DCPs in 5 patients who had dorsum of hand defects due to trauma. The study was carried out on 6 fresh frozen cadavers (12 hands). Anatomical findings revealed the anatomical location, caliber, and consistent number of dorsal carpal artery perforators supplying the dorsum of the hand arranged in 2 rows. Clinically, we applied this insight to create V-Y flaps in 5 patients with successful outcomes, thus, offering DCP-based flap as an alternative to distant flaps. DCP-based flaps offer an efficient solution for reconstructing proximal hand defects over the dorsum, with minimal complications, enhancing our understanding of hand reconstruction options. The study's comprehensive anatomical insights and clinical outcomes contribute to improving hand defect management and surgical techniques.

Физические и химические способы выявления следов кожного покрова человека, не имеющего папиллярного узора

The article deals with physical and chemical methods of detecting traces of human skin without papillary pattern. The principles of work of each of these methods are given in detail. As a factual basis for the article the materials of earlier scientific researches on this problematic were used. The methodological basis of the study was formed by the dialectical method of cognition, logical method, method of system analysis, method of modelling, general scientific methods: structural and functional. The work allows us to come to the conclusions about the need to increase the level of application of traditional and new methods of work with traces of skin cover that does not have a papillary pattern. The combination of these methods will give the highest result in solving the crime.

A rare case of large femoral hematoma after femoral artery cannulation

Femoral vessel cannulation is a commonly performed procedure in clinical practice. However, hematomas are a frequent complication of this procedure. Notably, hematoma formation is more likely to occur with femoral arterial cannulation compared to venous cannulation. If a hematoma does form, management can range from external compression to surgical intervention. In this report, we present a rare case of a large femoral hematoma without external skin cover, which is an unusual presentation of a common complication associated with femoral vessel cannulation. An elderly female presented with complaints of a raw area, pain, and blackening at the site of femoral artery cannulation for 10 days. She underwent coronary angioplasty and stenting 20 days prior. On examination, she exhibited a large hematoma over the right groin at the cannulation site without external skin covering. She underwent hematoma debridement with a gracilis muscle flap covering of the exposed femoral vessels. Early recognition and prompt evacuation of hematoma, assessment of femoral vessel breach and its management, as well as plastic reconstruction of exposed vessels, are vital for favorable outcomes.

Retrograde Progression of Inner Preputial Skin to Overcome Skin Shortage in Cases of Congenital Buried Penis.

The aim of this study is to report our experience in the treatment of congenital buried penis using a simplified technique of retrograde progression of inner preputial skin for reconstruction and overcome skin shortage. This is a retrospective multi-institutional study conducted in the Department of Pediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India, and the Department of Paediatric Surgery, Rajiv Gandhi Super Specialty Hospital/Raichur Institute of Medical Sciences, Raichur, Karnataka, India, over a period of 3 years (from March 2019 to February 2022). A total of 14 cases of primary congenital buried penis were operated in the specified period. Age of the patients ranged between 8 months and 9 years. Retrograde progression of the inner preputial skin to provide coverage to the dorsal aspect of penile shaft and ventral transposition of the dorsal penile skin to cover the ventral penile shaft was used as a standard procedure for skin coverage. All patients had good-to-excellent outcomes with uniformly improved visualisation of penile shaft post-operatively. There were no significant post-operative complications apart from mild oedema which subsided over a period of 3 weeks. Genital hygiene had significantly improved in all the patients as a result of uninterrupted urinary stream. Retrograde progression of the inner preputial skin may be used as an effective technique to provide skin coverage to the penile shaft for reconstruction of congenital buried penis. It provides good functional and cosmetic results with adequate parental and patient satisfaction with minimal complications.

