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Shoham Y, Rosenberg L, Hickerson W, Goverman J, Iyer N, Barrera-Oro J, Lipovy B, Monstrey S, Blome-Eberwein S, Wibbenmeyer LA, Scharpenberg M, Singer AJ. Early Enzymatic Burn Debridement: Results of the DETECT Multicenter Randomized Controlled Trial. J Burn Care Res 2024; 45:297-307. [PMID: 37715999 DOI: 10.1093/jbcr/irad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Indexed: 09/18/2023]
Abstract
Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
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Affiliation(s)
- Yaron Shoham
- Department of Plastic Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8400711, Israel
| | - Lior Rosenberg
- Department of Plastic Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8400711, Israel
| | - William Hickerson
- Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Department of Medicine, Firefighters Regional Burn Center, Regional One Health, Memphis, TN 38163, USA
| | - Jeremy Goverman
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Narayan Iyer
- Burn and Blast Medical Countermeasures Program, Division of Chemical, Biological, Radiological/Nuclear Countermeasures (CBRN), Biomedical Advanced Research and Development Authority (BARDA), Administration for Preparedness and Response (ASPR) 20201, HHS
| | - Julio Barrera-Oro
- Burn and Blast Medical Countermeasures Program, Division of Chemical, Biological, Radiological/Nuclear Countermeasures (CBRN), Biomedical Advanced Research and Development Authority (BARDA), Administration for Preparedness and Response (ASPR) 20201, HHS
| | - Bretislav Lipovy
- Department of Burns and Plastic Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 60300, Czech Republic
| | - Stan Monstrey
- Department of Plastic and Reconstructive Surgery and Burn Center, University Hospital of Ghent, Ghent 9000, Belgium
| | | | - Lucy A Wibbenmeyer
- Department of Surgery, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA 52242, USA
| | - Martin Scharpenberg
- Universität Bremen, Kompetenzzentrum für Klinische Studien Bremen, Bremen 28359, Germany
| | - Adam J Singer
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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Gasteratos K, Michalopoulos J, Nona M, Morsi-Yeroyiannis A, Goverman J, Rakhorst H, van der Hulst RRWJ. Instructional Video of a Standardized Interprofessional Postsimulation Facilitator-guided Debriefing of a Fatality in Plastic Surgery. Plast Reconstr Surg Glob Open 2024; 12:e5583. [PMID: 38333029 PMCID: PMC10852376 DOI: 10.1097/gox.0000000000005583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024]
Abstract
Background Postsimulation facilitator-guided debriefing (PSFGD) is the process of intentional discussion of thoughts, actions, and events that took place during simulation amongst the facilitator(s) and trainees. Despite the significance of delivering high-quality debriefings, there is a lack of evidence-based guidelines. Our study aimed to provide an instructional video demonstration of a PSFGD of a fatality. Methods Fifty surgical interns participated in a burn simulation scenario in two groups. Group 1 (control, or "no exposure," n = 25) consisted of residents who received oral postsimulation debriefing from an independent faculty member who had no exposure to our instructional video on how to debrief effectively. Group 2 (intervention, or "exposure," n = 25) consisted of interns who were debriefed by the second faculty member who did watch our instructional video before the simulation and learned about "advocacy and inquiry" techniques. The outcome measures were the Debriefing Assessment for Simulation in Healthcare score and the postdebrief multiple-choice question (MCQ) quiz scores to assess debriefers' performance and interns' knowledge consolidation, respectively. Results The "exposure" group presented statistically significantly higher values for the Debriefing Assessment for Simulation in Healthcare score (P < 0.001) and MCQ score (P < 0.001) compared with the "no exposure" group. Conclusions Debriefers who followed the methodology as demonstrated in our instructional video were considered more competent, and the residents achieved higher MCQ scores. The quality of the debriefing ensures improved critical thinking and problem-solving skills. Safer practice and better patient outcomes are achieved by developing debriefing programs for educators.
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Affiliation(s)
| | | | | | | | - Jeremy Goverman
- Summer M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Hinne Rakhorst
- Department of Plastic Surgery, MST Enschede, ZGT Almelo, the Netherlands
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Gasteratos K, Kouzounis K, Goverman J. Autologous Stem Cell-derived Therapies for Androgenetic Alopecia: A Systematic Review of Randomized Control Trials on Efficacy, Safety, and Outcomes. Plast Reconstr Surg Glob Open 2024; 12:e5606. [PMID: 38352219 PMCID: PMC10863936 DOI: 10.1097/gox.0000000000005606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/05/2024] [Indexed: 02/16/2024]
Abstract
Background Androgenic alopecia (AGA), a prevalent and extensively studied condition characterized by hair loss, presents a significant global issue for both men and women. Stem cell therapy has emerged as a promising therapeutic approach for AGA due to its regenerative and immunomodulatory properties. The primary objective of this systematic review was to assess the current literature on the efficacy and safety of cellular and acellular stem cell-derived therapies in the management of AGA. Methods A computerized literature search was conducted in ClinicalTrials.gov, PubMed, and Cochrane Library in October 2023. The online screening process was performed by three independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. Results The search yielded 53 articles from 2013 to 2023. Twelve randomized controlled trials were included. Stem cells and their derivatives were isolated from human adipose tissue, hair follicles, bone marrow, umbilical cord blood, and exfoliated deciduous teeth. These trials showed that stem cell-derived treatments can promote hair regeneration and density. Conclusions Both cellular and acellular stem cell-based therapies are safe and effective in improving hair regeneration and density in AGA patients. Although the outcomes may be temporary in some cases, regenerative treatments may become useful adjuncts in combination with traditional methods of hair transplantation. Future research should focus on protocol optimization to enhance long-term patient outcomes.
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Affiliation(s)
| | | | - Jeremy Goverman
- Summer M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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Shoham Y, Gasteratos K, Singer AJ, Krieger Y, Silberstein E, Goverman J. Bromelain-based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long-term outcomes. Int Wound J 2023; 20:4364-4383. [PMID: 37455553 PMCID: PMC10681521 DOI: 10.1111/iwj.14308] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013-2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain-based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non-surgical eschar removal treatment modality. The benefits of Bromelain-based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain-based debridement are expanding to cover "off-label" cases with significant benefits to the global healthcare economy.
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Affiliation(s)
- Yaron Shoham
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health SciencesBen‐Gurion University of the NegevBeer ShebaIsrael
| | | | - Adam J. Singer
- Department of Emergency MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Yuval Krieger
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health SciencesBen‐Gurion University of the NegevBeer ShebaIsrael
| | - Eldad Silberstein
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health SciencesBen‐Gurion University of the NegevBeer ShebaIsrael
| | - Jeremy Goverman
- Sumner M. Redstone Burn Center, Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Gasteratos K, Daniels B, Gebhart SJ, Patterson N, Tarrant MJ, Goverman J, Rakhorst H, der Hulst RRWJ. Three-phase video-assisted multidisciplinary team debriefing (VAMTD) in high-fidelity blast simulation through the "advocacy and inquiry" method. Plast Reconstr Surg 2023:00006534-990000000-02128. [PMID: 37734003 DOI: 10.1097/prs.0000000000011070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Video-assisted debriefing (VAD) combined with the "advocacy and inquiry" (A&I) technique, is a tool that allows video playback of selected segments of a simulation, thereby assisting the debriefers to structure the session. Currently, however, no consensus exists on how to optimally perform a team debriefing. In our study, we aim to demonstrate and describe the methodology of A&I debriefing in an instructional simulated blast scenario and assess the impact of VAD on residents' technical and non-technical skills (NTS). MATERIALS AND METHODS After Institutional Review Board (IRB) approval, we performed a study with 50 residents who were randomly assigned to two groups. Group 1 (control, or "no VAD", n=25) consisted of residents who received oral debriefing by one independent faculty member without the recorded video of the simulation. Group 2 (intervention, or "VAD", n=25) consisted of residents who received VAD from the second independent faculty member. These residents repeated the same simulation scenario one week after their debrief. Every resident was assessed on the primary and secondary survey, as well as the NTS, based on the integrated skills (IS) score. RESULTS The "VAD" group presented significantly higher values for the IS score (p<0.001) compared to the "no VAD'' group. CONCLUSIONS Our demonstration of three-phase VAD emphasizes important aspects of coherent simulation-based training: psychological safety, A&I, reflection, cognitive frames, pre-brief, main debrief, summary, and translation of new discoveries to real-life patient care. The unique audio-visual aspect of the VAD enhanced residents' performance in simulation.
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Affiliation(s)
| | | | | | | | | | - Jeremy Goverman
- Summer M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hinne Rakhorst
- Department of Plastic Surgery, MST Enschede, ZGT Almelo, Netherlands
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Lisiecki J, Buta M, Taylor S, Tait M, Farina N, Levin J, Schulz J, Sangji N, Friedstat J, Hemmila M, Wang S, Levi B, Goverman J. Efficacy of Mepliex ® Ag Versus Xeroform ® As A Split-Thickness Skin Graft Donor Site Dressing: Bad Habits Die Hard. Ann Burns Fire Disasters 2023; 36:243-250. [PMID: 38680433 PMCID: PMC11041881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/01/2022] [Indexed: 05/01/2024]
Abstract
Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform® or Mepilex® Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex® Ag group and 11.4% in the Xeroform® group (p<0.0001). Patients with Xeroform® donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex® Ag and Xeroform® groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex® Ag) should be the standard of care in STSG donor site wound care.
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Affiliation(s)
- J.L. Lisiecki
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M.R. Buta
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - S. Taylor
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M. Tait
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - N. Farina
- Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - J. Levin
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - J. Schulz
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - N. Sangji
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J. Friedstat
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M.R. Hemmila
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S. Wang
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - B. Levi
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - J. Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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Shoham Y, Krieger Y, Goverman J. Anacaulase-bcdb for the treatment of severe thermal burns. Expert Opin Biol Ther 2023; 23:1185-1191. [PMID: 37833828 DOI: 10.1080/14712598.2023.2270903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision with knife has long since been standard of care, a newer technique for wound bed preparation utilizing a bromelain-based enzyme has gained popularity worldwide and may offer several advantages. AREAS COVERED Here we report the pharmacologic properties, evidence for clinical efficacy, safety, and tolerability of anacaulase-bcdb for the treatment of deep partial thickness and full thickness burns. EXPERT OPINION Anacaulase-bcdb is a safe, non-surgical, selective eschar removal agent. It offers advantages over surgical excision of burn with knife and fulfills two unmet needs: burn depth assessment and dermal preservation during excision. Evidence supports a faster time to complete eschar removal; reduced number of operations; reduction in the amount of autografting, length of stay, and blood loss; prevention of burn induced compartment syndrome; and improved cosmetic outcome.
