BACKGROUND Wide excision (WE) is generally considered to be the most common treatment for recurre... more BACKGROUND Wide excision (WE) is generally considered to be the most common treatment for recurrent hidradenitis suppurativa. When performed, excision is followed by decisions regarding best options for management of the surgical defect. Different reconstructive strategies (RSs) have been used, with varying rates of recurrence. OBJECTIVE To provide an up-to-date systematic review of the complete literature for different RS after WE and their recurrence rates. METHODS A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1,813 retrieved articles, 79 were included in the analysis. Most were retrospective analyses, with only one randomized controlled trial (RCT) and 7 prospective analyses. The RS described were divided into primary closure (PC), secondary intention healing (SIH), skin graft (SG), and fasciocutaneous flaps (FCF). The average estimated recurrence for PC was 22.0% (95% confidence interval [CI], 8.0%-40.0%), for SIH 11.0% (95% CI, 5.0%-20.0%), for SG 2.0% (95% CI, 0.0%-5.0%), and for FCF 2.0% (95% CI, 1.0%-5.0%) (p < .001). Hidradenitis suppurativa below the umbilicus was significantly associated with overall recurrence (p = .006). Quality of evidence was poor, and the reporting of results was mostly heterogeneous. CONCLUSION After WE, PC has the highest recurrence rates, whereas SG and FCF have the lowest rates. There is a need for more RCTs and guidelines, to be able to report uniformly on treatment outcomes.
Background A congenital melanocytic naevus (CMN) is a rare skin condition that can be associated ... more Background A congenital melanocytic naevus (CMN) is a rare skin condition that can be associated with abnormalities of the central nervous system (CNS). These anomalies can sometimes cause severe complications, and rarely death. Adequate information about aetiology and management is therefore crucial. To identify how to monitor patients with CMN, we aimed to estimate the prevalence of neurological involvement in patients with CMN and to summarize what specific neurological signs and symptoms and MRI abnormalities are reported in the medical literature. In addition, we summarized and evaluated the recommendations regarding MRI-screening reported in the medical literature. Methods This review was registered in PROSPERO and reported according to the MOOSE checklist. A search was conducted in EMBASE (Ovid), PubMed, and the Cochrane Library. We included studies with 10 or more patients with CMN, reporting on neurological signs and symptoms or CNS MRI. Study selection, data extraction and...
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2018
Basal cell carcinomas (BCCs) excised leaving positive tumour margins, are at a higher risk of rec... more Basal cell carcinomas (BCCs) excised leaving positive tumour margins, are at a higher risk of recurrence. Accordingly, complete tumour removal with preservation of healthy tissue, aiming for low recurrence rates, is the main goal in treating BCCs. The present study aimed to identify the reliability of the Whole Specimen Intraoperative Frozen Section Analysis (WIFSA) technique by comparing intraoperative WIFSA and postoperative Formalin-Fixed Paraffin-Embedded section analysis (FFPE) results in 1082 basal cell carcinomas and by assessing the recurrence rates during a follow-up period up to 10 years. A single-centre retrospective cohort of all patients with BCC of the face receiving surgical excision with the WIFSA method between January 2007 and December 2013 was evaluated. We compared the intraoperative frozen section results with postoperative FFPE in order to assess accuracy of the WIFSA. Recurrence rates were assessed among all BCCs with a tumour-free margin at final excision tha...
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014
Gynaecomastia, breast enlargement in men, is common in all age groups. It is operated on by plast... more Gynaecomastia, breast enlargement in men, is common in all age groups. It is operated on by plastic surgeons, general surgeons and paediatric surgeons. It is therefore possible that there is a difference in the populations treated, the indications for surgery and the management used by the different practitioners. We performed a survey in order to assess the approach to treatment of gynaecomastia by the different disciplines. An electronic survey questionnaire was sent to members of the Dutch societies of surgery, paediatric surgery and plastic surgery. We received 105 responses from plastic surgeons, 95 from general surgeons and 15 from paediatric surgeons, representing respective response rates of 38.7%, 23.8% and 42.8%. Plastic surgeons operated on gynaecomastia most frequently. The diagnostic criteria and workup were similar for all disciplines, although general surgeons used more imaging. There was a difference in the side operated on. General surgeons and paediatric surgeons operated mainly on unilateral cases (74% and 52%), while plastic surgeons operated mainly on bilateral cases (85%). Pharmaceutical treatment with Tamoxifen was reported only by general surgeons (13%). All disciplines used mainly the periareolar incision. Plastic surgeons reported more often the use of other surgical approaches as well as adjunctive liposuction and they did not always submit tissue for pathological examination. Perioperative antibiotics, drains and pressure garments were not always used. All disciplines agreed that the most common complication was bleeding, followed by seroma, infection, insufficient results, inverted nipple and nipple necrosis. This survey highlights some differences in the practice of gynaecomastia surgery. The findings appear to point to the fact that the indications are different, being more aesthetic in the case of plastic surgeons. The results of this survey are important in establishing the standard of care and may be helpful for setting guidelines.