Netakimab in the treatment of psoriatic erythroderma

Psoriasis is considered as system immunoassociated disease of the multifactorial nature with dominating value in development of genetic factors. Suffer псориазом from 2 to 7% of inhabitants of a planet. Psoriasis it is started, when environment factors activate plasmocytoid dentrid cages that leads to development numerous proinflammatory citokines, including the factor некроза to a tumour FNO-α, interferon (IFN) γ, interleukin (IL) 17, IL-22, IL-23 and IL-1β. Many of these citokines stimulate hyperproliferation keratinocyes which supports a chronic inflammation. The heaviest form psoriasis – psoriatic erythroderma, results adverse экзогенных from the factors, irritating treatment. Develops erythroderma at 1.5–3% of patients псориазом which amazes all surface of an integument. All skin cover gets brightly red colour, with a brown shade, is strained. Taking into account recent achievements in understanding of the inflammatory nature psoriatic research efforts have been concentrated to finding-out of a role specific proinflammatory cytokines which participate in pathogenesis diseases, for the purpose of working out of new purposeful methods of treatment. For treatment psoriatic erythroderma in medicine there is a wide spectrum of external and system means. Undoubtedly, psoriatic erythroderma has all indications to appointment of biological therapy, especially when does not give in traditional methods. Authors of article have presented a therapy material psoriatic erythroderma, a domestic preparation of genno-engineering biological therapy of (netakimab). The good clinical effect that opens prospect of application of this preparation is gained. The concrete clinical example of successful treatment is resulted.

Medially Based “Abdominal Rotation Advancement Flap”: A Promising Technique for Mastectomy Defect Reconstruction in “High-Risk Patients” Awaiting Adjuvant Radiotherapy

Abstract Background Extensive postmastectomy defects and soft-tissue defects often require some additional flap cover of reconstruction after excision. The reconstruction aim in this group should be a diligent and easy closure with a quality skin cover, early recovery, and brief stay in hospital so that the patients can receive early postoperative radiotherapy/chemotherapy. Medially based abdominal transposition flap is a type C fasciocutaneous flap based on medial perforating vessels. We present our experience in significant postmastectomy defects, especially in high-risk morbid patients. Materials and Methods This is a retrospective study conducted by the department of plastic surgery, from an analysis of the breast cancer database maintained by our hospital from 2019 to 2023. A total of 826 breast cancer patients underwent surgery, of which 547 were locally advanced breast cancer (LABC) patients and 138 (32.5%) LABC patients needed flap cover for mastectomy defect. Medially based abdominal transposition flap was used in 56 of 138 (40.5%) LABC patients for defect closure, and 42 of the 56 patients were stage IIIB patients. Upfront surgery was primarily done in 20 patients and 36 patients underwent surgery after neoadjuvant chemotherapy. This analysis aimed to assess the operative duration, postoperative morbidity, hospital stay, and time taken to start adjuvant treatment by analyzing the medical records of patients who underwent this procedure. Results Fifty-six patients with breast cancer underwent surgical intervention, whereby 8 patients presented with tip and edge necrosis, and 3 patients were infected. The mean duration of operation was 58.852 minutes, and the average length of hospital stay was 5.39 days. It took 24.57 days for the patients to stabilize sufficiently for adjuvant therapy. The average age of the patients in the study was 48.73 years. Conclusion Our clinical experience has demonstrated that the medial abdominal transposition fasciocutaneous (MATF) flap represents a straightforward, reliable, and cost-effective method for managing extensive postmastectomy soft-tissue defects in a subset of patients with LABC. This group typically consists of high-risk and comorbid patients. The procedure holds considerable promise for developing countries with limited infrastructure and expertise, owing to its ease of execution and short learning curve. By its simplicity and affordability, the MATF flap offers a viable and sustainable solution for treating LABC-associated soft-tissue defects.

A Comprehensive Review of Bilobed Flaps in Nasal Reconstruction: Technique, Outcomes, and Considerations.