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Affiliation(s)
- Yaron Shoham
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Beer Sheba, Israel
- Plastic Surgery Department and Burn Unit, Ben-Gurion University of the Negev Faculty of Health Sciences, Plastic Surgery, Beer-Sheva, Israel
| | - Yuval Krieger
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Beer Sheba, Israel
- Plastic Surgery Department and Burn Unit, Ben-Gurion University of the Negev Faculty of Health Sciences, Plastic Surgery, Beer-Sheva, Israel
| | - Jeremy Goverman
- Mass General Brigham, Inc. Department of Surgery, Massachusetts General Hospital, Sumner Redstone Burn Center, Harvard Medical School, Boston, MA, USA
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Gasteratos K, McCarthy M, Chatziathanasiou D, Vradeli G, Vlachopoulos N, Voitsidis P, Goverman J. A Systematic Review of Pediatric Nonaccidental Burns: Protecting the Children Through Knowledge, Vigilance, and Prevention. Ann Plast Surg 2023; 90:551-558. [PMID: 37157138 DOI: 10.1097/sap.0000000000003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inflicted burns on children are a particularly difficult medical and psychosocial issue. Pediatric nonaccidental burns (PNABs) are unfortunately relatively common. In our study, we aim to present the key findings on PNABs with the intention of raising awareness, improving early, and recognizing accurately by identifying red flags, developing triage tools, and establishing prevention strategies for this sensitive issue. METHODS A computerized literature search was conducted on PubMed, Google Scholar, and Cochrane for articles published until November 2020. The online screening process was performed by 3 independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS A total of 12 studies were included for analysis. Scald burns via forced immersion accounted for the majority of reported PNABs affecting both feet and hands. Complications included wound infection, sepsis, requiring systemic antibiotics, or intensive care. Abused children's parents had a history of mental illness, unemployment, substance abuse, incarceration, and/or low annual income. CONCLUSIONS Scalds via forced immersion remain the most common mechanism of PNABs. All health care professionals must remain vigilant, be able to recognize subtle signs of abuse, triage patients appropriately, report to police and/or social services, and ensure no further harm is made to the child or children. Repeated abuse with burns can lead to death. Prevention and education are the cornerstones for addressing this social phenomenon.
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Affiliation(s)
| | | | | | - Georgia Vradeli
- Department of Dermatology, Städtisches Klinikum Dessau, Germany
| | | | - Pantelis Voitsidis
- 1st Psychiatric Clinic, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jeremy Goverman
- Sumner M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, MA
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Wen W, Portales-Castillo I, Seethapathy R, Durant O, Mengesha B, Krinsky S, Kroshinsky D, Kalim S, Goverman J, Nazarian RM, Chitalia V, Malhotra R, Kramann R, Malhotra CK, Nigwekar SU. Intravenous Sodium Thiosulphate for Calciphylaxis of Chronic Kidney Disease: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2310068. [PMID: 37099293 PMCID: PMC10134003 DOI: 10.1001/jamanetworkopen.2023.10068] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Importance Calciphylaxis is a rare disease with high mortality mainly involving patients with chronic kidney disease (CKD). Sodium thiosulphate (STS) has been used as an off-label therapeutic in calciphylaxis, but there is a lack of clinical trials and studies that demonstrate its effect compared with those without STS treatment. Objective To perform a meta-analysis of the cohort studies that provided data comparing outcomes among patients with calciphylaxis treated with and without intravenous STS. Data Sources PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched using relevant terms and synonyms including sodium thiosulphate and calci* without language restriction. Study Selection The initial search was for cohort studies published before August 31, 2021, that included adult patients diagnosed with CKD experiencing calciphylaxis and could provide a comparison between patients treated with and without intravenous STS. Studies were excluded if they reported outcomes only from nonintravenous administration of STS or if the outcomes for CKD patients were not provided. Data Extraction and Synthesis Random-effects models were performed. The Egger test was used to measure publication bias. Heterogeneity was assessed using the I2 test. Main Outcomes and Measures Skin lesion improvement and survival, synthesized as ratio data by a random-effects empirical Bayes model. Results Among the 5601 publications retrieved from the targeted databases, 19 retrospective cohort studies including 422 patients (mean age, 57 years; 37.3% male) met the eligibility criteria. No difference was observed in skin lesion improvement (12 studies with 110 patients; risk ratio, 1.23; 95% CI, 0.85-1.78) between the STS and the comparator groups. No difference was noted for the risk of death (15 studies with 158 patients; risk ratio, 0.88; 95% CI, 0.70-1.10) and overall survival using time-to-event data (3 studies with 269 participants; hazard ratio, 0.82; 95% CI, 0.57-1.18). In meta-regression, lesion improvement associated with STS negatively correlated with publication year, implying that recent studies are more likely to report a null association compared with past studies (coefficient = -0.14; P = .008). Conclusions and Relevance Intravenous STS was not associated with skin lesion improvement or survival benefit in patients with CKD experiencing calciphylaxis. Future investigations are warranted to examine the efficacy and safety of therapies for patients with calciphylaxis.
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Affiliation(s)
- Wen Wen
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Olivia Durant
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Beza Mengesha
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott Krinsky
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Sahir Kalim
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeremy Goverman
- Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
| | | | - Vipul Chitalia
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Rajeev Malhotra
- Cardiovascular Research Center and the Cardiology Division of the Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Rafael Kramann
- Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany
- Institute of Experimental Medicine and Systems Biology, Medical Faculty RWTH Aachen University, Aachen, Germany
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
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Gasteratos K, Vlachopoulos N, Kokosis G, Goverman J. Efficacy and Safety of Microsurgical Pharyngolaryngeal and Pharyngoesophageal Reconstruction: A Systematic Review of the Literature. Plast Reconstr Surg Glob Open 2023; 11:e4958. [PMID: 37124383 PMCID: PMC10146040 DOI: 10.1097/gox.0000000000004958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 05/02/2023]
Abstract
Restoration of function and complication management after pharyngolaryngectomy remains a challenging task. The aim of our study was to compare the functional and clinical outcomes of pharyngolaryngeal and pharyngoesophageal reconstruction using free flaps, namely jejunal (FJF), anterolateral thigh, and radial forearm, and describe a reconstructive approach for these defects following tumor resection. Methods We performed a systematic literature review on PubMed (Medline), Embase and Cochrane Library over the last two decades for articles reporting the surgical reconstructive modalities available after total or partial pharyngeal and/or laryngeal resection using a structured search strategy and strict inclusion and elimination criteria. Results Our search identified a total of 677 articles, 112 full texts were fully reviewed for eligibility, and 39 met the inclusion criteria. The use of both FJF and fasciocutaneous flaps is safe. The FJF has optimal swallowing outcomes and a low incidence of major recipient-site complications. Nevertheless, free fasciocutaneous flaps exhibit comparable functional results, while they seem linked with fewer cases of perioperative mortality and flap failure. However, none of the currently available techniques can combine all potential benefits. Conclusions Despite these procedures being mainly palliative in nature, the advent of microvascular techniques and utilization of fasciocutaneous free flaps has allowed optimal restoration of function combined with a reduced rate of perioperative and longterm complications. Both FJF and fasciocutaneous flaps can be viable treatment options, depending on the expertise of the surgeon and patient selection, to ensure the best outcomes.
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Affiliation(s)
| | | | - George Kokosis
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill
| | - Jeremy Goverman
- Sumner M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, Mass
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Tsurumi A, Flaherty PJ, Que YA, Ryan CM, Banerjee A, Chakraborty A, Almpani M, Shankar M, Goverman J, Schulz JT, Sheridan RL, Friedstat J, Hickey SA, Tompkins RG, Rahme LG. A PREVENTIVE TOOL FOR PREDICTING BLOODSTREAM INFECTIONS IN CHILDREN WITH BURNS. Shock 2023; 59:393-399. [PMID: 36597771 PMCID: PMC9991965 DOI: 10.1097/shk.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Introduction: Despite significant advances in pediatric burn care, bloodstream infections (BSIs) remain a compelling challenge during recovery. A personalized medicine approach for accurate prediction of BSIs before they occur would contribute to prevention efforts and improve patient outcomes. Methods: We analyzed the blood transcriptome of severely burned (total burn surface area [TBSA] ≥20%) patients in the multicenter Inflammation and Host Response to Injury ("Glue Grant") cohort. Our study included 82 pediatric (aged <16 years) patients, with blood samples at least 3 days before the observed BSI episode. We applied the least absolute shrinkage and selection operator (LASSO) machine-learning algorithm to select a panel of biomarkers predictive of BSI outcome. Results: We developed a panel of 10 probe sets corresponding to six annotated genes ( ARG2 [ arginase 2 ], CPT1A [ carnitine palmitoyltransferase 1A ], FYB [ FYN binding protein ], ITCH [ itchy E3 ubiquitin protein ligase ], MACF1 [ microtubule actin crosslinking factor 1 ], and SSH2 [ slingshot protein phosphatase 2 ]), two uncharacterized ( LOC101928635 , LOC101929599 ), and two unannotated regions. Our multibiomarker panel model yielded highly accurate prediction (area under the receiver operating characteristic curve, 0.938; 95% confidence interval [CI], 0.881-0.981) compared with models with TBSA (0.708; 95% CI, 0.588-0.824) or TBSA and inhalation injury status (0.792; 95% CI, 0.676-0.892). A model combining the multibiomarker panel with TBSA and inhalation injury status further improved prediction (0.978; 95% CI, 0.941-1.000). Conclusions: The multibiomarker panel model yielded a highly accurate prediction of BSIs before their onset. Knowing patients' risk profile early will guide clinicians to take rapid preventive measures for limiting infections, promote antibiotic stewardship that may aid in alleviating the current antibiotic resistance crisis, shorten hospital length of stay and burden on health care resources, reduce health care costs, and significantly improve patients' outcomes. In addition, the biomarkers' identity and molecular functions may contribute to developing novel preventive interventions.
