Recent advances in technology have shown promise in improving outcomes in microsurgery. Although vascular compromise and flap loss represent major complications, flap monitoring techniques have evolved to improve rates of salvage. Enhanced recovery protocols have also been adapted to expedite patient recovery and length of stay. Early studies have shown benefits such as decreased complications and costs and improved patient outcomes. This review examines the current literature on these topics in the setting of microsurgery.
An inadequate response from macrophages, key orchestrators of the wound healing process, has been implicated in the pathophysiology of impaired healing in diabetes. This study explored the utility of nanoparticles presenting the α‐gal (Galα1‐3Galβ1‐4GlcNAc‐R) epitope to induce anti‐Gal antibody‐mediated local transient recruitment of macrophages to accelerate wound closure and healing in a diabetic murine model. α1,3galactosyltrasferase knockout mice were stimulated to produce anti‐Gal antibodies and subsequently diabetes was induced by streptozotocin‐induced β‐cell destruction. Six mm full‐thickness skin wounds were made and α‐gal nanoparticles (AGN) were topically applied on postwounding days 0 and 1. Wounds were analysed histologically for macrophage invasion and markers of wound healing, including epithelialization, vascularization and granulation tissue deposition through postoperative day 12. We found that application of AGN transiently but significantly increased macrophage recruitment into the wounds of diabetic mice. Treated wounds demonstrated more rapid closure and enhanced wound healing as demonstrated by significantly accelerated rates of epithelialization, vascularization and granulation tissue deposition. Thus, topical treatment of full‐thickness wounds in diabetic mice with α‐gal nanoparticles induced a transient but significant increase in macrophage recruitment resulting in an accelerated rate of wound healing. Using α‐gal nanoparticles as a topical wound healing adjunct is a simple, safe and effective means of augmenting dysregulated macrophage recruitment present in the diabetic state.
Introduction Comparison of rates of ventriculostomy-related infections (VRI) across institutions is difficult due to the lack of a standard definition. We sought to review published definitions of VRI and apply them to a test cohort to determine the degree of variability in VRI diagnosis. Materials and Methods We conducted a PubMed search for definitions of VRI using the search strings “ventriculostomy-related infection” and “ventriculostomy-associated infection.” We applied these definitions to a test cohort of 18 positive cerebrospinal fluid (CSF) cultures taken from ventriculostomies at two institutions to compare the frequency of infection using each definition. Results We found 16 unique definitions of VRI. When the definitions were applied to the test cohort, the frequency of infection ranged from 22–94% (median 61% with interquartile range (IQR) 56–74%). The concordance between VRI diagnosis and treatment with VRI-directed antibiotics for at least seven days ranged from 56–89% (median 72%, IQR 71–78%). Conclusions The myriad of definitions in the literature produce widely different frequencies of infection. In order to compare rates of VRI between institutions for the purposes of qualitative metrics and research, a consistent definition of VRI is needed.
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