24 results on '"Raffoul, Wassim"'
Search Results
2. Impact of platelet rich plasma and adipose stem cells on lymphangiogenesis in a murine tail lymphedema model
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Kalbermatten, Daniel F, Konerding, Moritz A, Erba, Paolo, Wettstein, Reto, Raffoul, Wassim, Ackermann, Maximilian, and Senaldi, Christopher
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610 Medicine & health - Abstract
BACKGROUND Lymphedema is an underdiagnosed pathology which in industrialized countries mainly affects cancer patients that underwent lymph node dissection and/or radiation. Currently no effective therapy is available so that patients' life quality is compromised by swellings of the concerned body region. This unfortunate condition is associated with body imbalance and subsequent osteochondral deformations and impaired function as well as with an increased risk of potentially life threatening soft tissue infections. METHODS The effects of PRP and ASC on angiogenesis (anti-CD31 staining), microcirculation (Laser Doppler Imaging), lymphangiogenesis (anti-LYVE1 staining), microvascular architecture (corrosion casting) and wound healing (digital planimetry) are studied in a murine tail lymphedema model. RESULTS Wounds treated by PRP and ASC healed faster and showed a significantly increased epithelialization mainly from the proximal wound margin. The application of PRP induced a significantly increased lymphangiogenesis while the application of ASC did not induce any significant change in this regard. CONCLUSIONS PRP and ASC affect lymphangiogenesis and lymphedema development and might represent a promising approach to improve regeneration of lymphatic vessels, restore disrupted lymphatic circulation and treat or prevent lymphedema alone or in combination with currently available lymphedema therapies.
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- 2015
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3. Pressure sore incidence and treatment in left ventricular assist device (LVAD)-equipped patients: Insights from a prospective series.
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Schaffer C, Gunga Z, Guillier D, Raffoul W, Kirsch M, and di Summa PG
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- Humans, Incidence, Retrospective Studies, Treatment Outcome, Heart-Assist Devices adverse effects, Pressure Ulcer epidemiology, Pressure Ulcer etiology, Pressure Ulcer therapy
- Abstract
Introduction: A left ventricular assistance device (LVAD) is indicated in patients with end-stage heart failure. Due to the non-physiologic blood flow, a LVAD may favor pressure sores with a devastating risk of infection. This work shows the prevalence and treatment of pressure sores in LVAD patients, to optimize their management., Material and Methods: We retrospectively investigated all LVAD implantations at the Lausanne University Hospital (CHUV) from 2015 to 2019. We detected patients who developed a pressure sore and evaluated the timeline, management, and outcomes., Results: Forty-two patients benefited from LVAD, among whom 5 (12%) developed a stage III/IV pressure sore, within a mean time of 25 days. Due to their poor overall condition, 4/5 patients were treated surgically and 1/5 conservatively. Half of the patients treated with surgery had major complications requiring reoperation. After flap coverage, the mean time to healing for patients was 6 weeks., Discussion: The rapid development of deep pressure sores seen in 12% of patients may be a manifestation of the maladaptive blood flow induced by LVADs, combined with their bedridden condition. Initial signs of pressure sores should be considered seriously, as they are rapidly evolving and needing an aggressive surgical treatment whenever possible (80%). Complication rate was similar compared to standard pressure sore flap treatment. All patients benefiting from flap surgery achieved effective coverage after a mean follow-up of 24 months. No patient developed a LVAD infection., Conclusion: Surgery must be considered early in this population to prevent potential device infection., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
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- 2023
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4. Locoregional anesthesia for post-operative pain management in microsurgical reconstruction of the lower extremities: A retrospective study.
