Efficacy Of Skin Substitutes For Management Of Acute Burn Cases: A Systematic Review

The early management of burn cases has always been a challenging medical problem. Skin substitutes have been consistently studied and employed as the prospective treatment modality for burn cases worldwide. However, this treatment method remains uncommon in many developing countries. This systematic review is designed to weigh the efficacy of skin substitutes compared to standard treatment for managing acute burn cases. A literature search was conducted using PubMed, Scopus and Cochrane database up to February 2020 combined with additional reference searching. Studies were restricted to randomized controlled trials (RCTs), with no date and language restrictions. We evaluated the risk of bias with a revised risk of bias tool for randomized trials (RoB2). Data were categorized based on skin substitutes with further subgroup analysis for each skin substitute. We included 13 studies with six types of skin substitutes, Biobrane®, TransCyte ®, Integra®, Glyaderm®, Suprathel® and Apligraft®. Outcomes measured included wound healing time, pain, length of hospitalization and scar formation. The findings for all skin substitutes demonstrated less severe pain compared to the control group. Faster wound healing time, scar formation and length of hospitalization were identified as heterogeneous depending on the type of skin substitutes used. All of the skin substitutes studied exhibited at least non-inferior to superior performance compared to standard treatment in terms of efficacy in treating acute burn wounds, not limited to burn depth, size, location or patient age.

Tracing in vivo the dorsal loop of the optic radiation: convergent perspectives from tractography and electrophysiology compared to a neuroanatomical ground truth

The temporo-parietal junction (TPJ) is a cortical area contributing to a multiplicity of visual, language-related, and cognitive functions. In line with this functional richness, also the organization of the underlying white matter is highly complex and includes several bundles. The few studies tackling the outcome and neurological burdens of surgical operations addressing TPJ document the presence of language disturbances and visual field damages, with the latter hardly recovered in time. This observation advocates for identifying and functionally monitoring the optic radiation (OR) bundles that cross the white matter below the TPJ. In the present study, we adopted a multimodal approach to address the anatomo-functional correlates of the OR's dorsal loop. In particular, we combined cadavers' dissection with tractographic and electrophysiological data collected in drug-resistant epileptic patients explored by stereoelectroencephalography (SEEG). Cadaver dissection allowed us to appreciate the course and topography of the dorsal loop. More surprisingly, both tractographic and electrophysiological observations converged on a unitary picture highly coherent with the data obtained by neuroanatomical observation. The combination of diverse and multimodal observations allows overcoming the limitations intrinsic to single methodologies, defining a unitary picture which makes it possible to investigate the dorsal loop both presurgically and at the individual patient level, ultimately contributing to limit the postsurgical damages. Notwithstanding, such a combined approach could serve as a model of investigation for future neuroanatomical inquiries tackling white matter fibers anatomy and function through SEEG-derived neurophysiological data.