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Affiliation(s)
- Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Patrick J. Flaherty
- Department of Mathematics and Statistics, University of Massachusetts at Amherst (Amherst, MA 01003, USA)
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland (3010 Bern, Switzerland)
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Ankita Banerjee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Arijit Chakraborty
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Marianna Almpani
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Malavika Shankar
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - John T. Schulz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Robert L. Sheridan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Jonathan Friedstat
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Sean A. Hickey
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Ronald G. Tompkins
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Laurence G. Rahme
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
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12
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Greenhalgh DG, Cartotto R, Taylor SL, Fine JR, Lewis GM, Smith DJ, Marano MA, Gibson A, Wibbenmeyer LA, Holmes JH, Rizzo JA, Foster KN, Khandelwal A, Fischer S, Hemmila MR, Hill D, Aballay AM, Tredget EE, Goverman J, Phelan H, Jimenez CJ, Baldea A, Sood R. Burn Resuscitation Practices in North America: Results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT). Ann Surg 2023; 277:512-519. [PMID: 34417368 PMCID: PMC8857312 DOI: 10.1097/sla.0000000000005166] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES ABRUPT was a prospective, noninterventional, observational study of resuscitation practices at 21 burn centers. The primary goal was to examine burn resuscitation with albumin or crystalloids alone, to design a future prospective randomized trial. SUMMARY BACKGROUND DATA No modern prospective study has determined whether to use colloids or crystalloids for acute burn resuscitation. METHODS Patients ≥18 years with burns ≥ 20% total body surface area (TBSA) had hourly documentation of resuscitation parameters for 48 hours. Patients received either crystalloids alone or had albumin supplemented to crystalloid based on center protocols. RESULTS Of 379 enrollees, two-thirds (253) were resuscitated with albumin and one-third (126) were resuscitated with crystalloid alone. Albumin patients received more total fluid than Crystalloid patients (5.2 ± 2.3 vs 3.7 ± 1.7 mL/kg/% TBSA burn/24 hours), but patients in the Albumin Group were older, had larger burns, higher admission Sequential Organ Failure Assessment (SOFA) scores, and more inhalation injury. Albumin lowered the in-to-out (I/O) ratio and was started ≤12 hours in patients with the highest initial fluid requirements, given >12 hours with intermediate requirements, and avoided in patients who responded to crystalloid alone. CONCLUSIONS Albumin use is associated with older age, larger and deeper burns, and more severe organ dysfunction at presentation. Albumin supplementation is started when initial crystalloid rates are above expected targets and improves the I/O ratio. The fluid received in the first 24 hours was at or above the Parkland Formula estimate.
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Affiliation(s)
- David G. Greenhalgh
- Department of Surgery, University of California, Davis School of Medicine and Shriners Hospitals for Children Northern California, Sacramento, CA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario
| | - Sandra L. Taylor
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA
| | - Jeffrey R. Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA
| | | | - David J. Smith
- Department of Surgery, University of South Florida, Tampa, FL
| | | | - Angela Gibson
- Department of Surgery, University of Wisconsin, Madison, WI
| | | | - James H. Holmes
- Department of Surgery, Wake Forrest University, Winston-Salem, NC
| | - Julie A. Rizzo
- Department of Surgery, Institute of Surgical Research, San Antonio, TX
| | | | | | - Sarah Fischer
- Department of Surgery, Ascension Via Christi St. Francis, Wichita, KS
| | - Mark R. Hemmila
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - David Hill
- Department of Pharmacy, University of Tennessee Health Science Center, Memphis, TN
| | | | - Edward E. Tredget
- Department of Plastic Surgery, University of Alberta, Edmonton, Alberta
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Herbert Phelan
- Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Carlos J. Jimenez
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Anthony Baldea
- Department of Surgery, University of Loyola, Maywood, IL
| | - Rajiv Sood
- Department of Plastic Surgery, University of Indiana, Indianapolis, IN
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13
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Wen W, Portales-Castillo I, Seethapathy R, Krinsky S, Kroshinsky D, Kalim S, Goverman J, Nazarian RM, Chitalia V, Malhotra R, Kramann R, Malhotra CK, Nigwekar SU. Intravenous sodium thiosulphate for vascular calcification of hemodialysis patients-a systematic review and meta-analysis. Nephrol Dial Transplant 2023; 38:733-745. [PMID: 35521751 PMCID: PMC10111152 DOI: 10.1093/ndt/gfac171] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vascular calcification (VC) is a common comorbidity among patients with chronic kidney disease (CKD), indicating major cardiovascular events. This study aimed to evaluate the effects and safety of intravenous sodium thiosulphate (STS) for VC in CKD patients. METHODS Electronic databases were searched for clinical trials that provided data comparing outcomes among patients treated with and without STS. The PRISMA guidelines were followed. Efficacy was assessed using calcification scores and arterial stiffness. Safety was examined by analyzing adverse symptoms, electrolytes and bone mineral density (BMD). Random-effects models were performed. Meta-regression and sensitivity analysis were done. The risk of bias was assessed using the Cochrane tools. RESULTS Among the 5601 publications, 6 studies involving 305 participants (mean age: 56 years, male: 56.6%) with all participants on maintenance hemodialysis met eligibility criteria. For efficacy, the progression in Agatston scores in the coronary arteries [107 patients, mean difference (MD): -241.27, 95% confidence interval (95% CI): -421.50 to -61.03] and iliac arteries (55 patients, MD: -382.00, 95% CI: -751.07 to -12.93) was lower in the STS treated group compared with controls. The increase in pulse wave velocity was lower in the STS group (104 patients, MD: -1.29 m/s, 95% CI: -2.24 to -0.34 m/s). No association was found between the change in calcification scores and STS regimen. For safety, gastrointestinal symptoms (e.g. nausea) and increased anion gap acidosis were noted. No reduction in BMD by STS was observed. CONCLUSIONS Intravenous STS may attenuate the progression of VC and arterial stiffness in hemodialysis patients. Large and well-designed randomized controlled trials are warranted.
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Affiliation(s)
- Wen Wen
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.,Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Scott Krinsky
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Sahir Kalim
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy Goverman
- Sumner Redstone Burn Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Vipul Chitalia
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Rajeev Malhotra
- Cardiovascular Research Center and the Cardiology Division of the Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rafael Kramann
- Division of Nephrology and Clinical Immunology, Medical Faculty RWTH Aachen University, Aachen, Germany.,Institute of Experimental Medicine and Systems Biology, Medical Faculty RWTH Aachen University, Aachen, Germany.,Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cindy K Malhotra
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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14
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Wen W, Krinsky S, Kroshinsky D, Durant O, He J, Seethapathy R, Hillien SAS, Mengesha B, Malhotra R, Chitalia V, Nazarian RM, Goverman J, Lyons KS, Nigwekar SU. Patient-Reported and Clinical Outcomes Among Patients With Calciphylaxis. Mayo Clin Proc Innov Qual Outcomes 2023; 7:81-92. [PMID: 36712824 PMCID: PMC9880339 DOI: 10.1016/j.mayocpiqo.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective To describe the pain intensity among hospitalized patients with calciphylaxis, elucidate the factors associated with pain improvement, and examine the link between pain improvement and clinical outcomes. Patients and Methods Patients were identified from the Partners Research Patient Data Registry and the Partners Calciphylaxis Registry and Biorepository (Clinicaltrials.gov ID: NCT03032835). Those with calciphylaxis requiring hospitalization for at least 14 consecutive days during the study period from May 2016 through December 2021 were included. Pain intensity was assessed using patient-reported pain scores on numerical rating scales from 0 to 10. Associations between pain improvement and clinical outcomes, including lesion improvement, amputation, and mortality, were examined using univariate and multivariate regression models. Results Our analysis included 111 patients (age, 58±14 years; men, 40%; on maintenance dialysis, 79%). No significant improvement of pain intensity was observed over the 14 days of hospitalization (mean difference, -0.71; P=.08). However, among 49 (44.1%) patients who showed at least 1-point improvement in the pain score, there was an association with surgical debridement during hospitalization (odds ratio, 3.37; 95% CI, 1.17-9.67; P=.02). Hyperbaric oxygen therapy was associated with pain improvement (odds ratio, 5.38; 95% CI, 1.14-25.50; P=.03) in patients on maintenance dialysis. Pain improvement was associated with lower rates of subsequent amputation at 6 months of follow up (6% vs 13%; P<.05) but did not predict lesion improvement or survival. Conclusion Pain control remains a challenge among hospitalized patients with calciphylaxis. Surgical debridement and hyperbaric oxygen therapy may improve pain intensity. Pain improvement predicted a lower risk of future amputation.