Reconstruction of nasal defects, particularly in the lower third of the nose, presents significant challenges due to the area's complex 3-dimensional structure and thicker, more sebaceous skin. The bilobed flap, a double transposition flap, has been a popular method for addressing these nasal defects. This retrospective review examines a single surgeon's experience with bilobed flaps for nasal reconstruction over the last 15 years. Demographics, defect characteristics, intraoperative details, postoperative complications, and revisionary procedures were documented, and univariate and multivariate logistic regression analyses were used to assess complication rate associations. In all, 148 bilobed reconstructions were analyzed, with a mean patient age of 62.6 years and 46.0% male prevalence. The most common indication for the procedure was basal cell carcinoma following Mohs surgery, with the majority of the defects located on the lower third of the nose. The average defect size was 1.11cm². Complications occurred in 52.0% of cases, including pincushioning, scar thickening, asymmetry, alar stenosis, and wound dehiscence. Reoperations and additional treatments such as dermabrasion, steroid injections, and laser therapy were frequently necessary to address these issues. Logistic regression analysis demonstrated significantly more postoperative complications when the defect was located on the lower third of the nose when compared with the upper two-thirds. While the bilobed flap can provide adequate skin coverage with perfect color match, it is associated with notable complications that impact esthetic outcomes. Proper patient selection and surgical technique are crucial for optimizing results.

Scalp Reconstruction With Free Tissue Transfer Using Descending Branch of Lateral Circumflex Femoral Vessels as Interposition Graft.

Despite the rich blood supply to the scalp, postoperative skin necrosis at the surgical site sometimes occurs, and unresolved defects often present a significant challenge for the surgeon. When planning a free flap for scalp reconstruction, distant anastomoses may be necessary if local recipient vessels are unavailable due to previous surgery. This study presents the authors' treatment strategy, which includes extending the pedicle length with arteriovenous bundle interposition grafts. Two patients who experienced surgical wound necrosis after bypass surgery for moyamoya disease underwent reconstruction for skin and soft tissue coverage. To evaluate the altered anatomical structures after the previous surgery, three-dimensional computed tomography angiography was performed, and preoperative photos were taken to accurately measure the expected defect. The surgical strategy was designed to accommodate their unique conditions, utilizing an arteriovenous interposition graft, which included 2 stages of microvascular anastomoses, for pedicle lengthening. The procedure successfully bridged the gap between distant recipient vessels and the extensive defect, and the wounds healed without major complications such as venous congestion or total flap loss. Both patients were satisfied with the surgical outcomes. Arteriovenous bundle interposition grafts can be a useful option for patients with complex scalp defects who lack local recipient vessels. The use of an anterolateral thigh flap with artery-to-artery anastomosis, utilizing the lateral circumflex femoral artery from the opposite side in this study, offers many advantages compared with traditional pedicle lengthening tools utilizing vein-to-artery anastomosis.

Intelligent skin-removal photoacoustic computed tomography for human based on deep learning.

Photoacoustic computed tomography (PACT) has centimeter-level imaging ability and can be used to detect the human body. However, strong photoacoustic signals from skin cover deep tissue information, hindering the frontal display and analysis of photoacoustic images of deep regions of interest. Therefore, we propose a 2.5 D deep learning model based on feature pyramid structure and single-type skin annotation to extract the skin region, and design a mask generation algorithm to remove skin automatically. PACT imaging experiments on the human periphery blood vessel verified the correctness our proposed skin-removal method. Compared with previous studies, our method exhibits high robustness to the uneven illumination, irregular skin boundary, and reconstruction artifacts in the images, and the reconstruction errors of PACT images decreased by 20% ~ 90% with a 1.65 dB improvement in the signal-to-noise ratio at the same time. This study may provide a promising way for high-definition PACT imaging of deep tissues.

Esthetic reconstruction of traumatic defects by plastic surgery

The primary goal is preservation of the affected extremity, which can be associated with limitations in tasks relevant for daily life and adistorted body image caused by the original trauma. Therefore, asecondary goal is to reduce the trauma sequelae. For an esthetic outcome the choice of flap surgery is crucial. Factors such as tissue thickness, skin color, and hair covering need to be considered. The flap should blend seamlessly with the tissue surrounding the defect. The localization and closure of the defect are also important. The flaps undergo vascular, lymphatic and trophic postoperative changes caused by the so-called autonomization. Measures, such as compression therapy reshape the microcirculation and result in volume reduction of the transplant. It is important to preoperatively educate patients about this process. After completion of the conditioning surgical thinning procedures are available for persistent unattractive results, e.g., open surgical and liposuction techniques. Microsurgical defect coverage of traumatic skin and soft tissue defects is acompromise between limb preservation and functionality. In cases of missing local soft tissue, secure closure of the defect should be prioritized but initial esthetic considerations should also influence the choice of tissue transplant. Patients should be informed early about the development of the flap surgery and undergo postoperative compression therapy for conditioning. Secondary operative corrections are also possible.