This study aimed to analyze the histopathology results of surgically excised breast specimens wit... more This study aimed to analyze the histopathology results of surgically excised breast specimens with the diagnosis of gynecomastia (GM). Gynecomastia is a term used to describe benign hypertrophy of the breast in men; it is a common, mostly transient, phenomenon in adolescents, but may also be seen in older men. Breast enlargement can lead to psychological problems; if it persists it can be surgically corrected. The obtained breast tissue specimens are routinely submitted for pathological examination. We performed this study to assess the prevalence of pathological findings after surgical management of GM. Pathology reports were obtained from the nationwide network and registry of histopathology and cytopathology in the Netherlands (PALGA). The reports of 5113 breasts were analyzed for the prevalence of pathologies in different age groups. The average age of the patients was 35.3 ± 18.3 years (range, 1-88 years). The most common finding was GM followed by pseudo-GM. The overall prevalence of invasive carcinomas was 0.11% and of in situ carcinomas was 0.18%. The youngest patient with invasive cancer was 65 years old and the youngest patient with carcinoma in situ was 24 years old. The overall prevalence of atypical ductal hyperplasia was 0.4%; in patients younger than 20 years, it was 0.23%. The youngest patient with atypical ductal hyperplasia was 16 years old. Pathological findings were found more often in unilateral procedures. The prevalence of malignancies in GM resection specimens is low; however, it increases with patient age. Unilateral cases have a statistically nonsignificant higher prevalence of pathologies. Prognostic/risk II.
The aim of this study is to prospectively evaluate the changes in the sensation of the skin of th... more The aim of this study is to prospectively evaluate the changes in the sensation of the skin of the abdominal wall and thighs following abdominoplasty. Patients underwent standard full abdominoplasty with reinsertion of the umbilicus. Sensory testing was performed preoperatively and at least 1 year postoperatively. Predetermined targets on the abdominal wall, umbilicus, and on the anterior thighs were tested for light touch, sensory thresholds, using Semmes-Weinstein monofilaments (SW), vibration, and temperature. Fourteen patients completed the study. On average targets demonstrated a decrease in sensory thresholds, average from SW 3.61 to 4.14 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), the targets that had the most significant decrease were the umbilicus SW 3.67 to 6.97 (P = 0.001) and the infra umbilical 3.75 to 6.57 P = 0.001. Similar findings were seen for the other modalities tested, there was a significant disappearance in their perception at the umbilical target and at the lower abdominal regions. We did not identify any significant decrease in the sensation of the thighs. Abdominoplasty causes lasting sensory changes concentrating on the umbilical and infraumbilical regions. This study enables surgeons to inform their patients about the expected sensory outcome following abdominoplasty.
Extirpation of noninvasive skin tumors of the anterior ear may create large defects. Various flap... more Extirpation of noninvasive skin tumors of the anterior ear may create large defects. Various flaps, described to cover these defects, demand special knowledge without which a loss of the fine detail of the ear may result. Healthy, exposed cartilage is deliberately excised leaving a basic framework for support, thus preserving contours and a well-vascularized recipient bed for full-thickness skin grafting. The grafts heal by revascularization and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;bridging,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; a phenomenon whereby grafts on avascular beds (such as denuded cartilage) are revascularized. By marrying clinical experience gained during microtia reconstruction with insights regarding the bridging phenomenon derived from the laboratory, our 17 reconstructed ears healed without serious complications and kept their normal contours and shape, and there was no recurrence of the carcinoma. Satisfactory patient-centered outcome can be obtained in reconstructing defects of one-third to two-thirds of the total anterior surface of the ear relying on the bridging phenomenon.
