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BACKGROUND: Split-thickness skin graft (STSG)1 integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL)2 imaging (MolecuLight®), which accurately locates areas of bacterial loads above 104 CFU/gr, for graft site assessment and preparation could yield better outcomes.
METHODS: This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>104 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm2) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed.
RESULTS: 38 patients were enrolled in the study. The mean total body surface area (TBSA)3 involvement was 14.5 ± 12.4 % [range 0.8 - 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %.
CONCLUSIONS: FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes.
METHODS: Level IIA, Therapeutic study.

BACKGROUND: Contact layer dressing (CLD) is standard after autologous skin cell suspension (ASCS); however, the authors wondered whether a poly-lactic acid dressing (PLAD) results in superior outcomes and cost savings.
METHODS: Retrospective cohort study including greater than 10% total body surface area (TBSA) burns treated with ASCS and either PLAD or CLD. Primary outcomes were infection and length of stay (LOS).
RESULTS: 71 patients (76% male, 24% pediatric, mean age 37 years) were included. Twenty-eight patients (39%) received CLD and 43 (61%) received PLAD. Wound infections were decreased in PLAD (7 vs 32%, p = 0.009). When controlling for area grafted (cm2) and TBSA, logistic regression revealed odds of post-operative infection was 8.1 times higher in CLD (p = 0.015). PLAD required antibiotics for fewer days (mean 0.47 vs 4.39, p = 0.0074) and shorter LOS (mean 17 vs 29 days, p < 0.001). Mean adjusted charges per %TBSA was $18,459 in PLAD vs. $25,397 in CLD (p = 0.0621).
CONCLUSIONS: In the first analysis of its kind, this study showed polylactic acid dressing combined with autologous skin cell suspension led to a decrease in postoperative infections, length of hospital stay, and total patient charges.

UNASSIGNED: Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established.
UNASSIGNED: Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function.
UNASSIGNED: The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary.
UNASSIGNED: Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process.
UNASSIGNED: Level IV, case series.

Chronic ulcers significantly affect the quality of life of patients and impose a high cost on the healthcare system. The therapeutic management should be comprehensive, taking into consideration the etiological diagnosis of the wound and the characteristics of the wound bed when deciding on a therapeutic proposal appropriate to the healing phase, correcting factors that delay healing. During the epithelialization phase, repair techniques with grafts are recommended to shorten re-epithelialization time, improve the quality of scar tissue, and achieve adequate pain management. Currently, due to the reported benefits of skin appendages, the technique of follicular unit auto-grafting obtained with a scalp punch is among the chosen strategies for wound repair. This is a minimally invasive, outpatient practice, whose technique has advantages over the donor site, patients recovery and well-being.

BACKGROUND: The current standard management of full-thickness or deep dermal burns is early tangential excision and skin grafting. A conservative approach to deep burns without the option of skin grafting results in delayed wound healing, possibly leading to wound infection and is associated with hypertrophic scarring and increased morbidity and mortality. The aim of this study was to improve the understanding of the management and availability to perform skin grafting for burns on the African continent. It also sought to identify challenges and perceived improvements.
METHODS: A web-based, structured, closed-formatted, multinational survey was designed to gather information on the current state and availability of skin grafting of burn wounds on the African continent. The questionnaire consisted of 27 questions, available in English and French. It was reviewed within the GAP-Burn collaboration network and sent to 271 health care professionals who had participated in a previous study and had initially been recruited by means of the snowball system.
RESULTS: The questionnaire was completed 84 times (response rate: 31.0%), of which 3 were excluded. Responses originated from 22 African countries. The majority 71 (87.7%) resulted from countries with a low Human Development Index (HDI), 7 (8.6%) from medium HDI countries. Split thickness skin grafting (STSG) is performed in 51 (63.0%) centers. The majority considers STSG to reduce length of stay (72.8%) and improve scarring (54.3%), yet some indicated that STSG is associated with increased risk of donor site infection (8.6%) and severe bleeding (7.4%). Factors preventing increased grafting included lack of equipment and training.
CONCLUSIONS: Skin grafting is not performed in a significant number of hospitals treating burns. The majority of the staff believe that more skin grafting would lead to a better outcome. Advocacy and improved infrastructure, human resources coupled with introduction to well-structured health coverage for all in African countries could help to better access and affordability in burn care.

Necrotizing fasciitis is a commonly encountered modality by a practicing clinician which needs urgent and vigilant management. To decrease the potential morbidity and mortality of the pathology, an aggressive multimodal approach shows promising results. In our report, we present a case of a three-year-old male child who presented to us with the findings consistent with necrotizing fasciitis. The case report highlights the importance of multimodal approach in such a case.

Calciphylaxis is characterized by extremely painful skin ulcers and develops in patients with or without severe kidney diseases. Herein, a female patient without renal dysfunction developed calciphylaxis in the right lower extremity and underwent successful surgical debridement and split-thickness skin grafting. Nevertheless, prompt wound evaluation and proper surgical approaches are essential.

Infrared thermography (IRT) is a technique that indirectly assesses peripheral blood circulation and its resulting amount of radiated heat. Due to these properties, thermal imaging is currently applied in human medicine to noninvasively evaluate peripheral vascular disorders such as thrombosis, thromboembolisms, and other ischemic processes. Moreover, tissular damage (e.g., burn injuries) also causes microvasculature compromise. Therefore, thermography can be applied to determine the degree of damage according to the viability of tissues and blood vessels, and it can also be used as a technique to monitor skin transplant procedures such as grafting and free flaps. The present review aims to summarize and analyze the application of IRT in veterinary medicine as a method to indirectly assess peripheral vascular integrity and its relation to the amount of radiated heat and as a diagnostic technique for tissue viability, degree of damage, and wound care.

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