Prevention of the development of diastasis of the wound edges during two-stage breast reconstruction

The main problem of breast reconstruction after a mastectomy is the complete destruction of all structural elements of the breast and the lack of integumentary tissues that do not allow carrying out one-stage breast reconstruction. To solve this problem, usually performing a two-stage reconstruction, which today is the most commonly used method of breast reconstruction. The peculiarity of this method is that after removal of the expander, during the second stage of reconstruction, some retraction of the skin and a decrease in the area of the prepared skin cover are observed. Thus, after installing a permanent implant and suturing the surgical wound, the skin sheath is tightened around the installed endoprosthesis, while the greater the retraction of the skin, the more pronounced the tension appears and, accordingly, the load on the sutured wound increases. As a result, the risks of developing diastasis of the wound edges with the exposure of the endoprosthesis increase, which leads to the need to remove the implant. Therefore, when carrying out the second stage of breast reconstruction, a very important moment of the operation is the suturing of the postoperative wound, the competent implementation of which allows the prevention of implant extrusion.

Therapeutic Recommendations for the Treatment of Acne Vulgaris in the US

Introduction: Acne vulgaris and related sequelae negatively impact quality of life and are associated with increased rates of anxiety and depression. However, treatment of acne can be difficult due to its long time course, chronicity, and low patient adherence. While national acne guidelines have been recently updated, there is a need for practical, easy-to-use guidance for healthcare practitioners who treat patients with acne. Methods: A roundtable discussion with a panel of eight clinicians and dermatologists was held to provide recommendations for the diagnosis and treatment of acne, including appropriate pharmaceutical treatments based on clinical presentation and patient population, patient discussion points, and advice for clinicians regarding acne treatment. Results: The consensus was that successful acne treatment is contingent upon meeting three core goals: 1) correct diagnosis; 2) proper treatment regimen; and 3) patient adherence and education. 1: Acne should be diagnosed using both quantitative and qualitative assessments, taking into consideration the patient’s lived experience with acne. Quantitative assessments include acne duration; lesion type and location; inflammation; acne-related sequelae; and family history of scarring. Qualitative assessments determine how bothersome acne and/or sequelae are to patients and how much they impact quality of life. Differential diagnoses should be performed to rule out acneiform lesions, genetic disorders, infections, and certain types of medications. 2: For most patients, a combination topical treatment containing benzoyl peroxide and a retinoid and/or an antibiotic is recommended to address the multiple acne pathological processes, though sequelae and patient characteristics should be considered (eg, post-inflammatory hyperpigmentation in patients with skin of color). Fixed-dose combinations are preferred to ensure proper skin coverage, simplify treatment complexity, and improve adherence. 3: For optimal outcomes, patients should be educated about their treatments and consequences of non-adherence; realistic treatment goals should be established to manage patient expectations. A patient handout on skin care best practices can be used to detail their overall skin care regimen, treatments, and subsequent visits. Conclusions: This practical guidance aims to assist clinicians in the successful diagnosis and treatment of acne as well as patient management/education.

Reverse Posterior Interosseous Artery Flap for Hand Defects

Abstract Background: Soft tissue defects in hand needs an early reconstructive procedure that is single stage and well vascularized for best functional outcomes. Usually flap coverage is required for joints, exposed bones and long tendons. When local flaps are inadequate for the required defects, regional flaps are used. Objective: The study was designed to evaluate the outcome of reverse posterior interosseous artery flap for hand soft tissue defects. Material and Methods: This is a retrospective chart review of patients from 2013 to 2019 at National Orthopedic Hospital at Bahawalpur and was compiled at DHQTH, Bannu in 2023. During this time, 45 cases of posterior interosseous artery flap meeting the inclusion criteria were included in this study. Results: In 34 cases the defect was due to crush, in 6 blast injury and in 5 thermal injury. Male to female ratio was 9:1. The defect was mostly on dorsum of hand and first web space. In all the cases, split thickness skin graft was used to cover the donor site. Three (7 %) patients had superficial flap necrosis at the distal most part, for which debridement and skin grafting was done. Conclusion: Reverse posterior interosseous artery flap is an excellent source of skin coverage of dorsal hand and 1st web space.