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To identify, critically appraise, an... more STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To identify, critically appraise, and synthesize research findings on non-sensate versus sensate flaps among individuals with spinal cord disease and pelvic pressure ulcers, with pressure ulcer recurrence as primary outcome. METHODS PubMed, EMBASE, and Cochrane CENTRAL were screened for relevant studies. Data on surgical characteristics, ulcer recurrence, and sensory outcomes were retrieved and tabulated. Risk of bias was assessed with MINORS. The level of evidence was evaluated with GRADE. Meta-analysis was performed when possible. RESULTS Meta-analysis of 1794 non-sensate locoregional reconstructions indicated a recurrence rate of 34% within several years (95% CI, 27-42). Twenty-one articles provided data on 75 sensate reconstructions, performed in 74 individuals. Meta-analysis of the sensate reconstructions indicated a recurrence rate of 1% (95% CI, 0-8). Sensate reconstructions were not associated with an increase of wound complications (19%; 95% CI, 7-40) compared with non-sensate ones (34%; 95% CI, 27-42). A very low level of evidence was determined with use of GRADE. CONCLUSION Although of a very low-level, the present evidence suggests that restoration of sensory innervation may be an effective intervention for the prevention of pressure ulcer recurrence among individuals with spinal cord disease. A prospective RCT is needed to confirm or refute the results of this systematic review.
The Journal of Trauma: Injury, Infection, and Critical Care, 2006
Skin stretching harnesses the same viscoelastic properties of the skin as expansion, with the dif... more Skin stretching harnesses the same viscoelastic properties of the skin as expansion, with the difference that the forces are applied externally and not internally. An improvised system for wound closure is presented. The system is assembled using silicone vascular loops used as sutures and the flow controllers of intravenous sets as locking devices. The wounds are gradually closed by increasing the tension applied by the devices. The system has been applied to nine traumatic wounds in six patients. The average size of the wounds was 70 cm; the average number of devices used was 4.3 (range, 1-9; median, 3); the average time to achieve closure was 1.55 days (range, 0-2 days; median, 2 days). This system permits the closure of wounds not suitable for closure by primary intention and avoids the use of skin grafts or flaps.
Severe hand injuries due to firecrackers are unfortunately common in the Netherlands. These injur... more Severe hand injuries due to firecrackers are unfortunately common in the Netherlands. These injuries are expected to have long-term functional and psychological sequalae. We performed a study to assess the long-term impact of such injuries on the victims and their parents. Eight sequential adolescent patients that underwent surgery for firecracker-induced severe hand injuries between September 2012 and March 2015 were included. The patient files were assessed for data on hand function. The impact of the injuries was measured by questionnaires and measure instruments: VAS for pain, CHEQ2.0 and COPM-DLV for activities and participation, PedsQL-4.0 for participation and quality of life, RSES for self-esteem, and DT-P for impact on parents. Seven of the eight patients underwent (partial) hand amputation. Three adolescents still reported pain at a mean of 3.2 years post-trauma. All adolescents required more time than peers performing activities. Seven showed a total of 34 activity and pa...
Ophthalmic Surgery, Lasers and Imaging Retina, 2000
... We present a child with neurofibromatosis type I (NF-I) who underwent excision of a large upp... more ... We present a child with neurofibromatosis type I (NF-I) who underwent excision of a large upper lid neurofibroma using a CO2-laser. Plexiform neurofibromas are notorious for their bleeding tendency and the inability to achieve complete surgical excision. ...
Background Pelvic sepsis after surgery for rectal cancer is a severe complication, mostly origina... more Background Pelvic sepsis after surgery for rectal cancer is a severe complication, mostly originating from anastomotic leakage. Complex salvage surgery, during which an omentoplasty is often used for filling of the pelvic cavity, is seldomly required. If this fails, a symptomatic recurrent presacral abscess with a risk of progressive inflammation can develop. Such patients have often undergone multiple surgeries and have disturbed abdominal wall integrity, adhesion formation, and presence of one or two stoma(s). Subsequent salvage surgery via the conventional anterior abdominal approach is therefore less suitable. We describe three cases with a chronic presacral sinus and failure of first salvage surgery. All three patients underwent a prone only approach with tailored sacrectomy. This novel approach provided direct access to the pelvic abscess with optimal exposure for complete and safe debridement. A unilateral or bilateral gluteal V–Y fasciocutaneous advancement flap was created ...