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Affiliation(s)
- Wen Wen
- Division of Nephrology, Massachusetts General Hospital, Boston, MA,Correspondence: Address to Wen Wen, MD, MMSc, Division of Nephrology, Massachusetts General Hospital, 165 Cambridge St, Suite 302, Boston, MA 02114.
| | - Scott Krinsky
- Division of Nephrology, Massachusetts General Hospital, Boston, MA
| | | | - Olivia Durant
- Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | | | | | | | - Beza Mengesha
- Division of Nephrology, Massachusetts General Hospital, Boston, MA
| | - Rajeev Malhotra
- Cardiovascular Research Center and the Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Boston, MA,Cardiovascular Research Center and the Cardiology Division of the Department of Medicine, Harvard Medical School, Boston, MA
| | - Vipul Chitalia
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA,Veterans Affairs Boston Healthcare System, Boston, MA,Institute of Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA
| | | | - Jeremy Goverman
- Sumner Redstone Burn Center, Massachusetts General Hospital, Boston, MA
| | - Karen S. Lyons
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
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15
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Ryan CM, Shapiro GD, Rencken CA, Griggs C, Jeng JC, Hickerson WL, Marino M, Goverman J, Kazis LE, Schneider JC. The Impact of Burn Size on Community Participation: A Life Impact Burn Recovery Evaluation (LIBRE) Study. Ann Surg 2022; 276:1056-1062. [PMID: 33351466 PMCID: PMC8265012 DOI: 10.1097/sla.0000000000004703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the association of burn size and community participation as measured by the LIBRE Profile. SUMMARY OF BACKGROUND DATA Burn size is an established clinical predictor of survival after burn injury. It is often a factor in guiding decisions surrounding early medical interventions; however, literature is inconclusive on its relationship to quality of life outcomes. METHODS This is a secondary data analysis of a cross-sectional survey of adult burn survivors. Self-reported data were collected between October 2014 and December 2015 from 601 burn survivors aged ≥18 years with ≥5% total body surface area (TBSA) or burns to critical areas. Sociodemographic characteristics were compared between participants with small burns (≤40% TBSA burned) and large burns (>40% TBSA burned). Ordinary least squares regression models examined associations between burn size and LIBRE Profile scale scores with adjustments for sex, current work status, burns to critical areas, and time since burn injury. RESULTS The analytic sample comprised 562 participants with data available for burn size. 42% of respondents had large burns (>40% TBSA burned) and 58% reported smaller burns (TBSA ≤40%). In adjusted regression models, patients with large burns tended to score lower on the Social Activities and Work & Employment scales ( P < 0.05) and higher on the Family & Friends scale ( P < 0.05). Participants with burns >40% TBSA scored lower for several individual items in the Social Activities scale and one item in the Work & Employment scale ( P < 0.05). CONCLUSIONS Increasing burn size was found to be negatively associated with selected items of Work & Employment and Social Activities, but positively associated with aspects of Family & Friend Relationships. Future longitudinal studies are necessary to assess and understand the long-term social impact of burn injuries on adult populations.
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Affiliation(s)
- Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Cornelia Griggs
- New York Presbyterian/Morgan Stanley Children’s Hospital Department of Pediatric Radiology and Surgery, New York, NY, USA
| | - James C. Jeng
- Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, PA
| | | | - Molly Marino
- Quality Measurement and Health Policy Program, RTI International, Waltham, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
- Spaulding Research Institute, Boston, MA
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16
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Kuriyama N, Nakamura T, Nakazawa H, Wen T, Berra L, Bittner EA, Goverman J, Kaneki M. Bioavailability of Reduced Coenzyme Q10 (Ubiquinol-10) in Burn Patients. Metabolites 2022; 12:metabo12070613. [PMID: 35888737 PMCID: PMC9321044 DOI: 10.3390/metabo12070613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial dysfunction has been implicated in the pathogenesis of inflammation and multi-organ dysfunction in major trauma, including burn injury. Coenzyme Q10 (CoQ10) is a metabolite of the mevalonate pathway and an essential cofactor for the electron transport in the mitochondria. In addition, its reduced form (ubiquinol) functions as an antioxidant. Little is known as to whether oral CoQ10 supplementation effectively increases intracellular CoQ10 levels in humans. To study the bioavailability of CoQ10 supplementation, we conducted a randomized, double-blind, placebo-controlled study of reduced CoQ10 (ubiquinol-10) (1800 mg/day, t.i.d.) in burn patients at a single, tertiary-care hospital. Baseline plasma CoQ10 levels were significantly lower in burn patients than in healthy volunteers, although plasma CoQ10/cholesterol ratio did not differ between the groups. CoQ10 supplementation increased plasma concentrations of total and reduced CoQ10 and total CoQ10 content in peripheral blood mononuclear cells (PBMCs) in burn patients compared with the placebo group. CoQ10 supplementation did not significantly change circulating levels of mitochondrial DNA, inflammatory markers (e.g., interleukins, TNF-α, IFN-γ), or Sequential Organ Failure Assessment (SOFA) scores compared with the placebo group. This study showed that a relatively high dose of reduced CoQ10 supplementation increased the intracellular CoQ10 content in PBMCs as well as plasma concentrations in burn patients.
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Affiliation(s)
- Naohide Kuriyama
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA; (N.K.); (T.N.); (H.N.); (T.W.); (L.B.); (E.A.B.)
- Shriners Hospitals for Children, 51 Blossom Steet, Boston, MA 02114, USA
| | - Tomoyuki Nakamura
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA; (N.K.); (T.N.); (H.N.); (T.W.); (L.B.); (E.A.B.)
- Shriners Hospitals for Children, 51 Blossom Steet, Boston, MA 02114, USA
| | - Harumasa Nakazawa
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA; (N.K.); (T.N.); (H.N.); (T.W.); (L.B.); (E.A.B.)
- Shriners Hospitals for Children, 51 Blossom Steet, Boston, MA 02114, USA
| | - Tyler Wen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA; (N.K.); (T.N.); (H.N.); (T.W.); (L.B.); (E.A.B.)
- Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604, USA
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA; (N.K.); (T.N.); (H.N.); (T.W.); (L.B.); (E.A.B.)
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA; (N.K.); (T.N.); (H.N.); (T.W.); (L.B.); (E.A.B.)
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA;
| | - Masao Kaneki
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA; (N.K.); (T.N.); (H.N.); (T.W.); (L.B.); (E.A.B.)
- Shriners Hospitals for Children, 51 Blossom Steet, Boston, MA 02114, USA
- Correspondence: ; Tel.: +617-726-8122; Fax: 617-726-8134
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17
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Holzer P, Chang EJ, Lu D, Adkins J, Rogers K, Man A, Chang K, Wicks J, Ko DSC, Schulz JT, Kaiser RA, Swartz HM, Cetrulo CL, Monroy R, Goverman J. 90 Efficacy of Porcine Skin Xenotransplants Indistinguishable from Allograft in First-in-human Clinical Evaluation. J Burn Care Res 2022. [PMCID: PMC8946259 DOI: 10.1093/jbcr/irac012.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction Human cadaver allograft (HCA) is the current standard of care for temporary wound closure of large burns, but a critical need for high-quality alternatives exists. Porcine skin shares many similarities with human skin, and hyperacute rejection is prevented via a single genetic modification. Like human skin, non-terminally sterilized porcine skin contains viable dermal and epidermal cells and intact vasculature that enables restoration of barrier function. These characteristics are distinct from those of traditional, terminally sterilized “xenografts” and may offer greater therapeutic capability. We report here key efficacy outcomes specific to severe burn care from a first-in-human clinical trial to assess the capability of genetically engineered porcine skin xenotransplants to provide temporary wound closure for severe and extensive deep-partial and full-thickness burn wounds, compared to HCA. Methods Split-thickness skin containing epidermal and dermal layers was harvested from Designated Pathogen Free, GalT-KO, porcine donors, cGMP processed to achieve USP< 71 > sterility and cryopreserved to retain >70% cell viability. These were transplanted side by side with HCA on debrided full-thickness burn wounds in six human subjects. Temporary wound closure, incidence of complete wound closure following autografting, and quality of healing, including scarring, contour, and feel of healed skin, normalization of skin markings or pigmentation, were independently assessed. Results Across all patients and assessment time points, adherence, vascularity, and overall appearance were indistinguishable between porcine skin xenotransplants and HCA control. After surgical removal, wound beds treated with each type of dressing were perfused and otherwise appeared equivalent and clinically suitable for autografting. Long-term outcomes were comparable between wound sites treated with porcine skin or HCA with no discernable differences in scarring or cosmesis. Conclusions Skin xenotransplants effectively provided temporary wound closure and restoration of barrier function via intact native vasculature, active cells, decreased antigenicity, and high-quality tissue architecture unimpacted by cryopreservation and thawing. These results show clinical promise as an interchangeable alternative to HCA in the treatment of severe burns. Expanded clinical evaluation is ongoing.
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Affiliation(s)
- Paul Holzer
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Elizabeth J Chang
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Diana Lu
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Jon Adkins
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Kaitlyn Rogers
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Angela Man
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Kristina Chang
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Joan Wicks
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Dicken S C Ko
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - John T Schulz
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Robert A Kaiser
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Harold M Swartz
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Curtis L Cetrulo
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Rod Monroy
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Jeremy Goverman
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
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18
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Nunez JH, Park C, Clark A, Akarichi C, Arnoldo B, Mandell SP, Carlson DL, Huebinger RM, Chan RK, Goverman J, Mironov S, Levi B, Berenfeld O. 533 Human Case Characterizations of Skin Burn Using Novel Multi-Spectral Short Wave Infrared Imaging. Journal of Burn Care & Research 2022. [PMCID: PMC8946290 DOI: 10.1093/jbcr/irac012.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Determining the depth of skin burns in patients is critical for surgical decision making, but currently lacks accuracy in clinical practice. Short-wave infrared (SWIR) light penetrates tissue more than visual or near-infrared light and is very sensitive to water content. We have shown in animal models that imaging of skin burns in the SWIR range distinguishes between superficial and deep tissue necrosis. Here we present the first 2 cases of multi-spectral SWIR imaging of human burn injury as a first step toward a non-invasive, label-free, technique for burn depth determination. Methods Two subjects admitted for mixed depth, thermal, 6% and 7% total body surface area (TBSA), burns were studied. Prior to burn excision, a novel system, based on a specialized camera, imaged the burn areas and normal skin at 4 different SWIR bands. Standard photographs from imaged areas were collected and presented for 5 independent, blinded, surgeons’ assessments. In SWIR images, 3-5 regions of interest (ROIs) were selected in burned and adjacent normal skin and the reflected light intensity in each ROI was averaged. Results Visual and SWIR images were collected for 9 burn areas in the hands, arms, and shoulder of 2 patients (Panel A). Fifty ROIs from the burn areas were assessed by the surgeons and 30 (60%) ROIs were agreed as being superficial or superficial partial thickness (n=5), deep partial thickness (n=11), or full thickness (n=14) burns by a majority (60% or above consensus together with a possible disagreement only between deep partial and full thickness burn). In Panel B the cumulative SWIR reflectance intensity at the 4 SWIR bands for the 3 burn groups, determined by expert surgeon evaluation, and normal skin are compared. The reflectance from superficial and superficial partial thickness burns (yellow) were 102.7±1.2%, 102.3±0.7% and 103.4±1.4% of the normal skin reflectance for 1200, 1650 and 1940 nm, respectively. On the other hand, the reflectance from deep partial thickness burns (grey) were 96.7±0.1% and 94.7±0.1%, and for full thickness burn (red) were 96.1±1.4% and 93.7±1.6% of normal skin reflectance for 1650 and 1940 nm, respectively. Conclusions We present the first human SWIR study demonstrating a distinct reflectance intensity of SWIR wavelengths for different burn depths based on surgeon assessments. The results motivate further studies of SWIR imaging of burns in the hope to non-invasively and accurately identify operative versus non-operative burns.