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Martineau J, Guillier D, Maruccia M, Guiotto M, Borens O, Raffoul W, and di Summa PG
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- Analgesics, Analgesics, Opioid therapeutic use, Humans, Lower Extremity surgery, Morphine Derivatives, Pain, Postoperative drug therapy, Pain, Postoperative etiology, Pain, Postoperative prevention & control, Retrospective Studies, Nerve Block methods
- Abstract
Objective: Opioid-based analgesia is often used in the management of postoperative pain in arthroplasty cases. This article analyses the safety of single-shot peripheral nerve block (PNB) and potential analgesic benefits in patients undergoing lower limb free flap reconstruction., Methods: A retrospective review including all patients undergoing lower limb reconstruction with free flaps between October 2017 and April 2020 was performed. Patients were divided into two groups based on PNB utilization. The use of oral opioids, post-operative pain scores, flap-related outcomes, patient morbidity, and length of hospital stay (LOS) were compared between groups., Results: Thirty-one patients who underwent lower limb reconstruction with free flaps, were finally included in the study. Preoperative PNB was performed on 14 patients, while 17 patients received general anesthesia (GA) alone. Pain at rest, measured using the visual analog scale (VAS) score, was significantly lower (2.2 ± 1.7 vs. 4.9 ± 1.7) in the PNB group on postoperative day 1 (POD). The mean [median]±SD amounts of opioids consumed in morphine milligram equivalent (MME) were significantly lower in the PNB group on both POD1 (33.5 [22.5] ± 33.9 vs. 61.6 [48.0] ± 39.0), POD2 (29.0 [15.0] ± 29.2 vs. 58.0 [52.5] ± 37.0) and cumulatively over 7 days (164.0 [197.0] ± 132.8 vs. 315.4 [225] ± 203.2). Complication rates and LOS were not statistically different between groups, although trending toward lower take-back procedures and major complications in the PNB group., Conclusion: Preoperative single-shot PNB significantly reduced postoperative opioid use and patient-reported pain severity and was not associated with an increase in complication rates., Competing Interests: Declaration of Competing Interest None declared, (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2022
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5. Implications of chlorhexidine use in burn units for wound healing.
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Abdel-Sayed P, Tornay D, Hirt-Burri N, de Buys Roessingh A, Raffoul W, and Applegate LA
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- Anti-Infective Agents, Local administration & dosage, Burn Units, Chlorhexidine administration & dosage, Ethanol adverse effects, Excipients adverse effects, Humans, Practice Guidelines as Topic, Surveys and Questionnaires, Anti-Infective Agents, Local adverse effects, Chlorhexidine adverse effects, Practice Patterns, Physicians', Wound Healing
- Abstract
Chlorhexidine is known to be a potent antiseptic with evidence of a beneficial role in burn care. Nevertheless, several in vitro studies have reported cytotoxicity on cultured cells, while in vivo and clinical data seem to show more controversial results. In the frame of this work, we aimed to evaluate the use of chlorhexidine in burn units worldwide be sending a survey to professionals of the field. We associated survey results to those perspectives reported in the literature to update recommendations for the use of chlorhexidine in specific protocols for burn management. The survey results showed that there is no clear consensus on the use of chlorhexidine regarding the concentrations, the type of excipient and the cleansing after application. Literature searches showed evidence that the skin of premature infants appears to be more sensitive to chlorhexidine that adult skin, with more reported cases of adverse effects. It was also determined that aqueous formulations of chlorhexidine do not appear to be necessarily less efficient than with alcohol as an excipient, and that lower concentrations are as efficient as higher concentrations. In view of this study, we have adjusted our protocols for the use of aqueous formulations at low concentrations and investigated further the role of washing after application in order to standardize the indication of chlorhexidine and minimize the probability of adverse effects., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2020
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6. Reply to the Letter to the Editor on "The use of antiseptics in burn wounds - our perspective".
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Abdel-Sayed P, Tornay D, Hirt-Burri N, de Buys Roessingh A, Raffoul W, and Applegate LA
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- Burn Units, Chlorhexidine, Humans, Wound Healing, Anti-Infective Agents, Local, Burns
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- 2020
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7. Nonvascularized human skin chronic allograft rejection.
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Rotman S, Koch N, Wiesner L, Aubert V, Rosales IA, Colvin RB, Raffoul W, and Pascual M
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- Aged, Chronic Disease, Graft Rejection etiology, Graft Survival, Humans, Male, Neovascularization, Pathologic etiology, Prognosis, Risk Factors, Transplantation, Homologous, Burns therapy, Graft Rejection diagnosis, Isoantibodies adverse effects, Neovascularization, Pathologic diagnosis, Skin Transplantation adverse effects
- Abstract
A 65-year-old man had extensive burns of the lower legs in 1991, at the age of 40 years. He was treated by nonvascularized and de-epithelialized, allogeneic split-thickness skin allograft and cyclosporine monotherapy for 2 months. Ulcers developed between 10 and 25 years after transplantation and a surgical debridement on the lower extremities was required. Analyses of the removed tissue allografts showed chronic antibody-mediated and cellular rejection with extensive and dense fibrosis, and diffuse capillary C4d deposits. An anti-DRB1*08:01, donor-specific antibody was present. A unique clinical condition with late immunopathological features of human skin chronic allograft rejection is reported., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2019
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8. Composite ALT flap for structured reconstruction of the abdominal wall: New insights from long-term outcomes in 14 patients.