BACKGROUND An appropriate reconstruction strategy after wide excision for severe cases of anogeni... more BACKGROUND An appropriate reconstruction strategy after wide excision for severe cases of anogenital hidradenitis suppurativa (aHS) is important to optimize outcomes, but there is no consensus on which reconstruction strategy should be preferred. OBJECTIVE Evaluate which reconstruction strategy after wide excision in patients with severe aHS is associated with the best outcomes in terms of recurrence rate, complications and patient-reported outcomes on range of motion, pain, appearance, sexual health and satisfaction. METHODS Multicenter retrospective analysis between 2009 and 2019 of wide excision and reconstruction by primary closure, secondary intention healing, split-thickness skin grafts or fasciocutaneous flaps (FCF). The recurrence rate was the primary endpoint of multivariable logistic regressions to determine variables with an independent effect on recurrence. RESULTS A total of 93 patients were included. The overall recurrence rate was 62% after a median follow-up of 43 months, without statistical significance between reconstruction strategies (P = 0.737). The number of interventions during follow-up was an independent risk factor for recurrence (odds ratio, 2.55; confidence interval, 1.24-5.25; P = 0.011). Complications (37%) were more severe after FCF (P = 0.007). The mean score regarding patient-reported outcomes was 14.9 ± 2.8, of 24, with best appearance after FCF (P = 0.042). CONCLUSIONS These long-term follow-up data on severe aHS demonstrate a high recurrence rate after wide excision and reconstruction. Patients should be informed that treatment consists of long-term medicinal and surgical interventions with high recurrence rates, and surgeons may choose their own preferred reconstruction methods. Furthermore, more attention should be paid to the sexual health of patients with aHS.
BACKGROUND Wide excision (WE) is generally considered to be the most common treatment for recurre... more BACKGROUND Wide excision (WE) is generally considered to be the most common treatment for recurrent hidradenitis suppurativa. When performed, excision is followed by decisions regarding best options for management of the surgical defect. Different reconstructive strategies (RSs) have been used, with varying rates of recurrence. OBJECTIVE To provide an up-to-date systematic review of the complete literature for different RS after WE and their recurrence rates. METHODS A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1,813 retrieved articles, 79 were included in the analysis. Most were retrospective analyses, with only one randomized controlled trial (RCT) and 7 prospective analyses. The RS described were divided into primary closure (PC), secondary intention healing (SIH), skin graft (SG), and fasciocutaneous flaps (FCF). The average estimated recurrence for PC was 22.0% (95% confidence interval [CI], 8.0%-40.0%), for SIH 11.0% (95% CI, 5.0%-20.0%), for SG 2.0% (95% CI, 0.0%-5.0%), and for FCF 2.0% (95% CI, 1.0%-5.0%) (p < .001). Hidradenitis suppurativa below the umbilicus was significantly associated with overall recurrence (p = .006). Quality of evidence was poor, and the reporting of results was mostly heterogeneous. CONCLUSION After WE, PC has the highest recurrence rates, whereas SG and FCF have the lowest rates. There is a need for more RCTs and guidelines, to be able to report uniformly on treatment outcomes.
Background A congenital melanocytic naevus (CMN) is a rare skin condition that can be associated ... more Background A congenital melanocytic naevus (CMN) is a rare skin condition that can be associated with abnormalities of the central nervous system (CNS). These anomalies can sometimes cause severe complications, and rarely death. Adequate information about aetiology and management is therefore crucial. To identify how to monitor patients with CMN, we aimed to estimate the prevalence of neurological involvement in patients with CMN and to summarize what specific neurological signs and symptoms and MRI abnormalities are reported in the medical literature. In addition, we summarized and evaluated the recommendations regarding MRI-screening reported in the medical literature. Methods This review was registered in PROSPERO and reported according to the MOOSE checklist. A search was conducted in EMBASE (Ovid), PubMed, and the Cochrane Library. We included studies with 10 or more patients with CMN, reporting on neurological signs and symptoms or CNS MRI. Study selection, data extraction and...
