To Örebro University

INTRODUCTION: As breast cancer survival rates improve, the long-term quality of life (QoL) has become increasingly important. With a significant number of patients still undergoing mastectomy and experiencing its well-known negative impacts on QoL, breast reconstruction aims to mitigate this by restoring body integrity. This study aimed to evaluate the changes in QoL and satisfaction in patients after breast reconstruction and influence of various patient-related factors.

METHODS: Patients who underwent delayed unilateral deep inferior epigastric perforator (DIEP) breast reconstruction at a single institution between January 2016 and April 2019 were surveyed. QoL was assessed using the BREAST-Q questionnaire preoperatively and one year postoperatively. Scores were compared between the time points, and regression analysis was conducted to identify the influence of age, body mass index, economic status, education level, and relationship status on QoL.

RESULTS: Among the 93 patients, 55 completed the preoperative and one-year postoperative BREAST-Q questionnaires (response rate: 59%). Postoperative QoL scores significantly increased for the domains "satisfaction with breasts," physical well-being chest," "sexual well-being," and "psychosocial well-being" (p<0.001). The scores for the domain "physical well-being abdomen" remained unchanged one year postoperatively. Higher education correlated with greater satisfaction with the breasts. Lack of an intimate partnership was identified as a significant negative factor for poorer psychosocial well-being.

CONCLUSIONS: Delayed unilateral DIEP breast reconstruction significantly enhances QoL and breast satisfaction one year postoperatively without causing long-term physical discomfort at the donor site. Education level and relationship status significantly affect the postoperative outcomes. Tailored preoperative counseling and psychosocial support are essential to maximize patient satisfaction and well-being following reconstruction.

BACKGROUND: Head and neck cancer (HNC) is the seventh most prevalent cancer worldwide, usually requiring a multidisciplinary approach. The National Surgical Quality Improvement Program (NSQIP) risk calculator is a tool for predicting postoperative complications that possibly can help in decision-making, support patient education, and guide the choice between surgical and nonsurgical treatment options. The aim of this study was to assess the reliability of the NSQIP risk calculator as a predictor of postoperative complications following head and neck surgery with microvascular reconstruction.

METHODS: This retrospective study included 99 patients diagnosed with HNC who underwent microvascular reconstruction from January 2016 to February 2021. The observed complications were compared with those predicted by the NSQIP calculator. To assess the discriminatory power of the NSQIP estimates, receiver operating characteristic statistics, logistic regression, and the overall Brier score were used.

RESULTS: Forty-four percent of the patients experienced at least 1 postoperative complication, and 27.2% developed serious complications. The receiver operating characteristic analysis for any complications revealed an area under the curve (AUC) of 0.62 (95% confidence interval 0.51-0.73, P = 0.046). For serious complications, the AUC was 0.65 (95% confidence interval, 0.52-0.79, P = 0.021). Both AUC values fell short of the threshold for "acceptable discrimination" (0.7-0.8). The overall Brier score was 0.32, with scores less than 0.09 considered to have good accuracy.

CONCLUSIONS: The results suggest that the NSQIP risk calculator tends to underestimate the likelihood of postoperative complications in patients who are undergoing resection for HNC accompanied by microvascular reconstruction.

Nitrous oxide has a wide range of medical applications, such as being used as an analgesic in general anesthesia, dental procedures, childbirth and sedation. Lately, it has also been employed as an inhalant recreational drug to induce brief euphoria. Recent studies indicate a worldwide rise in the incidence of skin frostbites associated with nitrous oxide use. A scoping review was conducted to synthesize and summarize the existing literature published in English regarding frostbite injuries associated with the recreational use of nitrous oxide. The literature search was carried out in July 2024 using databases such as Embase, Web of Science and PubMed®. From an initial pool of 83 publications, 8 studies were ultimately selected for full-text review as they met our inclusion criteria for analysis. Additionally, we provide a representative clinical case involving a 21-year-old male who experienced frostbite following skin exposure to nitrous oxide. Most publications on nitrous oxide induced frostbites are from recent years, primarily between 2022 and 2024, with the first case documented in 1996. These injuries are mostly observed in young adults, with a female dominance, and are typically localized to the inner thighs. According to the existing literature, the predominant treatment approach is conservative management, with excision and split-thickness skin grafting (STSG) in the second place. This study represents the first literature review summarizing frostbite injuries to the skin from nitrous oxide misuse. There is a need for enhanced preventive measures to raise public awareness and reduce the incidence of frostbite injuries associated with the recreational use of nitrous oxide.