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di Summa PG, Watfa W, Giordano S, Elahi-Rausis L, Bauquis O, Hahnloser D, and Raffoul W
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- Adult, Cohort Studies, Databases, Factual, Female, Graft Survival, Humans, Length of Stay, Magnetic Resonance Imaging methods, Male, Middle Aged, Myocutaneous Flap blood supply, Operative Time, Regional Blood Flow physiology, Retrospective Studies, Tissue and Organ Harvesting methods, Tomography, X-Ray Computed methods, Abdominal Wall surgery, Myocutaneous Flap transplantation, Plastic Surgery Procedures methods, Thigh surgery, Wound Healing physiology
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- 2019
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9. Corrigendum to: "Systematic review of outcomes and complications in nonimplant-based mastopexy surgery" [J. Plast. Reconstr. Aesthet. Surg. 72 (2019) 243-272].
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di Summa PG, Oranges CM, Watfa W, Sapino G, Keller N, Tay SK, Chew BK, Schaefer DJ, and Raffoul W
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- 2019
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10. Comment on "Incidence of risk factors for bloodstream infections in patients with major burns receiving intensive care: A retrospective single-center cohort study".
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Krähenbühl SM, Pantet O, Berger MM, Raffoul W, and di Summa PG
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- Cohort Studies, Critical Care, Humans, Incidence, Retrospective Studies, Risk Factors, Bacteremia, Burns
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- 2019
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11. Systematic review of outcomes and complications in nonimplant-based mastopexy surgery.
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di Summa PG, Oranges CM, Watfa W, Sapino G, Keller N, Tay SK, Chew BK, Schaefer DJ, and Raffoul W
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- Female, Humans, Treatment Outcome, Mammaplasty adverse effects, Mammaplasty methods, Postoperative Complications etiology
- Abstract
Background: Mastopexy is one of the most performed cosmetic surgery procedures in the U.S. Numerous studies on mastopexy techniques have been published in the past decades, including case reports, retrospective reviews, and prospective studies. However, to date, no study has investigated the overall complications or satisfaction rates associated with the wide spectrum of techniques., Objectives: This review aims to assess the outcomes of the various mastopexy techniques, without the use of implants, thus focusing on associated complications, and to provide a simplified classification system., Methods: This systematic review was performed in accordance with the PRISMA guidelines. PubMed database was queried in search of clinical studies describing nonprosthetic mastopexy techniques, which reported the technique, indication, and outcomes., Results: Thirty-four studies, published from 1980 through 2016, were included and represented 1888 treated patients. Four main surgical technique categories were identified: dermal reshape, glandular reshape, glandular reshape associated with perforator flaps, and glandular reshape with mesh support. Despite varying techniques, mastopexy was generally found to be a reliable esthetic procedure with unsatisfactory breast shape, thus accounting for only 1.3% of the patients. The overall complication rate was 10.4%. The most represented complications were scar-related (3%, including hypertrophic or unesthetic appearance) and nipple-areola-related problems (2.9%; including distortion, asymmetry, and reduction in sensation)., Conclusions: Mastopexy techniques achieve high patient satisfaction and can be tailored according to patient needs and clinical presentation. Complication rates and morbidity are relatively low. However, a significant number of issues related to scars, asymmetry, and potential ptosis recurrence should be highlighted in the information provided to patients., (Copyright © 2018 Elsevier Ltd. All rights reserved.)
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- 2019
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12. Trace element intakes should be revisited in burn nutrition protocols: A cohort study.
