Skin defects left after excision of hypertrophic scars were treated with a dermal substitute and split-thickness skin grafts transplanted after vascularisation of the substitute. The used substitute was a synthetic porous scaffold made from the biodegradable copolymer polyethyleneglycol-terephtalate and polybuthylene-terephtalate. The study was designed to assess the rate of granulation tissue formation, graft take, and after 3 and 12 months the quality of life (pain, comfort of treatment, cosmetic or functional nuisance), scar formation and wound contraction. In addition, scaffold biodegradation and scar tissue formation were evaluated histologically.Seven patients with different causes of burn injury were enrolled, of which 5 completed the study. In the first 4 patients the time between scaffold application and split-thickness skin overgrafting was in between 17 and 24 days. The time point of overgrafting was significantly reduced to 10-12 days by meshing of the dermal scaffold as evidenced in the last 3 patients. Histological evaluation at 3 months revealed normal generation of dermal tissue, however, the collagen bundles were parallel organized like in scar tissue. In the deeper layers of the neodermis, fragments of the dermal substitute were present, causing a mild inflammatory response. One year post-treatment, some fragments of the copolymer were still observed. The extent of wound contraction after successful overgrafting ranged from 30% to 57% after 1 year. All 5 patients showed an improvement in the total Vancouver Scar Score compared to the value before scar removal being similar to what can be expected when treated with split-thickness skin grafts alone. No unanticipated adverse effects due to application of the substitute were observed.We conclude that although this synthetic dermal substitute can be safely used in humans, the presence of 3D dermal template in a full-thickness skin defect will not automatically improve the skin tissue regeneration process or inhibit wound contraction.
This project aimed to set up a control mechanism for the prevention of pressure injuries during surgery.Introduction: Structured and comprehensive risk assessment is effective in identifying individuals at risk for pressure injuries. The subsequent use of proper positioning aids (modern gel-filled positioning aids used to position the head and limbs: floating limb concept) reduces the incidence of surgery-related pressure injuries. Methods:The best practice implementation project used the JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in local healthcare practice. The study was carried out from January 2020 to February 2021 at the private clinic of aesthetic surgery (Brno, Czech Republic). A baseline audit involving 27 patients was undertaken and measured against six best practice recommendations. This step was followed by the implementation of targeted strategies and finally, a postimplementation follow-up audit was conducted. Results:The baseline audit results showed significant deficits between current practice and best practice in all but two criteria. Barriers to implementation of nursing clinical handover best practice criteria were identified by the project team and an education strategy was implemented, documentation for recording possible risks of pressure injuries was created, and new positioning aids were purchased and introduced into clinical practice. There were significantly improved outcomes across all best practice criteria in the follow-up audit. Conclusion:Clinical audits were proved to promote best practice in healthcare. Focused education, provision, and use of relevant tools and aids can have an immediate and positive impact on clinical practice. Future audits are planned to ensure the sustainability of practice changes.
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