The most common cited cause of split-thickness skin graft failure is infection and due to the association between bacterial findings in wound beds an attempt to decrease the bacterial burden before skin-grafting evolved. Thus, pre-operative microbiology swabs of the wound bed became routine at some institutions prior to grafting. This is not standard practice in the Pietermaritzburg burn service. Emphasis is instead placed on a strict protocol of intra-operative wound bed preparation to promote adequate graft take. This pilot study aims to evaluate whether pre-operative wound swabs are appropriate. We performed a prospective observational study to determine if positive wound cultures were associated with graft failure. All patients with a burn surface area of less than 10 %, where delayed grafting (later than 28 days from time of burn injury) was performed, from March to December 2021 were analyzed. Patient demographics, days from burn to graft, %TBSA burn, %TBSA grafted, whether sharp debridement prior to grafting in the same procedure was performed or not, use of topical gentamicin intra-operatively, graft outcome (% graft loss), need for regraft, and organism grown were recorded into an excel spread sheet for analysis. The sample included 52 patients. Of these, 17 (31.5%) were female. The median %TBSA grafted was 8% (IQR 4-13%) and similar in both groups. The median days from burn to grafting was 35 days. Thirty-nine patients (75%) had graft Take and 13 (25%) had graft Failure. In the failed group, median % graft failure was 50% (30 - 70%). Of the group with successful graft take, 90% were noted to have had a positive wound culture prior to grafting. A positive wound culture was not found to be a risk factor for graft failure (p=0.993). Despite the positive wound cultures graft take was more than 90 % in 75% of grafts performed and only 2/52 patients required supplementary grafting. We believe that this demonstrates that our local protocol is reasonable in this setting and that waiting for negative wound swabs prior to grafting should not be a reason to delay grafting.

Introduction: Nicotine consumption is linked to higher perioperative complications. The cellular damage secondary to smoking is due to cellular dysfunction and thrombogenesis following free radical release, tissue hypoxia, microvascular injury, and inhibition of immune cell function by oxidative stress. This has an impact on wound healing as a whole, while increasing risk of infection and wound dehiscence.

Method: A review of the literature was conducted to summarize all studies focusing nicotine-complications in Plastic and Hand surgery. Of 2,186 articles, retrieved from PubMed, Embase and Web of Science databases, 364 publications were included following a blinded parallel screening as per PRISMA.

Result: Numerous peri-operative complications have been attributed to smoking, from undesirable aesthetic outcomes to life threatening sepsis. Some previous studies have illustrated a few of nicotine’s physiological effects as reversible, through a smoking cessation ranging from 3 to 8 weeks, or even longer, while others seem persistent. Available literature has found a correspondence between the amount of nicotine consumption and complication rates. Both pre- and postoperative nicotine cessation has been proven to have favourable outcome.

Discussion: Nicotine abuse is linked to higher complication rates following Plastic and Hand Surgery, according to the published literature. Nicotine consumers are a high-risk patient group that needt o be stratified, evaluated for peri-operative morbidities, and provided risk-specific care and follow-up.

It is important to understand the pathophysiological mechanisms behind the negative effects of nicotine on postoperative recovery. A standardized pre- and postoperative nicotine detox routine should be established to minimize the rate of postoperative complications.

Introduction: In Sweden, approximately 1700 patients are diagnosed with head and neck cancer (HNC) every year. HNC is relatively rare (2,6 % of all cancers). Risk factors for HNC are smoking, high consumption of alcohol, human papilloma virus (HPV) infection and inflammation 1. The Örebro head and neck cancer registry (ÖHNCR) was founded 1988 to register amount of HNC patients, treatment, reconstruction and overall survival.

Method: We performed a retrospective review of all microvascular and local/regional reconstructions in ÖHNCR from 1988 to 2023. It includes in total 4111 patients in the registry to present day.