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Jafari P, Thomas A, Haselbach D, Watfa W, Pantet O, Michetti M, Raffoul W, Applegate LA, Augsburger M, and Berger MM
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Male, Middle Aged, Nutritional Status, Prospective Studies, Spectrophotometry, Atomic, Young Adult, Burns blood, Burns drug therapy, Dietary Supplements, Nutritional Requirements, Trace Elements blood, Trace Elements therapeutic use
- Abstract
Background & Aims: Due to inflammatory and hypermetabolic responses and to extensive exudative trace element (TEs) losses, major burn patients have substantially increased nutritional requirements. To date, information is only available for Cu, Se, and Zn. We aimed at analyzing losses of 12 TEs and Mg through burn wound exudation and corresponding plasma concentrations during the first week after burn injury, and to evaluate the impact of current TE repletion protocols., Methods: Burn wound exudate was collected under negative pressure in 15 adult patients burned 29 ± 20% of body surface (TBSA) for 8 days after injury. Two samples were collected daily. The TE concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS). Losses and serum concentrations were compared to intakes., Results: For the majority of 12 TEs, the highest losses were observed on day 1, and declined thereafter. Despite Cu supplementation (4.23 mg/day) serum levels remained below reference values. Se supplements (745 μg/day) normalized and even increased serum levels to upper normal value. Despite large supplements (Zn 67.5 mg/day), serum Zn values remained below reference range. Large exudative losses of B, Br and Mg were found, as well as of Fe and I, with the latter being probably due to contamination., Conclusion: Current nutritional Cu, Se, Zn repletion protocols in major burn patients which were based on measured exudative losses should be revised to include higher Cu and lower Se doses, as well as planned Mg administration. In burns <20% TBSA and for the other TEs the recommended parenteral nutrition TE doses appear sufficient., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)
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- 2018
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13. Split-sciatic nerve surgery: A new microsurgical model in experimental nerve repair.
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Schiraldi L, Sottaz L, Madduri S, Campisi C, Oranges CM, Raffoul W, Kalbermatten DF, and di Summa PG
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- Animals, Autophagy, Fibrin Tissue Adhesive pharmacology, Hindlimb, Image Processing, Computer-Assisted, Male, Models, Animal, Nerve Regeneration, Rats, Rats, Sprague-Dawley, Transplantation, Autologous, Microsurgery methods, Neurosurgical Procedures methods, Sciatic Nerve surgery
- Abstract
Introduction: Sciatic experimental surgery in rat often leads to hindlimb autophagy, with considerable ethical and research issues. In this work, the distal part of the sciatic nerve was split following the natural bifurcation between tibial and peroneal branches, before applying regenerative stem cells in a fibrin conduit on the peroneal segment. The new microsurgical model was tested in terms of animal morbidity and consistency of research outcomes, particularly comparing to the standard total sciatic axotomy procedure., Materials and Methods: After dissection of sciatic the nerve, the tibial and peroneal fibres were split upwards and a total axotomy was performed in the peroneal side. The 1 cm nerve gap between the proximal sciatic nerve and peroneal nerve was crossed using fibrin conduits. The tibial nerve was not included. Experimental groups involved either empty or fibrin conduit seeded with Schwann cell-like differentiated adipose derived stem cells (dASC) (Fib + dASC). Autografts and sham rats were used as controls (total n = 20). At 12 weeks post-implantation, an extensive histomorphometric analysis was performed. Functional aspects of regeneration were analysed by walking track analysis., Results: No major autophagy occurred using the split-sciatic technique. A detailed histomorphometric analysis showed consistent results with previous literature using fibrin conduits in a full sciatic axotomy experimental setting. Walking track analysis reflected the histological regeneration pattern, displaying superior regeneration in both autograft and dASC groups., Conclusion: Split-Sciatic nerve surgery reduced animal morbidity, while being representative of the whole nerve as regeneration outcomes were consistent with previous data obtained on the whole sciatic nerve. The decreased autophagy rate allowed for a more efficient functional evaluation., (Copyright © 2017. Published by Elsevier Ltd.)
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- 2018
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14. Reticular Perineurioma of the Hand: Diagnosis and Treatment of a Rare Case of Hand Mass.
