Vacuum-assisted surgical treatment of large and complex Morel-Lavallée lesions in lower extremities

Aim: Morel-Lavallée lesion (MLL) is the separation of the skin from the deep fascia caused by shear stress after trauma and the formation of a fluid-filled cavity between the fascia layers. After the inflammation develops, a fibrous capsule develops around the serosanguineous fluid, preventing its absorption. Cavity infection, skin necrosis, and muscle, tendon, bone, and implant exposure were observed in untreated MLLs. This study presents vacuum-assisted surgical treatment for large and complex MLLs and the effects of treatment on the functionality of lower extremities. Methods: 23 patients who were diagnosed with post-traumatic MLL in the lower extremities and underwent vacuum-assisted surgical treatment were examined. Demographic characteristics, comorbidities, smoking status, body mass index (BMI), type of trauma, anatomical location, skin characteristics of the cavity, additional injuries, duration of treatment delay, medical and surgical procedures, return to work, and social life were investigated. All cavities were evaluated using ultrasonography, and cavity volumes were measured. All patients underwent percutaneous incision drainage and radical debridement of necrotic tissues and cavities. Lower extremity function was evaluated using the lower extremity functional scale (LEFS). Results: A total of 82.6% of patients had chronic MLLs. All patients had high-volume MLLs and functional impairment due to MMLs. The vacuum-assisted wound closure provided compression, drainage, and obliteration of the cavity alone in the treatment of MLL. Additionally, the positive effects of negative-pressure wound therapy (NPWT) on wound healing prevented complications such as recurrent MLLs, seroma, dehiscence, and graft loss. This method has also positively affected lower-extremity functionality during subsequent periods (p<0.001). Conclusions: In treating large-volume acute and chronic MLLs, percutaneous drainage, radical debridement, cavity closure with quilting sutures, and pressure support with NPWT are reliable methods that ensure problem-free healing of MLLs. This method has also positively affected lower-extremity functionality during subsequent periods

A novel protective barrier for extremity surgeries during the COVID-19 pandemic

Aim: To present a novel protective barrier for COVID-19 transmission and investigate its effectiveness in protection against spreading aerosols and droplets during extremity surgery. Methods: We enrolled 436 patients who underwent urgent and essential surgery on the upper and lower extremity using a novel protective barrier under wide-awake local anesthesia. All patients were investigated in detail for COVID-19 infection with anamnesis, symptom questionnaires, and the required tests before surgery. Patient satisfaction regarding comfort during the surgery behind the protective barrier was analyzed using a five-point Likert scale. The protective effect of the transparent barrier was quantitatively and experimentally analyzed using smoke and saline transmission tests in different clinic scenarios with and without the protective barrier. Results: A total of 345 patients with no signs of COVID-19 infection underwent surgery. Ninety-one suspected patients who had positive COVID-19 symptoms or close contact with a COVID-19 infected patient underwent COVID-19 tests before surgery. All patients underwent urgent surgical treatment on the upper and lower extremities, and easily tolerated and were satisfied with the protective barrier. There was a statistically significant reduction in smoke and saline particles when using the protective barrier (p<0.001). The addition of negative suction and oxygen to the protective barrier potentiated the protective effect (p<0. 001). Conclusions: Extremity surgeries, especially hand surgeries, are one of the most common surgical procedures during the COVID-19 pandemic. Our protective barrier significantly reduced aerosol particles in our experimental model and was successfully used in clinical practice during extremity surgery. &nbsp

Surgical Management of Scarring Alopecia

Cicatricial alopecia presents a heterogeneous group of disorders, which are characterized by the destruction of hair follicles, and resulting in scarring and irreversible hair loss. Cicatricial alopecia is classified into two categories depending on the target pathological process. In primary cicatricial alopecia (PCA), the hair follicle is the sole target of a progressive inflammatory process in various skin or systemic diseases. In secondary cicatricial alopecia (SCA), non-specific and generalized disruption of the skin and skin appendages results in fibrotic scarring of the skin and permanent loss of hair follicles due to underlying disease or an external agent. The aim of the treatment of PCA is to reduce inflammation and prevent progression to irreversible alopecia by using immunosuppressive and antimicrobial agents at the earliest phase of the disease. When permanent hair loss occurs in PCA and SCA, scar tissue should be removed or camouflaged by surgical treatment. However, it is difficult to remove the existing scar and treat alopecia. Follicular unit extraction technique hair transplantation is a minimally invasive and alternative treatment with a high success and satisfaction rate in the treatment of cicatricial alopecia

Post-Burn Skin Deformities of the Face and Neck Region in Pediatric Patients: Single-Stage Treatment Using Collagen Elastin Matrix

Objective: Treating severe post-burn deformities of the face and neck region in pediatric populations is challenging because of technical difficulties (e.g., limited full thickness skin graft donor site, limited flap options, unavailability for expander placement) and increased donor site morbidity (e.g., related to flap and graft donor sites). In this study, we present the single-stage treatment of severe post-burn skin deformities of the face and neck region in pediatric patients using collagen-elastin matrix (Matriderm®) combined with partial thickness skin grafts. Material and Methods: The total number of cases was eight (four females, four males), and the ages were between two and 11 years. All cases were operated on for only one region. Following the release of contractures and/or excision of wide excessive/ unfavorable dermal scars, defects were reconstructed using collagen- elastin matrix (Matriderm®) combined with partial-thickness skin grafts. The final functional and aesthetic results were evaluated using photography and examination. Results: The deformities were in the form of contractures and/ or excessive dermal scarring. The involved regions were the face (n=3) and neck (n=5). The grafts yielded favorable plication and texture, and no recurrence of excessive dermal scarring was observed. All contractures healed unproblematically. Two patients were re-operated on for regrafting caused by minor graft loss (5% and 12% of the total area, respectively). Conclusion: In this study, we observed that collagen elastin matrix combined with partial-thickness skin grafts provides a favorable option for the treatment of pediatric late post-burn complications in the face and neck region with limited surgical options