Application of Cross-Groin Flap for Coverage of Large Skin and Soft Tissue Defects of the Foot and Ankle in Children

In children with large soft tissue defects of the foot and ankle, it is difficult to cover the wound completely using a local skin flap, and skin grafting of the donor area for repair causes secondary damage. Free skin flaps require good vascular anastomoses and are prone to vascular crises. The authors evaluated the effectiveness and safety of cross-inguinal flaps for the repair of large soft tissue defects of the foot and ankle in children. The records of 15 children who underwent cross-groin flap transplantation between June 2017 and June 2021 were analyzed retrospectively. All the flaps survived without infection, necrosis, or other complications. The flap shape was good, the donor area was sutured directly, and the damage was minimal. This surgical method is simple, effective, and safe and can replace microsurgery, making it suitable for use in primary-level hospitals that are not equipped for microscopic surgery.

Characterization of wound infections among patients injured during the Ruso-Ukrainian war in a Role 4 hospital

IntroductionThe management of infections in war wounds is a problem aggravated by the presence of multiresistant bacteria and requires a combined approach with surgery. Literature has identified the risks and patterns of antibiotic resistance in previous armed conflicts, but the Russian-Ukrainian conflict has required the study of specific bacterial resistance patterns. MethodsWe included war-injured patients from the Russian-Ukrainian conflict transferred for treatment to the General Defense Hospital of Zaragoza from May 2022 to October 2023. Epidemiological data, factors related to the injury, presence of infection and microbiological results were collected; These data were subsequently analyzed statistically. ResultsFifty-three patients were included in the study, with a mean age of 35.6 years; 83% were injured by an explosive mechanism and all received antibiotic therapy prior to transfer. Seventeen patients had skin, soft tissue or joint infection. Correlation was demonstrated with the presence of bone lesion (p 0.03), skin coverage defect (p 0.000) and presence of foreign bodies (p 0.006). Nine patients had monomicrobial cultures, and the most frequently isolated microorganisms were Gram negative bacilli (GNB) and Staphylococcus aureus. Virtually all GNB presented some resistance mechanism. ConclusionOur work shows the correlation of war wound infection with the presence of foreign bodies and affected tissues. Likewise, the presence of polymicrobial wounds is emphasized, with a predominance of GNB and multidrug-resistant S. aureus.

Single-stage Auricular Reconstruction in Hemifacial Microsomia With Low Hairline by Using Temporoparietal Fascia Flap.

Auricular reconstruction is one of the most complicated operations in plastic surgery and is more difficult for patients with a low hairline due to limited skin availability. In traditional operations, the skin of the mastoid area was used to cover the front of the ear scaffold, and the retroauricular fascia, combined with a free skin graft, was used to cover the back of the ear framework. This may cause problems such as inadequate skin coverage and affecting the shape of the reconstructed ear when the hairline is low. Hemifacial microsomia patients with low hairline have little skin flap to perform the ear reconstruction, and we refined a single-stage ear reconstruction surgery to solve the problem. The temporoparietal fascia is used to cover the entire costal cartilage scaffold, and its surface is covered with a free split-thickness skin taken from the chest wall, thigh, and other parts. From December 2019 to December 2020, 12 patients with hemifacial microsomia underwent single-stage reconstruction with temporoparietal fascia. The duration of patient follow-up was 6 to 24 months. The application of this technique can solve the problem of insufficient available skin flap, complete the ear reconstruction through 1 operation, reduce the treatment cycle, achieve a good shape of the reconstructed ear, and the postoperative effect is satisfactory. According to the characteristics of the HFM patients with low hairline, we recommend this new, improved single-stage auricular reconstruction using the temporoparietal fascia for these patients. This method is a suitable choice for HFM patients with low hairline.Level of Evidence: Level-IV, Cases Study.