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Zaugg P, Maeder B, Nobile A, Raffoul W, Bollmann C, and di Summa PG
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- Female, Hand diagnostic imaging, Humans, Nerve Sheath Neoplasms diagnostic imaging, Soft Tissue Neoplasms diagnostic imaging, Young Adult, Nerve Sheath Neoplasms diagnosis, Nerve Sheath Neoplasms therapy, Soft Tissue Neoplasms diagnosis, Soft Tissue Neoplasms therapy
- Abstract
Reticular perineurioma is a rare and recently delineated morphologic variant of benign perineurioma of skin and soft tissues. Because of its nonspecific gross appearance, varying histologic patterns, and potential range of cellularity, perineurioma of the hand is likely to be confused with more commonly encountered tumor or tumor-like conditions such as schwannoma, neurofibroma, fibromyxoid tumors, and giant tumor of tendon sheath. We report the case of a 20-year-old woman who presented with a slowly growing mass of the hand, which was eventually identified as a reticular perineurioma., (Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
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- 2017
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15. Transabdominal-pelvic-perineal (TAPP) anterolateral thigh flap: A new reconstructive technique for complex defects following extended abdominoperineal resection.
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di Summa PG, Matter M, Kalbermatten DF, Bauquis O, and Raffoul W
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- Adult, Aged, Cohort Studies, Female, Follow-Up Studies, Humans, Length of Stay, Magnetic Resonance Imaging methods, Male, Middle Aged, Operative Time, Pelvic Exenteration methods, Pelvic Exenteration psychology, Postoperative Complications physiopathology, Retrospective Studies, Risk Assessment, Thigh surgery, Time Factors, Treatment Outcome, Myocutaneous Flap blood supply, Myocutaneous Flap transplantation, Perineum surgery, Quality of Life, Plastic Surgery Procedures methods, Wound Healing physiology
- Abstract
Background: Abdominoperineal resection (APR) following radiotherapy is associated with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic anteroposterior defects. This is used for the first time transabdominally through the pelvis and the perineum (TAPP) in the infero-posterior directions; this technique has been described and illustrated in this study., Methods: Among over 90 patients who underwent perineal reconstruction between May 2004 and June 2011, six patients presented high-grade tumours invading perineum, pelvis and sacrum, thereby resulting in a continuous anteroposterior defect. ALT + VL TAPP reconstructions were performed after extended APR and, subsequently, sacrectomy. Patients were examined retrospectively to determine demographics, operative time, complications (general and flap-related), time to complete healing and length of hospital stay. Long-term flap coverage, flap volume stability and functional and aesthetic outcomes were assessed., Results: Mean operating time of the reconstruction was 290 min. No deaths occurred. One patient presented partial flap necrosis. Another patient presented a novel wound dehiscence after flap healing, due to secondary skin dissemination of the primary tumour. Following volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was observed. All flaps fully covered the defects. No late complications such as fistulas or perineal hernias occurred. Donor-site recovery was uneventful with no functional deficits., Conclusions: The use of the ALT + VL flap transabdominally is an innovative method to reconstruct exceptionally complex perineal and pelvic defects extending up to the lower back. This flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting the pelvic floor., (Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2016
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16. Sildenafil as a therapeutic option for digital ischemic ulceration: case report.
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Krähenbühl SM, Depairon M, Faure M, Vietti Violi N, Applegate LA, and Raffoul W
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- Adult, Female, Humans, Ischemia etiology, Necrosis, Peripheral Vascular Diseases etiology, Skin Ulcer etiology, Arm blood supply, Ischemia drug therapy, Peripheral Vascular Diseases drug therapy, Sildenafil Citrate therapeutic use, Skin Ulcer drug therapy, Thoracic Outlet Syndrome complications, Vasodilator Agents therapeutic use
- Abstract
We report the case of a 37-year-old woman who developed critical upper limb ischemia caused by a cervical rib. Because the malformation was initially undiagnosed, a vascular bypass was performed, and failure occurred. Following a 6-month therapy with sildenafil, revascularization of the arm was successful and amputation was avoided. A 6-year follow-up shows a rich collateral network at the compression site and normal values of digital plethysmography. Because hand surgeons often see patients with digital ulcerations and other manifestations of peripheral vascular pathology, therapy of ischemia with sildenafil could be an effective treatment option in patients not responding to classic drugs., (Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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17. Insurance coverage of pediatric burns: Switzerland versus USA.