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Affiliation(s)
- Johanna H Nunez
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Caroline Park
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Audra Clark
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Chiaka Akarichi
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Brett Arnoldo
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Samuel P Mandell
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Deborah L Carlson
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Ryan M Huebinger
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Rodney K Chan
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Jeremy Goverman
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Sergey Mironov
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Benjamin Levi
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Omer Berenfeld
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
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19
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Stockly OR, Wolfe AE, Goldstein R, Roaten K, Wiechman S, Trinh NH, Goverman J, Stoddard FJ, Zafonte R, Ryan CM, Schneider JC. Predicting Depression and Post-Traumatic Stress Symptoms Following Burn Injury: A Risk Scoring System. J Burn Care Res 2021; 43:899-905. [PMID: 34751379 DOI: 10.1093/jbcr/irab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Depression and post-traumatic stress are common psychiatric comorbidities following burn injury. The purpose of this study was to develop an admission scoring system that assesses the risk of development of depression or post-traumatic symptoms in the burn population. This study is a retrospective review of the prospectively collected Burn Model System National Database. Adult burn survivors enrolled from 2014-2018 (n=486) were included. The primary outcome was the presence of depression or post-traumatic stress symptoms at 6, 12, or 24 months post-injury. Logistic regression analysis was used to identify demographic and clinical predictors of depression and post-traumatic stress symptoms. A risk scoring system was then created based on assigning point values to relevant predictor factors. The study population had a mean age of 46.5±15.8 years, mean burn size of 18.3±19.7%, and was 68.3% male. Prior to injury, 71.3% of the population was working, 47.9% were married, and 50.8% had completed more than a high school education. An 8-point risk scoring system was developed using the following predictors of depression or post-traumatic stress symptom development: gender, psychiatric treatment in the past year, graft size, head/neck graft, etiology of injury, and education level. This study is the first to develop a depression and post-traumatic stress symptom risk scoring system for burn injury. This scoring system will aid in identifying burn survivors at high risk of long-term psychiatric symptoms that may be used to improve screening, monitoring, timely diagnosis and interventions.
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Affiliation(s)
- Olivia R Stockly
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Nhi-Ha Trinh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Harvard Medical School, Boston, MA.,Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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20
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Gasteratos K, Paladino JR, Murray WB, Goverman J. Video-Assisted Simulation Training in Burn Management: A Comparative Cohort Study on the Assessment of Technical and Non-technical Competencies. Injury 2021; 52:2154-2159. [PMID: 33773802 DOI: 10.1016/j.injury.2021.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Written material remains one of the most common methods of education, however the current generation of learners may benefit from additional different media. In our study, we aim to quantify the effects of an innovative video instruction on subsequent resident performance in a burn patient simulation. METHODS Following IRB approval, 60 Plastic Surgery residents were randomly assigned to two groups. The control group ("non-video" group) (n = 30) was given only written material as preparation. The experimental group ("video" group) (n = 30) was provided access to video training materials in addition to the written material on technical and non-technical skills. Their videotaped performances on simulation were evaluated by a blinded surgical faculty member. The comparison of variables between the two groups was performed using a Mann-Whitney test for non-normal distributions of quantitative variables, and Fisher's Exact Probability test for qualitative data. Statistical significance was set at p < 0.05. RESULTS Compared to the non-video group, the video group achieved significantly higher scores in the technical skills of assessment of breathing (p = 0.015), disability (p = 0.023), and exposure (p = 0.005) and in the non-technical skills of decision-making (p = 0.035). CONCLUSIONS In residents participating in burn patient simulations, video training in advance of the simulation significantly improved their assessments of breathing, disability, and exposure as well as decision-making. Our video is a valuable tool to enhance trainees' technical and non-technical competencies in managing burn patient simulations.
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Affiliation(s)
- Konstantinos Gasteratos
- Department of Plastic and Reconstructive Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Joseph Robert Paladino
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - W Bosseau Murray
- Anesthesiology, Pennsylvania State University College of Medicine at Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Jeremy Goverman
- Massachusetts General Hospital, Burns Center, Harvard Medical School, Boston, MA, United States.
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21
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Yelvington M, Godleski M, Lee AF, Goverman J, Parry I, Herndon DN, Suman OE, Kowalske K, Holavanahalli R, Gibran NS, Esselman PC, Ryan CM, Schneider JC. Contracture Severity at Hospital Discharge in Children: A Burn Model System Database Study. J Burn Care Res 2021; 42:425-433. [PMID: 33247583 DOI: 10.1093/jbcr/iraa169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Contractures can complicate burn recovery. There are limited studies examining the prevalence of contractures following burns in pediatrics. This study investigates contracture outcomes by location, injury, severity, length of stay, and developmental stage. Data were obtained from the Burn Model System between 1994 and 2003. All patients younger than the age of 18 with at least one joint contracture at hospital discharge were included. Sixteen areas of impaired movement from the shoulder, elbow, wrist, hand, hip, knee, and ankle joints were examined. Analysis of variance was used to assess the association between contracture severity, burn size, and length of stay. Age groupings were evaluated for developmental patterns. A P value of less than .05 was considered statistically significant. Data from 225 patients yielded 1597 contractures (758 in the hand) with a mean of 7.1 contractures (median 4) per patient. Mean contracture severity ranged from 17% (elbow extension) to 41% (ankle plantarflexion) loss of movement. Statistically significant associations were found between active range of motion loss and burn size, length of stay, and age groupings. The data illustrate quantitative assessment of burn contractures in pediatric patients at discharge in a multicenter database. Size of injury correlates with range of motion loss for many joint motions, reflecting the anticipated morbidity of contracture for pediatric burn survivors. These results serve as a potential reference for range of motion outcomes in the pediatric burn population, which could serve as a comparison for local practices, quality improvement measures, and future research.
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Affiliation(s)
| | | | - Austin F Lee
- Massachusetts General Hospital, Boston.,University of Massachusetts Medical School, Worcester
| | - Jeremy Goverman
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ingrid Parry
- Shriners Hospital for Children, Northern California/UC Davis Medical Center, Sacramento
| | - David N Herndon
- University of Texas Medical Branch, Shriners Hospitals for Children, Galveston
| | - Oscar E Suman
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Boston
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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22
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Thorpe CR, Ucer Ozgurel S, Simko LC, Goldstein R, Grant GG, Pagani C, Hwang C, Vasquez K, Sorkin M, Vaishampayan A, Goverman J, Sheridan RL, Friedstat J, Schulz JT, Schneider JC, Levi B, Ryan CM. Investigation into Possible Association of Oxandrolone and Heterotopic Ossification Following Burn Injury. J Burn Care Res 2020; 40:398-405. [PMID: 31053861 DOI: 10.1093/jbcr/irz063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oxandrolone, a testosterone analog, is used to counteract the catabolic effects of burn injury. Recent animal studies suggest a possible hormonal association with heterotopic ossification (HO) development postburn. This work examines oxandrolone administration and HO development by exploring historical clinical data bridging the introduction of oxandrolone into clinical practice. Additionally, we examine associations between oxandrolone administration and HO in a standardized mouse model of burn/trauma-related HO. Acutely burned adults admitted between 2000 and 2014, survived through discharge, and had a HO risk factor of 7 or higher were selected for analysis from a single burn center. Oxandrolone administration, clinical and demographic data, and elbow HO were recorded and were analyzed with logistic regression. Associations of oxandrolone with HO were examined in a mouse model. Mice were administered oxandrolone or vehicle control following burn/tenotomy to examine any potential effect of oxandrolone on HO and were analyzed by Student's t test. Subjects who received oxandrolone had a higher incidence of elbow HO than those that did not receive oxandrolone. However, when controlling for oxandrolone administration, oxandrolone duration, postburn day oxandrolone initiation, HO risk score category, age, sex, race, burn size, and year of injury, there was no significant difference between rates of elbow HO between the two populations. In agreement with the review, in the mouse model, while there was a trend toward the oxandrolone group developing a greater volume of HO, this did not reach statistical significance.
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Affiliation(s)
- Catherine R Thorpe
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | - Laura C Simko
- Shriners Hospitals for Children-Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Gabrielle G Grant
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | | | | | | | | | - Jeremy Goverman
- Massachusetts General Hospital, Boston.,Harvard Medical School, Cambridge, Massachusetts
| | - Robert L Sheridan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jonathan Friedstat
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - John T Schulz
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jeffrey C Schneider
- Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Benjamin Levi
- Shriners Hospitals for Children-Boston, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
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23
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Yelvington ML, Godleski M, Lee AF, Goverman J, Herndon DN, Suman OE, Kowalske KJ, Holavanahalli RK, Gibran NS, Esselman PC, Simko LC, Ryan CM, Schneider JC. A Comparison of Contracture Severity at Acute Discharge in Patients With and Without Heterotopic Ossification: A Burn Model System National Database Study. J Burn Care Res 2020; 40:349-354. [PMID: 30838385 DOI: 10.1093/jbcr/irz031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study assesses the association between heterotopic ossification and upper extremity contracture by comparing goniometric measured active range of motion outcomes of patients with and without heterotopic ossification. Data were obtained from the Burn Model System National Database between 1994 and 2003 for patients more than 18 years with elbow contracture at acute discharge. Absolute losses in elbow range of motion were compared for those with and without radiologic evidence of heterotopic ossification (location undefined) and were further examined by burn size subgroups using Wilcoxon rank-sum test. Differences in elbow range of motion were estimated using regression models, adjusted for demographic and clinical variables. Loss of range of motion of shoulder, wrist, forearm, and hand were also compared. From 407 instances of elbow contracture, the subjects with heterotopic ossification were found to have greater median absolute loss of elbow flexion among all survivors (median 50° [IQR 45°] vs 20° [30°], P < .0001), for the 20 to 40% total body surface area burn subgroup (70° [20°] vs 20° [30°], P = .0008) and for the >40% subgroup (50° [45°] vs 30° [32°], P = .03). The adjusted estimate of the mean difference in the absolute loss of elbow flexion between groups was 23.5° (SE ±7.2°, P = .0013). This study adds to our understanding of the potential effect of heterotopic ossification on upper extremity joint range of motion, demonstrating a significant association between the presence of heterotopic ossification and elbow flexion contracture severity. Further study is needed to determine the functional implications of heterotopic ossification and develop treatment protocols.
