Tie-over dressings are frequently used for skin grafts. Although a dressing is necessary for split-thickness skin grafts, their use in full-thickness skin grafts (FTSGs) is questionable.
This review ...was conducted to investigate the influence of different tie overs and dressings on graft take for FTSGs in cutaneous surgery.
An electronic database search was performed in MEDLINE, EMBASE, Web of Science, and the Cochrane library. The following search terms and comparable were used: skin transplantation, tie-over, fixation, sutures, and take.
Fifteen articles met the inclusion criteria. Eight studies describe no use of a tie-over dressing for FTSGs. Dressing types included antibacterial dressings, foam or sponges, and bolsters. The lowest graft take was 80% (with a tie-over dressing). The highest graft take was 100% (with and without a tie-over dressing).
The results show that, regardless of the technique used, the overall graft success rate is high. Although a definite recommendation could not be made, it seems that a graft without a tie-over dressing can suffice in certain circumstances.
The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described for high-tension wounds, but ...not much is known about their mechanical properties. Complications of excessive tension include dehiscence, infection, and ischemic necrosis and could be prevented. This study aimed to compare forces in five techniques (single, horizontal mattress, vertical mattress, pulley, and modified pulley suture) in a standardized wound tension model.
A standardized neoprene wound model was developed on the ForceTRAP system (MediShield B.V., Delft, The Netherlands) to mimic a 5 Newton (N) wound. Five different suture techniques were each repeated 10 times by a student, resident dermatology, and dermsurgeon. The pulling force of the suture's first throw was measured with the Hook-in-Force sensor (Technical University Delft, The Netherlands). Changes in wound tension were measured by the ForceTRAP system. The ForceTRAP is a platform measuring forces from 0 to 20 N in three dimensions with an accuracy of 0.1 N. The Hook-in-Force is a force sensor measuring 0-15 N with an accuracy of 0.5 N. Maximum and mean forces were calculated for each suture technique and operator.
Mean maximum pulling force: 5.69 N (standard deviation SD, 0.88) single, 7.25 N (SD, 1.33) vertical mattress, 8.11 N (SD, 1.00) horizontal mattress, 3.46 N (SD, 0.61) pulley, and 4.52 N (SD, 0.67) modified pulley suture. The mean force increase on the skin (substitute) ranged between 0.80 N (pulley) and 0.96 N (vertical mattress).
The pulley suture requires less pulling force compared with other techniques. The mechanical properties of sutures should be taken in consideration when choosing a technique to close wounds.
Rosacea: New Concepts in Classification and Treatment van Zuuren, Esther J.; Arents, Bernd W. M.; van der Linden, Mireille M. D. ...
American journal of clinical dermatology,
07/2021, Letnik:
22, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Rosacea is a chronic inflammatory dermatosis mainly affecting the cheeks, nose, chin, and forehead. Rosacea is characterized by recurrent episodes of flushing or transient erythema, persistent ...erythema, phymatous changes, papules, pustules, and telangiectasia. The eyes may also be involved. Due to rosacea affecting the face, it has a profound negative impact on quality of life, self-esteem, and well-being. In addition to general skin care, there are several approved treatment options available for addressing these features, both topical and systemic. For some features, intense pulse light, laser, and surgery are of value. Recent advances in fundamental scientific research have underscored the roles of the innate and adaptive immune systems as well as neurovascular dysregulation underlying the spectrum of clinical features of rosacea. Endogenous and exogenous stimuli may initiate and aggravate several pathways in patients with rosacea. This review covers the new phenotype-based diagnosis and classification system reflecting pathophysiology, and new and emerging treatment options and approaches. We address new topical and systemic formulations, as well as recent evidence on treatment combinations. In addition, ongoing studies investigating novel therapeutic interventions will be summarized.
Background
Clinical practice guidelines (CPGs) are essential in delivering optimum healthcare, such as for atopic dermatitis (AD), a highly prevalent skin disease. Although many CPGs are available ...for AD, their quality has not been critically appraised.