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Deghayli L, Moufarrij S, Norberg M, Sheridan R, Raffoul W, de Buys Roessingh A, Hirt-Burri N, and Applegate LA
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- Adolescent, Burns economics, Child, Child, Preschool, Humans, Infant, Switzerland, United States, Burn Units economics, Burns rehabilitation, Insurance Coverage, Insurance, Health
- Abstract
Burn care and research have significantly improved over the past years. However, insurance coverage of such treatments does not reflect the improvements in this multi-disciplinary field. Government insurance policies in first world countries renown for burn care treatment, such as Switzerland and the United States, have not adapted to the complexity and longitudinal nature of burn care. Using case studies from both countries, we have analyzed both the institutional and policy approach to pediatric burn treatment coverage. Subsequently, by presenting the Shriners burn care model, we offer a policy recommendation to both the Swiss and the American governments to better their present legislation and infrastructure on pediatric burn coverage., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)
- Published
- 2014
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18. Functional late outgrowth endothelial progenitors isolated from peripheral blood of burned patients.
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Rignault-Clerc S, Bielmann C, Delodder F, Raffoul W, Waeber B, Liaudet L, Berger MM, Feihl F, and Rosenblatt-Velin N
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- Actins metabolism, Adult, Animals, Burns metabolism, Cells, Cultured, Disease Models, Animal, Endothelial Cells metabolism, Female, Humans, Immunohistochemistry, Ischemia physiopathology, Male, Mice, Mice, Nude, Middle Aged, Muscle, Smooth metabolism, Peripheral Blood Stem Cell Transplantation methods, Platelet Endothelial Cell Adhesion Molecule-1 metabolism, Stem Cells metabolism, Vascular Endothelial Growth Factor A metabolism, Burns pathology, Endothelial Cells cytology, Stem Cells cytology
- Abstract
Background: Bioengineered skin substitutes are increasingly considered as a useful option for the treatment of full thickness burn injury. Their viability following grafting can be enhanced by seeding the skin substitute with late outgrowth endothelial progenitor cells (EPCs). However, it is not known whether autologous EPCs can be obtained from burned patients shortly after injury., Methods: Late outgrowth EPCs were isolated from peripheral blood sampled obtained from 10 burned patients (extent 19.6±10.3% TBSA) within the first 24h of hospital admission, and from 7 healthy subjects. Late outgrowth EPCs were phenotyped in vitro., Results: In comparison with similar cells obtained from healthy subjects, growing colonies from burned patients yielded a higher percentage of EPC clones (46 versus 17%, p=0.013). Furthermore, EPCs from burned patients secreted more vascular endothelial growth factor (VEGF) into the culture medium than did their counterparts from healthy subjects (85.8±56.2 versus 17.6±14pg/mg protein, p=0.018). When injected to athymic nude mice 6h after unilateral ligation of the femoral artery, EPCs from both groups of subjects greatly accelerated the reperfusion of the ischaemic hindlimb and increased the number of vascular smooth muscle cells., Conclusions: The present study supports that, in patients with burns of moderate extension, it is feasible to obtain functional autologous late outgrowth EPCs from peripheral blood. These results constitute a strong incentive to pursue approaches based on using autotransplantation of these cells to improve the therapy of full thickness burns., (Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.)
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- 2013
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19. Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan.
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Potin M, Sénéchaud C, Carsin H, Fauville JP, Fortin JL, Kuenzi W, Lupi G, Raffoul W, Schiestl C, Zuercher M, Yersin B, and Berger MM
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- Humans, Military Medicine organization & administration, Models, Organizational, Switzerland, Triage, Burns therapy, Emergency Service, Hospital organization & administration, Intensive Care Units organization & administration, Mass Casualty Incidents
- Abstract
Introduction: Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland., Methods: Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles., Results: Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20-30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources., Conclusions: Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan., (2009 Elsevier Ltd and ISBI. All rights reserved.)
- Published
- 2010
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20. Impact of a pain protocol including hypnosis in major burns.
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Berger MM, Davadant M, Marin C, Wasserfallen JB, Pinget C, Maravic P, Koch N, Raffoul W, and Chiolero RL
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- Adolescent, Adult, Aged, Analgesics, Opioid therapeutic use, Analysis of Variance, Blood Pressure, Burns physiopathology, Female, Health Care Costs, Heart Rate, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Pain economics, Pain physiopathology, Pain Measurement, Skin Transplantation statistics & numerical data, Wound Healing physiology, Young Adult, Burns complications, Burns therapy, Hypnosis, Pain Management
- Abstract
Background: Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs., Methods: All patients admitted to the ICU, aged >18 years, with an ICU stay >24h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area., Findings: Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36+/-14 years old and burned 27+/-15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24h (p<0.0001) followed by a later reduction with lower pain scores (p<0.0001), less procedural related anxiety, less procedures under anaesthesia, reduced total grafting requirements (p=0.014), and lower hospital costs per patient., Conclusion: A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits.