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2018
Basal cell carcinomas (BCCs) excised leaving positive tumour margins, are at a higher risk of rec... more Basal cell carcinomas (BCCs) excised leaving positive tumour margins, are at a higher risk of recurrence. Accordingly, complete tumour removal with preservation of healthy tissue, aiming for low recurrence rates, is the main goal in treating BCCs. The present study aimed to identify the reliability of the Whole Specimen Intraoperative Frozen Section Analysis (WIFSA) technique by comparing intraoperative WIFSA and postoperative Formalin-Fixed Paraffin-Embedded section analysis (FFPE) results in 1082 basal cell carcinomas and by assessing the recurrence rates during a follow-up period up to 10 years. A single-centre retrospective cohort of all patients with BCC of the face receiving surgical excision with the WIFSA method between January 2007 and December 2013 was evaluated. We compared the intraoperative frozen section results with postoperative FFPE in order to assess accuracy of the WIFSA. Recurrence rates were assessed among all BCCs with a tumour-free margin at final excision tha...
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014
Gynaecomastia, breast enlargement in men, is common in all age groups. It is operated on by plast... more Gynaecomastia, breast enlargement in men, is common in all age groups. It is operated on by plastic surgeons, general surgeons and paediatric surgeons. It is therefore possible that there is a difference in the populations treated, the indications for surgery and the management used by the different practitioners. We performed a survey in order to assess the approach to treatment of gynaecomastia by the different disciplines. An electronic survey questionnaire was sent to members of the Dutch societies of surgery, paediatric surgery and plastic surgery. We received 105 responses from plastic surgeons, 95 from general surgeons and 15 from paediatric surgeons, representing respective response rates of 38.7%, 23.8% and 42.8%. Plastic surgeons operated on gynaecomastia most frequently. The diagnostic criteria and workup were similar for all disciplines, although general surgeons used more imaging. There was a difference in the side operated on. General surgeons and paediatric surgeons operated mainly on unilateral cases (74% and 52%), while plastic surgeons operated mainly on bilateral cases (85%). Pharmaceutical treatment with Tamoxifen was reported only by general surgeons (13%). All disciplines used mainly the periareolar incision. Plastic surgeons reported more often the use of other surgical approaches as well as adjunctive liposuction and they did not always submit tissue for pathological examination. Perioperative antibiotics, drains and pressure garments were not always used. All disciplines agreed that the most common complication was bleeding, followed by seroma, infection, insufficient results, inverted nipple and nipple necrosis. This survey highlights some differences in the practice of gynaecomastia surgery. The findings appear to point to the fact that the indications are different, being more aesthetic in the case of plastic surgeons. The results of this survey are important in establishing the standard of care and may be helpful for setting guidelines.
This study aimed to analyze the histopathology results of surgically excised breast specimens wit... more This study aimed to analyze the histopathology results of surgically excised breast specimens with the diagnosis of gynecomastia (GM). Gynecomastia is a term used to describe benign hypertrophy of the breast in men; it is a common, mostly transient, phenomenon in adolescents, but may also be seen in older men. Breast enlargement can lead to psychological problems; if it persists it can be surgically corrected. The obtained breast tissue specimens are routinely submitted for pathological examination. We performed this study to assess the prevalence of pathological findings after surgical management of GM. Pathology reports were obtained from the nationwide network and registry of histopathology and cytopathology in the Netherlands (PALGA). The reports of 5113 breasts were analyzed for the prevalence of pathologies in different age groups. The average age of the patients was 35.3 ± 18.3 years (range, 1-88 years). The most common finding was GM followed by pseudo-GM. The overall prevalence of invasive carcinomas was 0.11% and of in situ carcinomas was 0.18%. The youngest patient with invasive cancer was 65 years old and the youngest patient with carcinoma in situ was 24 years old. The overall prevalence of atypical ductal hyperplasia was 0.4%; in patients younger than 20 years, it was 0.23%. The youngest patient with atypical ductal hyperplasia was 16 years old. Pathological findings were found more often in unilateral procedures. The prevalence of malignancies in GM resection specimens is low; however, it increases with patient age. Unilateral cases have a statistically nonsignificant higher prevalence of pathologies. Prognostic/risk II.