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Affiliation(s)
| | - Matthew Godleski
- Ross Tilley Burn Centre/St. John's Rehab, University of Toronto, Canada
| | - Austin F Lee
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jeremy Goverman
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - David N Herndon
- Shriners Hospitals for Children, University of Texas Medical Branch, Galveston
| | | | | | | | | | | | - Laura C Simko
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colleen M Ryan
- Shriners Hospitals for Children, Massachusetts General Hospital, Boston
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
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24
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Affiliation(s)
- Harold D Waller
- 1 Department of Surgery, Massachusetts General Hospital, Boston, MA, US
| | | | - Jeremy Goverman
- 1 Department of Surgery, Massachusetts General Hospital, Boston, MA, US
| | - Haytham Kaafarani
- 1 Department of Surgery, Massachusetts General Hospital, Boston, MA, US
| | - Anahita Dua
- 2 Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School. Boston MA, US
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25
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Shanbhag SS, Chodosh J, Fathy C, Goverman J, Mitchell C, Saeed HN. Multidisciplinary care in Stevens-Johnson syndrome. Ther Adv Chronic Dis 2020; 11:2040622319894469. [PMID: 32523661 PMCID: PMC7236394 DOI: 10.1177/2040622319894469] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are potentially fatal mucocutaneous diseases that can involve many organ systems. Manifestations of SJS/TEN outside of the skin, eyes, and oral mucosa are not well defined or well recognized, and, therefore, are often not addressed clinically. As supportive care improves and mortality from SJS/TEN decreases, chronic complications in affected organ systems are becoming more prevalent. Recognition of the manifestations of SJS/TEN in the acute phase is critical to optimal care. In this review, we review the organ systems that may be involved in SJS/TEN, provide an overview of their management, and propose a list of items that should be communicated to the patient and family upon discharge. The organ systems discussed include the pulmonary, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic, genitourinary, and renal systems. In addition, the significant psychosocial, nutritional, and pain consequences and management of SJS/TEN are discussed.
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Affiliation(s)
- Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Cherie Fathy
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Sumner Redstone Burn Center, Boston, MA, USA
| | - Caroline Mitchell
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA
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Wong SL, Goverman J, Staudinger C, Wagner DD. Recombinant human ADAMTS13 treatment and anti-NET strategies enhance skin allograft survival in mice. Am J Transplant 2020; 20:1162-1169. [PMID: 31730284 PMCID: PMC7103495 DOI: 10.1111/ajt.15703] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/18/2019] [Accepted: 11/07/2019] [Indexed: 01/25/2023]
Abstract
Enhancing skin allograft longevity lessens the need for new allografts before optimal intervention is available. Reduced activity of ADAMTS13 (an enzyme that cleaves the pro-thrombotic and proinflammatory von Willebrand factor) and presence of neutrophil extracellular traps (NETs) have been implicated in liver and lung allograft failures. The effect of ADAMTS13 treatment and the impact of NETs on skin allografts, however, remain unexplored. Here, we adopted a murine model of complete mismatch full-thickness skin transplant by grafting dorsal skin from BALB/c mice to C57BL/6J background mice. Recombinant human ADAMTS13 (rhADAMTS13) treatment of graft recipients increased allograft survival. Western blot and immunofluorescence microscopy revealed the presence of NETs in allografts of vehicle, but surprisingly, not in rhADAMTS13-treated mice, 3 days after surgery. Recapitulating the observations in mice, NETs were also observed in all the examined allografts from burn patients. Intriguingly, knocking out peptidylarginine deiminase 4 (PAD4, a key enzyme for NET formation) or DNase 1 treatment (which cleaves NETs) also prolonged allograft survival. In summary, rhADAMTS13 lessens inflammation in allografts by reducing NET burden, resulting in enhanced allograft survival. RhADAMTS13 and anti-NET treatments could be new therapeutic strategies to promote skin allograft longevity and, hence, the survival of patients with severe burns.
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Affiliation(s)
- Siu Ling Wong
- Program in Cellular and Molecular Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, Current institution: Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - Caleb Staudinger
- Program in Cellular and Molecular Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Denisa D. Wagner
- Program in Cellular and Molecular Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Division of Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
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Pham TN, Goldstein R, Carrougher GJ, Gibran NS, Goverman J, Esselman PC, Kazis LE, Ryan CM, Schneider JC. The impact of discharge contracture on return to work after burn injury: A Burn Model System investigation. Burns 2020; 46:539-545. [PMID: 32088093 DOI: 10.1016/j.burns.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine the association of extremity contractures with employment after burn injury. METHODS We obtained data from the Burn Model System database from 1994 to 2003. We included in the study cohort all adult patients who were working prior to injury and identified those discharged with and without a contracture in one of the major extremity joints (shoulder, elbow, wrist, hip, knee and ankle). We classified contracture severity according to mild, moderate and severe categories. We performed descriptive analyses and predictive modeling to identify injury and patient factors associated with return to work (RTW) at 6, 12, and 24 months. RESULTS A total of 1,203 participant records met criteria for study inclusion. Of these, 415 (35%) had developed a contracture at discharge; 9% mild, 12% moderate, and 14% severe. Among 801 (67%) participants who had complete data at 6 months after discharge, 70% of patients without contracture had returned to work compared to 45% of patients with contractures (p < 0.001). RTW increased at each subsequent follow-up time point for the contracture group, however, it remained significantly lower than in no-contracture group (both p < 0.01). In multivariable analyses, female sex, non-Caucasian ethnicity, larger burn size, alcohol abuse, number of in-hospital operations, amputation, and in-hospital complications were associated with a lower likelihood of employment. In adjusted analyses, discharge contracture was associated with a lower probability of RTW at all 3 time points, although its impact significantly diminished at 24 months. CONCLUSIONS This study indicates an association between discharge contracture and reduced employment 6, 12 and 24 months after burn injury. Among many other identified patient, injury, and hospitalization related factors that are barriers to RTW, the presence of a contracture at discharge adds a significant reintegration burden for working-age burn patients.
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Affiliation(s)
- Tam N Pham
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States.
| | - Richard Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Nicole S Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Jeremy Goverman
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, United States
| | - Lewis E Kazis
- Department of Health Law and Policy and Management, Boston University School of Public Health, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
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28
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Christensen JM, Shanbhag SS, Shih GC, Goverman J, Pomahac B, Chodosh J, Ehrlichman RJ. Multidisciplinary Treatment to Restore Vision in Ocular Burns. J Burn Care Res 2019; 41:859-865. [PMID: 31808803 DOI: 10.1093/jbcr/irz201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Periorbital burns generate contraction and distortion of periorbital soft tissue, causing eyelid malfunction, further contributing to loss of vision from corneal scarring or perforation. We present our multidisciplinary algorithm to restore vision in patients with burn-related bilateral corneal blindness with light perception. Chart review was performed for four consecutive burn patients requiring periocular reconstruction and keratoprosthesis. Initial treatment included globe coverage with eyelid releases and grafts. Strategy of corneal replacement was determined by eyelid position and function and sufficiency of tear production. All patients were corneal blind with light perception only and cicatricial ectropion. The eye with better visual prognosis was reconstructed. Eyelid reconstruction procedures consisted of lid releases with full-thickness skin graft (FTSG) or split-thickness skin graft (STSG). Two patients regained adequate lid function and underwent standard keratoprosthesis placement. Two underwent mucous membrane grafts followed by keratoprosthesis. All patients experienced improved postoperative vision in their reconstructed eye. Corneal injury due to periocular burns can lead to blindness. Early involvement of ophthalmology, protective measures, and early ectropion release are critical. For severe burns, a multidisciplinary approach, where adequate globe protection is followed by keratoprosthesis placement, can effectively restore vision in patients with burn-related corneal blindness.
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Affiliation(s)
- Joani M Christensen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston
| | | | - Grace C Shih
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Richard J Ehrlichman
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston
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Sheckter CC, Goverman J. Reply: The impact of skin allograft on inpatient outcomes in the treatment of major burns 20-50% total body surface area - A propensity score matched analysis using the nationwide inpatient sample. Burns 2019; 45:1487-1488. [PMID: 31176510 DOI: 10.1016/j.burns.2019.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Clifford C Sheckter
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA, United States.