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- 2010
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21. Hypercalcaemia and acute renal failure after major burns: An under-diagnosed condition.
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Kohut B, Rossat J, Raffoul W, Lamy O, and Berger MM
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- Acute Kidney Injury diagnosis, Adolescent, Adult, Aged, Aged, 80 and over, Burns pathology, Calcium blood, Creatinine blood, Female, Humans, Hypercalcemia diagnosis, Intensive Care Units statistics & numerical data, Length of Stay statistics & numerical data, Male, Middle Aged, Retrospective Studies, Young Adult, Acute Kidney Injury etiology, Burns complications, Hypercalcemia etiology
- Abstract
Background: Hypercalcaemia has been shown to occur in about 20% of patients with major burns requiring prolonged intensive care unit (ICU) treatment, and it may be associated with renal failure. Having observed the early onset of hypercalcaemia, the study aimed to determine the frequency and timing of this condition in a European patient cohort., Methods: A retrospective cohort study on a prospectively collected, computerised database of the 225 burn-injury ICU admissions between 2001 and 2007 was undertaken. The inclusion criteria included: burns >20% of the body surface area (BSA) or in-hospital stay >20 days. Hypercalcaemia was defined as an ionised plasma calcium (Ca(2+)) concentration >1.32 mmol l(-1) (or total corrected calcium=[Ca]c>2.55 mmol l(-1)). Four emblematic cases are reported in this article., Results: A total of 73 patients met the inclusion criteria (age: 13-88 years, burns: 12-85% BSA): of these, 22 (30%) developed hypercalcaemia. The median time to the first hypercalcaemia value was 21 days. Only 11 patients had both high Ca(2+) and elevated [Ca]c (which remained normal in others). The risk factors of the disorder were burned surface (p=0.017) and immobilisation (fluidised bed use: p<0.05, duration: p=0.02) followed by burned BSA. Acute renal failure tended to be more frequent in hypercalcaemic patients (five (23%) vs. three (6%): p=0.11), while mortality was not increased. The disorder resolved with hydration and mobilisation in most cases: pamidronate was successful in three cases that were most severe., Conclusion: Hypercalcaemia and associated acute renal failure occur more frequently and earlier than previously reported. Determining the ionised Ca rather than the total Ca with albumin correction enables earlier detection of hypercalcaemia. Bisphosphonates are an effective treatment option in controlling severe hypercalcaemia and preventing bone loss., (Copyright 2009 Elsevier Ltd and ISBI. All rights reserved.)
- Published
- 2010
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22. 'Practical guidelines for nutritional management of burn injury and recovery'--a guideline based on expert opinion but not including RCTs.
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Berger MM, Raffoul W, and Shenkin A
- Subjects
- Evidence-Based Medicine, Humans, Randomized Controlled Trials as Topic, Burns diet therapy, Nutritional Requirements, Practice Guidelines as Topic
- Published
- 2008
- Full Text
- View/download PDF
23. Trace element supplementation after major burns increases burned skin trace element concentrations and modulates local protein metabolism but not whole-body substrate metabolism.
