PURPOSE: Skin graft is the gold standard surgical treatment in burn wound management. Until now, wet to dry dressing is regarded as the traditionally standard dressing for skin graft. But it needs to be changed daily, burdens the patients and medical caring team and is time consuming. The authors apply VAC to skin graft to secure the skin and compared the outcomes with previous standard dressing technique. METHODS: 38 burn patients who underwent skin graft were included in this study. Patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a VAC appliance after split-thickness skin graft, while those in the control group received wet to dry dressing after the procedure. Time to complete epithelization, rates of skin graft taken areas, satisfaction of patients and medical caring team was evaluated. RESULTS: A shorter time to complete epithelization (12.5 days) was observed in the experimental group than in the control group (14.6 days), and a higher rates of skin graft taken areas (89%) was observed in the experimental group when compared with the control group (84.5%), A higher satisfaction of both the patients and doctors was observed in the experimental group, compared to the control group, with all statistical significance (P<0.05). CONCLUSION: VAC shortens epithelization period and elevate skin graft taken rates. It also makes the patients and doctors the comfortable in burn patients. The VAC is an excellent alternative for securing skin graft.
Bandages ; Burns ; Humans ; Negative-Pressure Wound Therapy ; Skin ; Transplants

PURPOSE: Skin graft is the gold standard surgical treatment in burn wound management. But it has functional and aesthetic limitations, such as burn scar contracture, low quality of the grafted skin, unnatural looking skin, loss of skin elasticity, especially in extensive deep burn wound which has tendon or bone exposed. The authors used Matriderm(R), a dermal analogue, with split-thickness skin graft simultaneously in burn wound and evaluate the effectiveness of Matriderm(R) for treatment of burn wounds, in comparison with the skin graft only. METHODS: 40 burn patients with skin graft were included in this study. Patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a meshed Matriderm(R) appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. Time to complete epithelization, rates of skin graft taken areas, Vancouver scar scale assessment, skin elasticity was evaluated. RESULTS: A better scores of Vancouver scar scale assessment (3 points) were observed in the experimental group with the control group (6 points) with statistical significance (P<0.05). A higher elasticity ratio of the affected side to the non-affected side was observed in the experimental group, compared with the control group (P<0.05), and a similar time to complete epithelization and rates of skin graft taken areas were observed in the experimental group when compared with the control group. CONCLUSION: Meshed Matriderm(R) enables effective healing and improves functional and aesthetic results in split thickness skin graft treatment of burn wounds.
Burns ; Cicatrix ; Contracture ; Elasticity ; Humans ; Skin ; Skin Transplantation ; Tendons ; Transplants

PURPOSE: Facial abrasions have been treated by moist occlusive dressing for many years. But previous dressing methods have several disadvantages such as difficulty of fixation due to varied contours, too frequent dressing changes with pain, discomfort due to volume of the dressing materials. The authors applied dried bovine amniotic membrane (Amnisite BA(R)) to facial abrasions as a new therapeutic option and compared its efficacy with previous foam dressing treatments. METHODS: From June 2010 to May 2011, thirty two patients suffering from facial abrasions were included in this study, with a mean age of 32.4. Patients were divided into two groups by patient preference. One group was treated with dried bovine amniotic membrane while the other group was treated with ointment and foam dressings. Subjects were followed by regular outpatient clinic visits until complete epithelization. Healing time, treatment costs, scar formation, skin elasticity and moisture content were evaluated to compare the efficacy of dried bovine amniotic membrane in comparison to foam dressing groups. RESULTS: All of thirty two patients were well healed after appliance of dried bovine amniotic membrane or foam dressing without any complication. The healing time for patients treated with dried bovine amniotic membrane was significantly shorter (P<0.05) and no significant difference between the two groups regarding treatment costs, scar formation, skin elasticity or moisture content was shown. CONCLUSION: Facial abrasion can be effectively treated with dried bovine amniotic membrane with a shortening of epithelization period and similar effectiveness as previous foam dressings. In addition, dried bovine amniotic membranes have several benefits. easy appliance to any parts of face, reducing the frequency of dressing changes, early adaptation to social life and so on, These presented benefits make this material a new standard for treatment of facial abrasion.
Ambulatory Care Facilities ; Amnion ; Bandages ; Biological Dressings ; Cicatrix ; Elasticity ; Health Care Costs ; Humans ; Occlusive Dressings ; Patient Preference ; Skin ; Stress, Psychological ; Treatment Outcome