Result: The majority, approximately 71.8% of the patients, were judged to be tumour-free at the last check-up. The five-year survival rate for all HNC patients has increased from 49.8% in 1988 to 55.1% in 2023, an increase of 5.3%. Overall survival varies between types of cancer within HNC. The number of both free and local/regional flaps has increased over the past two decades. Of all reported patients in ÖHHCR, approximately 44 patients (34%) have been reconstructed each year. The most common free flap for soft tissue reconstruction were, radial free flap (n=331, 49%) and osteocutaneous reconstruction was the fibula free flap (n=210, 31%). The most common local/regional flap were pectoralis major flap (n=242, 33%).

Discussion: The registry data trends correspond with the current literature, with increased incidence of number of cases with HNC and following reconstruction. We speculate that the increased number of reconstructions, permits an increased number of radical HNC resections followed by improved oncological- and functional outcomes.

Flera fall av vårdorsakade brännskador har rapporterats till Ivo och Socialstyrelsen de senaste decennierna.

Alkoholbaserade lösningar för perioperativ steriltvätt i kombination med diatermi kan orsaka brand och brännskador om lösningen inte torkat ordentligt.

Tvättlösningar kan ansamlas i draperingsveck eller i tyger. Det är viktigt att säkerställa att alkoholbaserade tvättlösningar har torkat ordentligt före användning av diatermi.

Majoriteten av incidenter relaterade till intraoperativa brännskador orsakade av diatermi beror på felaktig användning.

Around 36 000 people seek care in Sweden due to burns annually. This usually requires repeated wound care and in some case surgery. Iatrogenic burns are rare but may be deep. One cause could be preparation of a patient with alcohol before surgery, or direct skin contact with a diathermic probe. In this case series we present two patients with this type of burns. These cases highlight the potential harm toward the patient, and it is important to have clear guidelines and take precautions when performing a diathermy

Scald is one type of burn that s often mentioned alone and occurs mostly in the paediatric population. Inhaled steam is mostly cooled off in the airways, why thermal damage is rarely seen. A sudden exposure to hot steam/inhalation can cause a thermal inhalation injury. A scoping review was performed, with the aim to summarize all published papers in English, about steam-related injuries. The search was conducted using the PubMed (R) and Cochrane libraries on 19th of May 2021, without a set time period. Out of a total of 1186 identified records, 31 were chosen for review. Burns related to the contact with steam are generally rare and can be both minor and severe. The more severe cases related to steam exposure are mostly workplace accidents and the minor injuries reported in the literature are often related to steam inhalation therapy, especially in the paediatric population. This review describes the challenges that can be found dealing with patients suffering from cutaneous steam burns and/or steam inhalation injuries. A steam injury to the airways or the skin can be directly life-threatening and should be treated with caution. This type of injury can lead to acute respiratory insufficiency and sometimes death. A case of a male patient with extensive cutaneous steam burns and a steam inhalation injury who passed away after 11 days of treatment is also presented to illustrate this review. Level of evidence: Level V, Therapeutic; Risk/Prognostic Study.

Electrical incidents are common and mostly uneventful, though can be severe and sometimes lethal. Aside from skin, muscle and soft tissue damage, electrical injuries can cause cardiac arrhythmias, the most common cardiac complication. The case of a 14-year-old girl who sustained 48.5% TBSA burns following a high-voltage electrical injury is described. She suffered five episodes of asystole 78 h following the injury, requiring extracorporeal membrane oxygenation. The cause of the delayed asystole was investigated and a PubMed literature search was conducted to explore late presenting cardiac sequelae following electrical injuries. This yielded fifteen studies, identified as relevant, of high quality and in the English language. These studies included a total of 1411 patients of whom only 3 were found to have had late potentially lethal arrhythmias, all manifesting within the first 24 h after the injury. Of these patients, 32 suffered cardiac arrests shortly after the electrical injury, 11 of which were documented as asystolic arrests though these were all from a single study with the rural locale and prolonged delay in arrival to the hospital setting contributing to this finding. To our knowledge, this is the only pediatric cardiac arrest developing in a stable patient over 72 h following the initial electrical injury. No other patient has suffered any significant cardiac complications first presenting outside the initial 24-h period following the electrical injury. Guidelines and recommendations on post electrical injury observation of patient vary and further research into this field is required to allow for guidance unification.