- Author
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Berger MM, Binnert C, Chiolero RL, Taylor W, Raffoul W, Cayeux MC, Benathan M, Shenkin A, and Tappy L
- Subjects
- Adult, Burns surgery, Burns therapy, Carbon Isotopes, Copper analysis, Copper deficiency, Copper metabolism, Copper therapeutic use, Deuterium, Dietary Supplements, Enteral Nutrition, Female, Humans, Male, Prospective Studies, Protein Biosynthesis drug effects, Selenium analysis, Selenium deficiency, Selenium metabolism, Selenium therapeutic use, Skin Transplantation, Trace Elements analysis, Trace Elements deficiency, Wound Healing drug effects, Wound Healing physiology, Zinc analysis, Zinc deficiency, Zinc metabolism, Zinc therapeutic use, Burns metabolism, Nutritional Requirements, Proteins metabolism, Skin metabolism, Trace Elements metabolism, Trace Elements therapeutic use
- Abstract
Background: After major burns, patients exhibit an intense catabolism, and the wounds require surgery and grafting for closure. Complications, such as weight loss and delayed wound healing, are worsened by trace element (TE) deficiencies., Objective: We aimed to assess the effects of TE supplements on systemic substrate turnover and local protein metabolism during wound healing after major burns., Design: This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y with burns on 45 +/- 16% of their body surface area; 12 had skin biopsies performed on days 3, 10, and 20, and 10 patients underwent a stable-isotope investigation on day 10. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. On day 10, [(13)C]phenylalanine (600-microg/kg bolus followed by 12 microg x kg(-1) x min(-1)) plus 6-[(2)H(2)]glucose and [(2)H(5)]glycerol were infused for 6 h to determine skin protein turnover. Biopsies were performed 1 and 6 h after the start of infusion to determine [(13)C]phenylalanine enrichment., Results: The patients' mean age and burn severity did not differ significantly between the groups nor between the skin investigations subgroups. Plasma TE concentrations were significantly higher in the TE group. In the burned areas, the skin contents of selenium (P=0.02) and zinc (P=0.03) increased by day 20. The supernatant-to-plasma (13)C enrichment ratio in burned skin was 0.363 +/- 0.094 (TE group) and 0.286 +/- 0.130 (V group) after 1 h (NS) and 0.592 +/- 0.153 (TE group) and 0.262 +/- 0.171 (V group) after 6 h, which reflected lower catabolism in the TE group (P=0.03). No significant differences in whole-body substrate turnover were found between the groups., Conclusion: TE supplementation was associated with an increased skin tissue content of selenium and zinc and with a reduction in skin protein catabolism.
- Published
- 2007
- Full Text
- View/download PDF
24. Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations.
- Author
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Berger MM, Baines M, Raffoul W, Benathan M, Chiolero RL, Reeves C, Revelly JP, Cayeux MC, Sénéchaud I, and Shenkin A
- Subjects
- Adult, Antioxidants metabolism, Copper deficiency, Copper metabolism, Copper therapeutic use, Dietary Supplements, Enteral Nutrition, Female, Humans, Infusions, Intravenous, Male, Oxidation-Reduction, Pneumonia prevention & control, Prospective Studies, Selenium deficiency, Selenium metabolism, Selenium therapeutic use, Skin Transplantation, Treatment Outcome, Wound Healing physiology, Zinc deficiency, Zinc metabolism, Zinc therapeutic use, Burns complications, Burns metabolism, Burns surgery, Burns therapy, Nutritional Requirements, Pneumonia epidemiology, Skin metabolism, Trace Elements deficiency, Trace Elements metabolism, Trace Elements therapeutic use, Wound Healing drug effects
- Abstract
Background: After major burns, patients can develop nutritional deficiencies including trace element (TE) deficiencies. Various complications, such as infections and delayed wound healing, influence the clinical course of such patients., Objectives: We aimed to investigate the effects of large, intravenous doses of TE supplements on circulating and cutaneous TE tissue concentrations, on antioxidant status, and on clinical outcome after major burns., Design: This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y (x +/- SD) with burns on 45 +/- 21% of their body surface area. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. Blood and urine samples were collected until day 20, and skin biopsy specimens were collected on days 3, 10, and 20., Results: The age of the patients and the severity of their burns did not differ significantly between the groups. Plasma TE concentrations were significantly higher in the TE group. In burned areas, skin contents of both selenium (P=0.05) and zinc (P=0.04) increased significantly by day 20. Plasma and tissue antioxidant status was improved by supplementation. The number of infections in the first 30 d was significantly lower in the TE group (P=0.015), with a median number of 2 versus 4 infections per patient in the TE and V groups, respectively, as a result of a reduction in pulmonary infections (P=0.03). Wound healing was improved in the TE group, with lower requirements for regrafting (P=0.02)., Conclusions: TE supplementation was associated with higher circulating plasma and skin tissue contents of selenium and zinc and improved antioxidant status. These changes were associated with improved clinical outcome, including fewer pulmonary infections and better wound healing.
- Published
- 2007
- Full Text
- View/download PDF
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