| | - Jeremy Goverman
- Division of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Friedstat JS, Stockley O, Chang K, Levin J, Sangji N, Sheridan R, Schulz JT, Kasis L, Ryan CM, Goverman J, Schneider JC. 310 Evaluation of Patient Reported Outcomes Before and After Burn Reconstruction. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J S Friedstat
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - O Stockley
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - K Chang
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - J Levin
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - N Sangji
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - R Sheridan
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - J T Schulz
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - L Kasis
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - C M Ryan
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - J Goverman
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
| | - J C Schneider
- Massachusetts General Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University, Boston, MA; Spaulding Rehabiliation Hospital, Boston, MA
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31
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Sangji NF, Levin JM, Friedstat JS, Goverman J, Chang KM, Schulz JT. 475 Acute and Reconstructive Burn Surgery with a Bilaminate Polyurethane Skin Substitute: A Case Series. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- N F Sangji
- Massachusetts General Hospital, Boston, MA
| | - J M Levin
- Massachusetts General Hospital, Boston, MA
| | | | - J Goverman
- Massachusetts General Hospital, Boston, MA
| | - K M Chang
- Massachusetts General Hospital, Boston, MA
| | - J T Schulz
- Massachusetts General Hospital, Boston, MA
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32
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Shoham Y, Tsur R, Krieger Y, Silberstein E, Ayzenberg T, Maor E, Haik J, Goverman J. 332 Topical Steroids for Suppression of Granulation Tissue in Burns: Results of an ABA Member Survey. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Y Shoham
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
| | - R Tsur
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
| | - Y Krieger
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
| | - E Silberstein
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
| | - T Ayzenberg
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
| | - E Maor
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
| | - J Haik
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
| | - J Goverman
- Soroka University Medical Center, Beer Sheba, Israel; Sheba Medical Center, Tel Hashomer, Israel; Mass General Hospital, Boston, MA
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33
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Sangji NF, Levin JM, Schulz III JT, Friedstat JS, Chang KM, Brown DJ, Goverman J. 346 Silver Impregnated Silicon Foam Dressing Leads to Fewer Donor Site Infections Compared to Petroleum Gauze: A Retrospective Review. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N F Sangji
- Massachusetts General Hospital, Boston, MA
| | - J M Levin
- Massachusetts General Hospital, Boston, MA
| | | | | | - K M Chang
- Massachusetts General Hospital, Boston, MA
| | - D J Brown
- Massachusetts General Hospital, Boston, MA
| | - J Goverman
- Massachusetts General Hospital, Boston, MA
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34
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Olaniran KO, Percy SG, Zhao S, Blais C, Jackson V, Kamdar MM, Goverman J, Kroshinsky D, Temel JS, Nigwekar SU, Eneanya ND. Palliative Care Use and Patterns of End-of-Life Care in Hospitalized Patients With Calciphylaxis. J Pain Symptom Manage 2019; 57:e1-e3. [PMID: 30399415 PMCID: PMC6476330 DOI: 10.1016/j.jpainsymman.2018.10.514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Kabir O Olaniran
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Shananssa G Percy
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sophia Zhao
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chantal Blais
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mihir M Kamdar
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy Goverman
- Summer M. Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Temel
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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35
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Portales-Castillo I, Kroshinsky D, Malhotra CK, Culber-Costley R, Cozzolino MG, Karparis S, Halasz CL, Goverman J, Manley HJ, Malhotra R, Nigwekar SU. Calciphylaxis-as a drug induced adverse event. Expert Opin Drug Saf 2018; 18:29-35. [DOI: 10.1080/14740338.2019.1559813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Cindy K. Malhotra
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Roberta Culber-Costley
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mario Gennaro Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | - Shelly Karparis
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Charles L. Halasz
- Department of Dermatology, Columbia University Medical Center, New York, NY, USA
| | - Jeremy Goverman
- Burn Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harold J. Manley
- Reach Medication Therapy Management, Dialysis Clinic, Inc., Albany, NY, USA
| | - Rajeev Malhotra
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sagar U. Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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36
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37
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Chen L, Lee AF, Shapiro GD, Goverman J, Faoro N, Schneider JC, Kazis LE, Ryan CM. The Development and Validity of the Adult Burn Outcome Questionnaire Short Form. J Burn Care Res 2018; 39:771-779. [PMID: 29931275 PMCID: PMC9834984 DOI: 10.1093/jbcr/irx043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient Reported Outcome Measures (PROMs) are useful for understanding the health needs and outcomes of the general public. We aim to develop a burn-specific metric-Adult Burn Outcome Questionnaire (ABOQ)-that is brief and can be administered electronically to all burn survivors over the age of 18. The 14-item ABOQ was developed from the already validated Young Adult Burn Outcome Questionnaire (YABOQ) long form. The ABOQ questionnaire, along with Patient-Reported Outcomes Measurement System-10 (PROMIS-10), was administered to 120 outpatient burn survivors at three hospitals. Clinical validity of the ABOQ was measured by testing associations between ABOQ items and burn size, the PROMIS-10 generic items and composite scales using correlational analysis including multivariate canonical analysis. Nine out of 14 ABOQ items were significantly correlated with burn size (correlations ranging from -0.25 to -0.46, P < .01). The canonical correlation between ABOQ and burn size was 0.68 (P = .0002). The overall canonical correlation between two instruments was also significant (P < .0001). At the item level, at least 25% of the variation in each of the five ABOQ items could be explained by PROMIS-10 items and composite scores, while six other items could only be accounted for by less than 15% of the variation. ABOQ short form assessment can be used to efficiently measure burn outcomes across a range of relevant clinical domains with credible validity. A large proportion of the variation in ABOQ scores was not accounted for by PROMIS-10, suggesting that ABOQ provided additional health-related information specifically for the burn population beyond the generic instrument.
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Affiliation(s)
- Liang Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts,Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Austin F. Lee
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts,School of Insurance and Economics, University of International Business and Economics, Beijing, China,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts
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38
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Hickey S, Goverman J, Friedstat J, Sheridan R, Schulz J. Thermal injuries from exploding electronic cigarettes. Burns 2018; 44:1294-1301. [DOI: 10.1016/j.burns.2018.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/11/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
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39
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Godleski M, Lee AF, Goverman J, Herndon DN, Suman OE, Kowalske KJ, Holavanahalli RK, Gibran NS, Esselman PC, Simko LC, Ryan CM, Schneider JC. Quantifying Contracture Severity at Hospital Discharge in Adults: A Burn Model System National Database Study. J Burn Care Res 2018; 39:604-611. [PMID: 29901805 PMCID: PMC9218764 DOI: 10.1093/jbcr/irx027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Contracture is a common complication of burn injury and can cause significant barriers to functional recovery and rehabilitation. There are limited studies of quantitative range of motion after burn injury. The purpose of this study is to examine quantitative contracture outcomes by anatomical location, burn size, and length of stay in adults. Data were obtained from the Burn Model System National Database from 1994 to 2003. All adult patients with a joint contracture at acute discharge were included and 16 joint motions were examined. Contractures were reported as both mean absolute loss of normal range of motion in degrees and percent loss of normal range of motion. Analysis of variance was used to assess for a linear trend for contracture severity by burn size and length of stay. Data from 659 patients yielded 6,228 instances of contracture. Mean absolute loss of normal range of motion ranged from 20° to 65° representing an 18 to 45% loss of normal movement across the studied joint motions. In the majority of joint motions, contracture severity significantly increased with larger burn size and longer length of stay; however, wrist and many lower extremity joint movements did not demonstrate this trend. The data illustrate the quantitative assessment of range of motion deficits in adults with burn injury at discharge and the relation to burn size and length of stay.
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Affiliation(s)
- Matthew Godleski
- Department of Physical Medicine & Rehabilitation, Ross Tilley Burn Centre, St. John’s Rehab, University of Toronto, Toronto, Ontario, Canada
| | - Austin F. Lee
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - David N. Herndon
- Department of Surgery, University of Texas Medical Branch, Shriners Hospitals for Children, Galveston, Texas
| | - Oscar E. Suman
- Department of Surgery, University of Texas Medical Branch, Shriners Hospitals for Children, Galveston, Texas
| | - Karen J. Kowalske
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Radha K. Holavanahalli
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington
| | - Peter C. Esselman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Laura C. Simko
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey C. Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
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40
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Shoham Y, Tsur R, Krieger Y, Silberstein E, Bogdanov-Berezovsky A, Maor U, Ayzenberg T, Rosenberg L, Haik J, Harats M, Goverman J. 361 Topical Steroid Treatment for Suppression of Granulation Tissue in Burns: Results of a European Survey. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Y Shoham
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - R Tsur
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - Y Krieger
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - E Silberstein
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - A Bogdanov-Berezovsky
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - U Maor
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - T Ayzenberg
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - L Rosenberg
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - J Haik
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - M Harats
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
| | - J Goverman
- Soroka University Medical Center, Beer Sheva,Israel; Meir Medical Center, Kfar Saba,Israel; Sheba Medical Center, Tel Hashomer,Israel; Mass General Hospital, Boston, MA
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Wells C, Dellheim V, Goverman J, Ryan CM, Schneider JC. 492 Development of a Decision Tree to Assist with Treatment of Burn-Related Ankle Contractures. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C Wells
- Spaulding Rehabilitation Hospital, Charlestown, MA; Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital Harvard Medical School and Shriners Hospitals for Children, Boston, MA
| | - V Dellheim
- Spaulding Rehabilitation Hospital, Charlestown, MA; Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital Harvard Medical School and Shriners Hospitals for Children, Boston, MA
| | - J Goverman
- Spaulding Rehabilitation Hospital, Charlestown, MA; Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital Harvard Medical School and Shriners Hospitals for Children, Boston, MA
| | - C M Ryan
- Spaulding Rehabilitation Hospital, Charlestown, MA; Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital Harvard Medical School and Shriners Hospitals for Children, Boston, MA
| | - J C Schneider
- Spaulding Rehabilitation Hospital, Charlestown, MA; Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital Harvard Medical School and Shriners Hospitals for Children, Boston, MA
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Brown DJ, Hickey S, Levin J, Chang K, Sheridan R, Ryan C, Friedstat J, Schulz J, Goverman J. 532 The Use of Topical Steroids for the Treatment of Burn-Related Hypertrophic Granulation Tissue and Unstable Scar. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- D J Brown
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - S Hickey
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - J Levin
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - K Chang
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - R Sheridan
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - C Ryan
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - J Friedstat
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - J Schulz
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
| | - J Goverman
- Sumner M. Redstone Burn Center - Massachusetts General Hospital, Boston, MA
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Brown DJ, Lu KJG, Chang K, Levin J, Schulz JT, Goverman J. A rare case of severe third degree friction burns and large Morel-Lavallee lesion of the abdominal wall. Burns Trauma 2018; 6:6. [PMID: 29556506 PMCID: PMC5838870 DOI: 10.1186/s41038-018-0108-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/23/2018] [Indexed: 01/07/2023]
Abstract
Background Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma; therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. Case presentation We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. Conclusion MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.