The aim of this study is to prospectively evaluate the changes in the sensation of the skin of th... more The aim of this study is to prospectively evaluate the changes in the sensation of the skin of the abdominal wall and thighs following abdominoplasty. Patients underwent standard full abdominoplasty with reinsertion of the umbilicus. Sensory testing was performed preoperatively and at least 1 year postoperatively. Predetermined targets on the abdominal wall, umbilicus, and on the anterior thighs were tested for light touch, sensory thresholds, using Semmes-Weinstein monofilaments (SW), vibration, and temperature. Fourteen patients completed the study. On average targets demonstrated a decrease in sensory thresholds, average from SW 3.61 to 4.14 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), the targets that had the most significant decrease were the umbilicus SW 3.67 to 6.97 (P = 0.001) and the infra umbilical 3.75 to 6.57 P = 0.001. Similar findings were seen for the other modalities tested, there was a significant disappearance in their perception at the umbilical target and at the lower abdominal regions. We did not identify any significant decrease in the sensation of the thighs. Abdominoplasty causes lasting sensory changes concentrating on the umbilical and infraumbilical regions. This study enables surgeons to inform their patients about the expected sensory outcome following abdominoplasty.
Extirpation of noninvasive skin tumors of the anterior ear may create large defects. Various flap... more Extirpation of noninvasive skin tumors of the anterior ear may create large defects. Various flaps, described to cover these defects, demand special knowledge without which a loss of the fine detail of the ear may result. Healthy, exposed cartilage is deliberately excised leaving a basic framework for support, thus preserving contours and a well-vascularized recipient bed for full-thickness skin grafting. The grafts heal by revascularization and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;bridging,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; a phenomenon whereby grafts on avascular beds (such as denuded cartilage) are revascularized. By marrying clinical experience gained during microtia reconstruction with insights regarding the bridging phenomenon derived from the laboratory, our 17 reconstructed ears healed without serious complications and kept their normal contours and shape, and there was no recurrence of the carcinoma. Satisfactory patient-centered outcome can be obtained in reconstructing defects of one-third to two-thirds of the total anterior surface of the ear relying on the bridging phenomenon.
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To identify, critically appraise, an... more STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To identify, critically appraise, and synthesize research findings on non-sensate versus sensate flaps among individuals with spinal cord disease and pelvic pressure ulcers, with pressure ulcer recurrence as primary outcome. METHODS PubMed, EMBASE, and Cochrane CENTRAL were screened for relevant studies. Data on surgical characteristics, ulcer recurrence, and sensory outcomes were retrieved and tabulated. Risk of bias was assessed with MINORS. The level of evidence was evaluated with GRADE. Meta-analysis was performed when possible. RESULTS Meta-analysis of 1794 non-sensate locoregional reconstructions indicated a recurrence rate of 34% within several years (95% CI, 27-42). Twenty-one articles provided data on 75 sensate reconstructions, performed in 74 individuals. Meta-analysis of the sensate reconstructions indicated a recurrence rate of 1% (95% CI, 0-8). Sensate reconstructions were not associated with an increase of wound complications (19%; 95% CI, 7-40) compared with non-sensate ones (34%; 95% CI, 27-42). A very low level of evidence was determined with use of GRADE. CONCLUSION Although of a very low-level, the present evidence suggests that restoration of sensory innervation may be an effective intervention for the prevention of pressure ulcer recurrence among individuals with spinal cord disease. A prospective RCT is needed to confirm or refute the results of this systematic review.
The Journal of Trauma: Injury, Infection, and Critical Care, 2006
Skin stretching harnesses the same viscoelastic properties of the skin as expansion, with the dif... more Skin stretching harnesses the same viscoelastic properties of the skin as expansion, with the difference that the forces are applied externally and not internally. An improvised system for wound closure is presented. The system is assembled using silicone vascular loops used as sutures and the flow controllers of intravenous sets as locking devices. The wounds are gradually closed by increasing the tension applied by the devices. The system has been applied to nine traumatic wounds in six patients. The average size of the wounds was 70 cm; the average number of devices used was 4.3 (range, 1-9; median, 3); the average time to achieve closure was 1.55 days (range, 0-2 days; median, 2 days). This system permits the closure of wounds not suitable for closure by primary intention and avoids the use of skin grafts or flaps.