Objectives
To identify CPGs on AD worldwide and to assess with validated instruments whether those CPGs are clear, unbiased, trustworthy and evidence based (CUTE).
Methods
We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library, Emcare, Epistemonikos, PsycINFO and Academic Search Premier for CPGs on AD published between 1 April 2016 and 1 April 2021. Additionally we hand searched prespecified guideline resources. Screening, data extraction and quality assessment of eligible guidelines were independently carried out by two authors. Instruments used for quality assessment were the AGREE II Reporting Checklist, the US Institute of Medicine (IOM) criteria of trustworthiness and Lenzer’s Red Flags.
Results
Forty CPGs were included, mostly from countries with a high sociodemographic index. The reporting quality varied enormously. Three CPGs scored ‘excellent’ on all AGREE II domains and three scored ‘poor’ on all domains. We found no association between AGREE II scores and a country’s gross domestic product. One CPG fully met all nine IOM criteria and two fully met eight. Three CPGs had no red flags. ‘Applicability’ and ‘rigour of development’ were the lowest scoring AGREE II domains; ‘external review’, ‘updating procedures’ and ‘rating strength of recommendations’ were the IOM criteria least met; and most red flags were for ‘limited or no involvement of methodological expertise’ and ‘no external review’. Management of conflicts of interest (COIs) appeared challenging. When constructs of the instruments overlapped, they showed high concordance, strengthening our conclusions.
Conclusions
Overall, many CPGs are not sufficiently clear, unbiased, trustworthy or evidence based (CUTE) and lack applicability. Therefore improvement is warranted, for which using the AGREE II instrument is recommended. Some improvements can be easily accomplished through robust reporting. Others, such as transparency, applicability, evidence foundation and managing COIs, might require more effort.
What is already known about this topic?
Atopic dermatitis is a skin disease with a high prevalence and high burden of disease.
Clinical practice guidelines are essential for good clinical practice and shared decision making, for both patients and caregivers, in order to reduce disease burden.
Many clinical practice guidelines are available for atopic dermatitis worldwide, but their quality has not yet been critically appraised.
What does this study add?
Forty guidelines <5 years old were identified, mostly from countries with a high sociodemographic index, many of which are not sufficiently clear, unbiased, trustworthy or evidence based (CUTE).
Improvement of guidelines is warranted, for example by using the AGREE II instrument and robust reporting.
Some guideline domains can be improved without much effort, yet improving transparency and applicability and managing conflicts of interest might be more challenging.
Many clinical practice guidelines are available for atopic dermatitis worldwide, but their quality has not been critically appraised as yet. Forty guidelines less than five years old were identified, mostly from countries with a high socio‐demographic index, many of which are not clear, unbiased, trustworthy or evidence based (CUTE) enough; Improvement of guidelines is warranted, e.g. by using the AGREEII instrument and robust reporting
Plain language summary available online
The Global Guidelines in Dermatology Mapping Project (GUIDEMAP) assesses the methodological quality of clinical practice guidelines (CPGs) for high‐burden skin diseases. This review focuses on ...contact dermatitis. We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library, Emcare, Epistemonikos, PsycINFO and Academic Search Premier for CPGs published between 1 November 2018 and 1 November 2023. Prespecified guideline resources were hand searched. Two authors independently undertook screening, data extraction and quality assessments. Instruments used were the Appraisal of Guidelines for Research and Evaluation (AGREE) II Reporting Checklist, the U.S. Institute of Medicine's (IOM) criteria of trustworthiness, The Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument and Lenzer's Red Flags. Twenty five CPGs were included, exhibiting heterogeneity in both the topics they addressed and their methodological quality. Whereas the CPGs on management of hand eczema from Denmark, Europe and the Netherlands scored best, most CPGs fell short of being clear, unbiased, trustworthy and evidence‐based. Disclosure of conflicts of interest scored well, and areas needing improvement include ‘strength and wording of recommendations’, ‘applicability’, ‘updating’ and ‘external review’. Adhering to AGREE II and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) enhances methodological quality.
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