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Affiliation(s)
- Darnell J Brown
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Kuo Jung G Lu
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Kristina Chang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jennifer Levin
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - John T Schulz
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jeremy Goverman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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Goverman J, Mathews K, Goldstein R, Holavanahalli R, Kowalske K, Esselman P, Gibran N, Suman O, Herndon D, Ryan CM, Schneider JC. Adult Contractures in Burn Injury: A Burn Model System National Database Study. J Burn Care Res 2018; 38:e328-e336. [PMID: 27380122 PMCID: PMC10032147 DOI: 10.1097/bcr.0000000000000380] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the overall survival rate for burn injury has improved, increased emphasis is placed on postburn morbidity and the optimization of functional and cosmetic outcomes. One major cause of morbidity and functional deficits is that of joint contractures. The true incidence of postburn contractures and their associated risk factors remains unknown. This study examines the incidence and severity of contractures in a large, multicenter, burn population. The associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for adult burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar spine, and thoracic spine) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures, with P < .05 used for statistical significance. Of the 1865 study patients, 620 (33%) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean is three (3.38) contractures per person. The shoulder was the most frequently contracted joint (23.0%), followed by the elbow (19.9%), wrist (17.3%), ankle (13.6%), and knee (13.4%). Most contractures were mild (47.2%) or moderate (32.9%) in severity. Statistically significant predictors of contracture development were male sex, black race, Hispanic ethnicity, medical problems, neuropathy, TBSA grafted, and TBSA burned. Predictors of the severity of contracture included male sex, black race, medical problems, neuropathy, TBSA grafted, and TBSA burned. Predictors of the number of contractures included male sex, medical problems, flash burn, neuropathy, TBSA burned, and TBSA grafted. Similar to a previous single-center study on postburn contractures, approximately one third of the patients with an eligible burn injury requiring autografting developed a contracture at hospital discharge. It is likely that these contractures develop despite early therapeutic interventions such as positioning and splinting; therefore, the challenge to the burn community remains, to identify new and better prevention strategies.
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Affiliation(s)
- Jeremy Goverman
- Surgical Services, Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Shriners Hospitals for Children®-Boston, Massachusetts
| | - Katie Mathews
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas
| | - Peter Esselman
- Department of Surgery, University of Washington Medicine Regional Burn Center, University of Washington, Seattle
| | - Nicole Gibran
- Department of Surgery, University of Washington Medicine Regional Burn Center, University of Washington, Seattle
| | - Oscar Suman
- University of Texas Medical Branch, Shriners Hospitals for Children, Galveston
| | - David Herndon
- University of Texas Medical Branch, Shriners Hospitals for Children, Galveston
| | - Colleen M. Ryan
- Surgical Services, Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Shriners Hospitals for Children®-Boston, Massachusetts
| | - Jeffrey C. Schneider
- Surgical Services, Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Shriners Hospitals for Children®-Boston, Massachusetts
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45
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Abstract
Split-thickness skin grafting is a useful method of wound repair in burn and reconstructive operations. However, skin grafts require a donor site injury that creates a secondary wound at risk for delayed wound healing. Though in young healthy patients such donor sites have minimal risk, patients with risk factors for delayed wound healing are more challenging. We present a method for graft donor site management that offers an alternative to healing by secondary intention for patients with higher risk of poor wound healing. In those patients considered to be at high risk for donor site healing complications, we chose to treat the donor site with a split-thickness skin graft, or "graft back" procedure. An additional graft is taken adjacent to the initial donor site, and meshed 4:1 to cover both donor sites at once. Out of the 17 patients who received this procedure, 1 patient had a complication from the procedure that did not require an operation, and all patients appear to have good functional and cosmetic outcomes. No patients had any graft loss or graft infection. Histologic analysis showed complete epithelialization of the back-grafted area. The graft back method converts an open wound to a covered wound and may result in decreased wound healing time, improved cosmetic outcomes, and fewer complications, particularly in patients where wound healing is a concern. Importantly, it seems to have minimal morbidity. More detailed prospective studies are needed to ensure no additional risk is incurred by this procedure.
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Affiliation(s)
- Jeremy Goverman
- From the *Division of Burn Surgery, Department of Surgery, Harvard Medical School, Boston, Massachusetts; †University of Michigan Medical School, Ann Arbor; and ‡Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor
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Hickey S, Gomez J, Meller B, Schneider J, Cheney M, Nejad S, Schulz J, Goverman J. Response to Letter to the Editor: 'Interactive home telemedicine and burns: A new method'. Burns 2017; 44:233-234. [PMID: 29169697 DOI: 10.1016/j.burns.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Sean Hickey
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - Jason Gomez
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - Benjamin Meller
- Massachusetts General Hospital, TeleHealth, MA, United States
| | | | - Meredith Cheney
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Shamim Nejad
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - John Schulz
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - Jeremy Goverman
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States.
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Abstract
OBJECTIVE The objective of this study is to review our experience incorporating Interactive Home Telehealth (IHT) visits into follow-up burn care. METHODS A retrospective review of all burn patients participating in IHT encounters over the course of 15 months was performed. Connections were established through secure video conferencing and call-routing software. Patients connected with a personal computer or tablet and providers connected with a desktop computer with a high-definition web camera. In some cases, high-definition digital images were emailed to the provider prior to the virtual consultation. For each patient, the following was collected: (1) patient and injury demographics (diagnosis, prognosis, and clinical management), (2) total number of encounters, (3) service for each encounter (burn, psychiatry, and rehabilitation), (4) length of visit, including travel distance and time saved and, (5) complications, including re-admissions and connectivity issues. RESULTS 52 virtual encounters were performed with 31 patients during the first year of the pilot project from March 2015 to June 2016. Mean age of the participant was 44 years (range 18-83 years). Mean total burn surface area of the participant was 12% (range 1-80%). Average roundtrip travel distance saved was 188 miles (range 4-822 miles). Average round trip travel time saved was 201min (range 20-564min). There were no unplanned re-admissions and no complications. Five connectivity issues were reported, none of which prevented completion of the visit. CONCLUSIONS Interactive Home Telehealth is a safe and feasible modality for delivering follow-up care to burn patients. Burn care providers benefit from the potential to improve outpatient clinic utilization. Patients benefit from improved access to multiple members of their specialized burn care team, as well as cost-reductions for patient travel expenses. Future studies are needed to ensure patient and provider satisfaction and to further validate the significance, cost-effectiveness and safety.
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Affiliation(s)
- Sean Hickey
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - Jason Gomez
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - Benjamin Meller
- Massachusetts General Hospital, TeleHealth, MA, United States
| | | | - Meredith Cheney
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Shamim Nejad
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - John Schulz
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States
| | - Jeremy Goverman
- Massachusetts General Hospital, Department of Surgery, Sumner Redstone BurnCenter, MA, United States.
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49
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Jank BJ, Goverman J, Guyette JP, Charest JM, Randolph M, Gaudette GR, Gershlak JR, Purschke M, Javorsky E, Nazarian RM, Leonard DA, Cetrulo CL, Austen WG, Ott HC. Creation of a Bioengineered Skin Flap Scaffold with a Perfusable Vascular Pedicle. Tissue Eng Part A 2017; 23:696-707. [PMID: 28323545 DOI: 10.1089/ten.tea.2016.0487] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Full-thickness skin loss is a challenging problem due to limited reconstructive options, demanding 75 million surgical procedures annually in the United States. Autologous skin grafting is the gold standard treatment, but results in donor-site morbidity and poor aesthetics. Numerous skin substitutes are available on the market to date, however, none truly functions as full-thickness skin due to lack of a vascular network. The creation of an autologous full-thickness skin analogue with a vascular pedicle would result in a paradigm shift in the management of wounds and in reconstruction of full-thickness skin defects. To create a clinically relevant foundation, we generated an acellular skin flap scaffold (SFS) with a perfusable vascular pedicle of clinically relevant size by perfusion decellularization of porcine fasciocutaneous flaps. We then analyzed the yielded SFS for mechanical properties, biocompatibility, and regenerative potential in vitro and in vivo. Furthermore, we assessed the immunological response using an in vivo model. Finally, we recellularized the vascular compartment of an SFS and reconnected it to a recipient's blood supply to test for perfusability. Perfusion decellularization removed all cellular components with preservation of native extracellular matrix composition and architecture. Biaxial testing revealed preserved mechanical properties. Immunologic response and biocompatibility assessed via implantation and compared with native xenogenic skin and commercially available dermal substitutes revealed rapid neovascularization and complete tissue integration. Composition of infiltrating immune cells showed no evidence of allorejection and resembled the inflammatory phase of wound healing. Implantation into full-thickness skin defects demonstrated good tissue integration and skin regeneration without cicatrization. We have developed a protocol for the generation of an SFS of clinically relevant size, containing a vascular pedicle, which can be utilized for perfusion decellularization and, ultimately, anastomosis to the recipient vascular system after precellularization. The observed favorable immunological response and good tissue integration indicate the substantial regenerative potential of this platform.
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Affiliation(s)
- Bernhard J Jank
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Jeremy Goverman
- 2 Divison of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Jacques P Guyette
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Jon M Charest
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Mark Randolph
- 3 Divison of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,4 Center for Transplantation Sciences at Massachusetts General Hospital , Boston, Massachusetts
| | | | | | | | | | - Rosalynn M Nazarian
- 7 Department of Pathology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - David A Leonard
- 4 Center for Transplantation Sciences at Massachusetts General Hospital , Boston, Massachusetts
| | - Curtis L Cetrulo
- 3 Divison of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,4 Center for Transplantation Sciences at Massachusetts General Hospital , Boston, Massachusetts
| | - William G Austen
- 2 Divison of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,3 Divison of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Harald C Ott
- 1 Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts.,8 Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
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50
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Connolly M, Axtell A, Hickey S, Whalen A, McNamara L, Albright D, Friedstat J, Goverman J. Chemical Burn From Cinnamon Oil. Eplasty 2017; 17:ic11. [PMID: 28607628 PMCID: PMC5459757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Margaret Connolly
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston
| | - Andrea Axtell
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston
| | - Sean Hickey
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston
| | - Ann Whalen
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston
| | - Lucy McNamara
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston
| | - Dorothy Albright
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston
| | - Jonathan Friedstat
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston
| | - Jeremy Goverman
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston,Correspondence:
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