Severe hand injuries due to firecrackers are unfortunately common in the Netherlands. These injur... more Severe hand injuries due to firecrackers are unfortunately common in the Netherlands. These injuries are expected to have long-term functional and psychological sequalae. We performed a study to assess the long-term impact of such injuries on the victims and their parents. Eight sequential adolescent patients that underwent surgery for firecracker-induced severe hand injuries between September 2012 and March 2015 were included. The patient files were assessed for data on hand function. The impact of the injuries was measured by questionnaires and measure instruments: VAS for pain, CHEQ2.0 and COPM-DLV for activities and participation, PedsQL-4.0 for participation and quality of life, RSES for self-esteem, and DT-P for impact on parents. Seven of the eight patients underwent (partial) hand amputation. Three adolescents still reported pain at a mean of 3.2 years post-trauma. All adolescents required more time than peers performing activities. Seven showed a total of 34 activity and pa...
Ophthalmic Surgery, Lasers and Imaging Retina, 2000
... We present a child with neurofibromatosis type I (NF-I) who underwent excision of a large upp... more ... We present a child with neurofibromatosis type I (NF-I) who underwent excision of a large upper lid neurofibroma using a CO2-laser. Plexiform neurofibromas are notorious for their bleeding tendency and the inability to achieve complete surgical excision. ...
Background Pelvic sepsis after surgery for rectal cancer is a severe complication, mostly origina... more Background Pelvic sepsis after surgery for rectal cancer is a severe complication, mostly originating from anastomotic leakage. Complex salvage surgery, during which an omentoplasty is often used for filling of the pelvic cavity, is seldomly required. If this fails, a symptomatic recurrent presacral abscess with a risk of progressive inflammation can develop. Such patients have often undergone multiple surgeries and have disturbed abdominal wall integrity, adhesion formation, and presence of one or two stoma(s). Subsequent salvage surgery via the conventional anterior abdominal approach is therefore less suitable. We describe three cases with a chronic presacral sinus and failure of first salvage surgery. All three patients underwent a prone only approach with tailored sacrectomy. This novel approach provided direct access to the pelvic abscess with optimal exposure for complete and safe debridement. A unilateral or bilateral gluteal V–Y fasciocutaneous advancement flap was created ...
BACKGROUND An appropriate reconstruction strategy after wide excision for severe cases of anogeni... more BACKGROUND An appropriate reconstruction strategy after wide excision for severe cases of anogenital hidradenitis suppurativa (aHS) is important to optimize outcomes, but there is no consensus on which reconstruction strategy should be preferred. OBJECTIVE Evaluate which reconstruction strategy after wide excision in patients with severe aHS is associated with the best outcomes in terms of recurrence rate, complications and patient-reported outcomes on range of motion, pain, appearance, sexual health and satisfaction. METHODS Multicenter retrospective analysis between 2009 and 2019 of wide excision and reconstruction by primary closure, secondary intention healing, split-thickness skin grafts or fasciocutaneous flaps (FCF). The recurrence rate was the primary endpoint of multivariable logistic regressions to determine variables with an independent effect on recurrence. RESULTS A total of 93 patients were included. The overall recurrence rate was 62% after a median follow-up of 43 months, without statistical significance between reconstruction strategies (P = 0.737). The number of interventions during follow-up was an independent risk factor for recurrence (odds ratio, 2.55; confidence interval, 1.24-5.25; P = 0.011). Complications (37%) were more severe after FCF (P = 0.007). The mean score regarding patient-reported outcomes was 14.9 ± 2.8, of 24, with best appearance after FCF (P = 0.042). CONCLUSIONS These long-term follow-up data on severe aHS demonstrate a high recurrence rate after wide excision and reconstruction. Patients should be informed that treatment consists of long-term medicinal and surgical interventions with high recurrence rates, and surgeons may choose their own preferred reconstruction methods. Furthermore, more attention should be paid to the sexual health of patients with aHS.
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