Life-threatening hemorrhage following maxillofacial injury (MFI) is rare but can be fatal. Conventional measures for hemostasis including nasal packing, balloon tamponade, and surgical ligation of bleeding points may not be effective or efficient in patients at risk of hypovolemic shock. Advantages of transarterial embolization (TAE) include rapid identification of the bleeding focus and its access, direct obstruction of the culprit vessels, ability to control multiple bleeding sites, and no requirement of general anesthesia. The internal maxillary artery is the most frequently targeted vessel for embolization. Several studies have demonstrated that TAE was technically successful at rates between 79.4% and 100% and was associated with good clinical outcomes. However, major complications such as tongue necrosis or facial nerve palsy have rarely been reported (0%–7%), probably because of rich collaterals in the maxillofacial region, and failure to diagnose complications in patients who are severely disabled or died. Traditionally, Gelfoam and coils have been widely used as embolic materials. Polyvinyl alcohol particles and n-butyl-cyanoacrylate are also favored, and newer embolic materials, such as Onyx or precipitating hydrophobic injectable liquid, are available for use. Operators should be familiar with the distinctive characteristics of each embolic material. Early treatment with TAE for intractable hemorrhage may improve outcomes in patients with MFI, and further studies are necessary to develop a treatment algorithm to define when to initiate TAE in cases of severe oronasal hemorrhage following MFI.

Although some vertebral artery dissection (VADs) cases heal naturally, others progress to stroke, necessitating intervention. Endovascular treatment (EVT) has gained prominence as a viable approach for addressing VADs owing to its perceived low risk of procedure-related complications and high effectiveness. In this review, we share our practical experience of this technique by incorporating the indications and methods for VAD treatment via EVT. Our EVT strategies covered the management of both ruptured and selected cases of unruptured VADs. Unruptured cases that require treatment include those complicated by lesions with recurring or progressive ischemia, large dissecting aneurysms with mass effects, early changes in the VAD structure during follow-up, and involvement of the basilar or bilateral vertebral arteries (VAs). In cases of ruptured VADs, we aimed to occlude the site of rupture through either VA occlusion or stent-assisted coiling. For unruptured VADs, the goal is to restore the original blood flow dynamics using a range of stenting techniques. The choice of EVT technique should be made on a case-by-case basis, considering factors such as the patient's presenting symptoms, hemodynamic status, adequacy of collateral blood supply, and anatomical characteristics of the important arteries and perforators.

Flow-diverting stents (FDSs) have proven advantageous for the treatment of large, fusiform, and dissecting aneurysms that are otherwise difficult to treat. Retreatment strategies for recurrent large or giant aneurysms after FDSs are limited to overlapping implantation of an additional FDS or definitive occlusion of the parent vessel. We report a recurrent giant aneurysm that was initially treated with an FDS with coils and was successfully treated with an additional FDS. Visual symptoms due to the mass effect of the recurrent aneurysm were completely resolved, and follow-up digital subtraction angiography revealed complete obliteration of the aneurysm. Additional FDS implantation for the retreatment of incompletely occluded aneurysms after the initial FDS treatment may be feasible and safe. Further studies are required to validate these results.

Although some vertebral artery dissection (VADs) cases heal naturally, others progress to stroke, necessitating intervention. Endovascular treatment (EVT) has gained prominence as a viable approach for addressing VADs owing to its perceived low risk of procedure-related complications and high effectiveness. In this review, we share our practical experience of this technique by incorporating the indications and methods for VAD treatment via EVT. Our EVT strategies covered the management of both ruptured and selected cases of unruptured VADs. Unruptured cases that require treatment include those complicated by lesions with recurring or progressive ischemia, large dissecting aneurysms with mass effects, early changes in the VAD structure during follow-up, and involvement of the basilar or bilateral vertebral arteries (VAs). In cases of ruptured VADs, we aimed to occlude the site of rupture through either VA occlusion or stent-assisted coiling. For unruptured VADs, the goal is to restore the original blood flow dynamics using a range of stenting techniques. The choice of EVT technique should be made on a case-by-case basis, considering factors such as the patient's presenting symptoms, hemodynamic status, adequacy of collateral blood supply, and anatomical characteristics of the important arteries and perforators.

Although some vertebral artery dissection (VADs) cases heal naturally, others progress to stroke, necessitating intervention. Endovascular treatment (EVT) has gained prominence as a viable approach for addressing VADs owing to its perceived low risk of procedure-related complications and high effectiveness. In this review, we share our practical experience of this technique by incorporating the indications and methods for VAD treatment via EVT. Our EVT strategies covered the management of both ruptured and selected cases of unruptured VADs. Unruptured cases that require treatment include those complicated by lesions with recurring or progressive ischemia, large dissecting aneurysms with mass effects, early changes in the VAD structure during follow-up, and involvement of the basilar or bilateral vertebral arteries (VAs). In cases of ruptured VADs, we aimed to occlude the site of rupture through either VA occlusion or stent-assisted coiling. For unruptured VADs, the goal is to restore the original blood flow dynamics using a range of stenting techniques. The choice of EVT technique should be made on a case-by-case basis, considering factors such as the patient's presenting symptoms, hemodynamic status, adequacy of collateral blood supply, and anatomical characteristics of the important arteries and perforators.

Although some vertebral artery dissection (VADs) cases heal naturally, others progress to stroke, necessitating intervention. Endovascular treatment (EVT) has gained prominence as a viable approach for addressing VADs owing to its perceived low risk of procedure-related complications and high effectiveness. In this review, we share our practical experience of this technique by incorporating the indications and methods for VAD treatment via EVT. Our EVT strategies covered the management of both ruptured and selected cases of unruptured VADs. Unruptured cases that require treatment include those complicated by lesions with recurring or progressive ischemia, large dissecting aneurysms with mass effects, early changes in the VAD structure during follow-up, and involvement of the basilar or bilateral vertebral arteries (VAs). In cases of ruptured VADs, we aimed to occlude the site of rupture through either VA occlusion or stent-assisted coiling. For unruptured VADs, the goal is to restore the original blood flow dynamics using a range of stenting techniques. The choice of EVT technique should be made on a case-by-case basis, considering factors such as the patient's presenting symptoms, hemodynamic status, adequacy of collateral blood supply, and anatomical characteristics of the important arteries and perforators.

Objective: To report our experience with intraprocedural rupture (IPR) of intracranial aneurysms during endovascular treatment and evaluate alterations in vital signs as independent prognostic factors to predict the outcomes of IPR. Methods: Between January 2008 and August 2021, 34 patients (8 ruptured and 26 unruptured) were confirmed to have IPR based on our dataset with 3178 endovascular coiling procedures. The patients who underwent additional surgeries related to IPR were classified as the OP group (n=9), while those who did not receive additional surgeries were classified as the non-OP group (n=25). Vital signs were recorded during the procedure by anesthesiologists and analyzed. Results: Of the 34 patients included in this study, eight initially presented with subarachnoid hemorrhage due to a ruptured aneurysm. The clinical outcomes at discharge were significantly different between the two groups (p=0.046). In the OP group, five patients showed favorable outcomes at discharge, while four showed unfavorable outcomes. In the non-OP group, 23 patients showed favorable outcomes at discharge while two patients showed unfavorable outcomes. Maximal (MAX) systolic blood pressure (SBP) (odds ratio [OR] 1.520, 95% confidence interval [CI] 1.084-2.110; p=0.037) and higher differential value MAX-median blood pressure (MBP) (OR 1.322, 95% CI 1.029-1.607; p=0.044) remained independent risk factors for poor prognosis after IPR on multivariate logistic regression analysis. Conclusions The MAX SBP and the difference between the maximal and baseline values of MBP are key factors in predicting the prognosis of patients after IPR, as well as providing useful information for predicting the outcome. Further research is required to confirm the relationship between naive pressure and prognosis.