Faculty Bibliography

INTRODUCTION/BACKGROUND:Wound care is an essential discipline in plastic surgery, especially as the prevalence of chronic wounds, such as pressure injuries, is increasing. The escalating volume of patient data and the numerous variables influencing wound outcomes are making traditional manual chart reviews in wound care and research increasingly complex and burdensome. The emergence of Natural Language Processing (NLP) software based on large language models (LLMs) such as ChatGPT presents an opportunity to automate the data extraction process. This study harnesses the capabilities of ChatGPT, hosted by our medical center's secure, private Azure OpenAI service, to automatically extract and process variables from patient charts following sacral wound visits. We assess ChatGPT's potential to revolutionize chart review through improved data retrieval accuracy and efficiency. METHODS:We evaluated the use of the medical center's internal ChatGPT in chart review. ChatGPT and a Python script were integrated into the existing chart review process for patients with sacral wounds from 2 hospital cohorts to extract and format variables related to wound care. Metrics include time taken for review, accuracy of extracted information, and assessment of ChatGPT-generated insights. RESULTS:ChatGPT reduced the average time per chart review from 7.56 minutes with the manual method to 1.03 minutes using ChatGPT. Furthermore, it achieved a 0.957 overall accuracy rate compared to manual chart review, ranging from 0.747 to 0.986 across extracted data elements. ChatGPT was also able to synthesize accurate narrative descriptions of patient wounds. CONCLUSIONS:We highlight ChatGPT's potential to enhance speed and precision of chart review in the context of both clinical care and wound care research, offering valuable implications for integration of artificial intelligence in healthcare workflows.

Increasing healthcare costs, limited healthcare resources, an aging population, and lifestyle-related diseases make wound management a growing clinical, social, and economic burden. This case series investigated the use of a novel, biocompatible, polymer-based transforming powder dressing (TPD) that transforms in situ to a shape-retentive wound matrix upon hydration for treating wounds of various etiologies.In this institutional review board-approved single-center retrospective case series, the researchers evaluated various acute and chronic wounds treated with TPD over a period of 2 years. Wounds were followed from the first TPD application up to 1 month after the last TPD application or until the wound healed or the patient was lost to follow-up, whichever came first. The researchers evaluated wound etiology, location, number of applications, change in wound surface area, and comorbidities.The researchers identified 50 patients who were treated with TPD and had at least one follow-up visit during the retrospective study period. The majority of wounds treated with TPD were venous leg ulcers (n = 27) followed by traumatic wounds (n = 11) and skin tears (n = 7). Normal rates of wound healing (>10% per week) were observed in the majority of patients (36/50, 72%) over their duration of treatment. Complete healing during the study period was observed in 43% of venous leg ulcers, 55% of traumatic wounds, 71% of skin tears, and 80% of other wound types. No adverse effects of TPD administration were observed. Treatment with TPD resulted in significant reductions in wound area of nearly all wounds, regardless of etiology.

INTRODUCTION/UNASSIGNED:, pressures can range from 1.4 atmospheres absolute (ATA) to 3 ATA. While different treatment profiles have been proposed, there is a paucity of literature comparing the effectiveness and risk profile associated with different pressures treating the same condition. Considering the therapeutic divergence, this study aims to survey Undersea and Hyperbaric Medical Society (UHMS) members on pressure modalities and their use in different clinical conditions. METHODS/UNASSIGNED:The study was a voluntary cross-sectional survey administered online and open to healthcare providers who were Undersea and Hyperbaric Medical Society members. UHMS itself distributed the survey link. The survey period lasted from November 2022 until January 2023. Data were collected utilizing the Qualtrics platform and analyzed through Microsoft Excel. RESULTS/UNASSIGNED:A total of 265 responses were recorded. The majority responded with utilizing 2.4 ATA (35.2%) as the pressure of choice, followed by 2.0 ATA only (27.1%), and those who utilized differing therapeutic pressures (26.4%). The overwhelming choice for treatment of osteoradionecrosis (ORN) of the jaw, radiation proctitis/cystitis, diabetic foot ulcer, and chronic osteomyelitis was 2.0 ATA (68.0- 74.9%). Among listed adverse effects, myopia was the most commonly reported complication at 24.4%, followed by barotrauma (14.9%) and confinement anxiety (11.5%). CONCLUSIONS/UNASSIGNED:. As adverse effects appear non-negligible, future prospective studies must be conducted weighing the risks and benefits of higher-pressure therapies compared to safer lower-pressure options.

INTRODUCTION:Chronic wounds represent a significant burden to the health care system and patients. OBJECTIVE:This study determined the effectiveness of a wound scaffold comprised of PCMP for use in nonhealing, cutaneous wounds; this study analyzes pooled data from the population of 3 combined registries. MATERIALS AND METHODS:A total of 3 combined registry populations were pooled from a single-center study of 41 patients, a single-center study of 86 patients, and the RESPOND Registry of 307 patients treated at 28 centers. All 434 patients received PCMP and were followed for up to 48 weeks. Male and female patients 18 years or older with wounds between 0.2 cm2 and 200 cm2 were included. RESULTS:In total, there were 95 VLUs, 78 DFUs, 90 PIs, 73 PSWs, and 98 wounds of other etiologies analyzed. The mean baseline area, depth, and volume of all 434 wounds was 15.1 cm2, 4.9 mm, and 7.2 cm3, respectively. K-M median time to wound closure for all wounds was 19 weeks. At weeks 20, 24, 28, and 48, the frequency of wound closure for all wounds was 51%, 56%, 62%, and 72%, respectively. The median time to closure by wound type was 22 weeks for VLUs, 24 weeks for DFUs, 23 weeks for PIs, 12 weeks for PSWs, and 14 weeks for other wounds. The proportion of wounds closed were 72% (VLUs), 52% (DFUs), 63% (PIs), 95% (PSWs), and 67% (other etiologies). CONCLUSIONS:This 434-patient PCMP cohort analysis showed 72% wound closure and median time to wound closure of 19 weeks. PCMP demonstrated effectiveness for use in multiple wound types.

GENERAL PURPOSE/OBJECTIVE:To discuss a standardized methodology for wound photography with a focus on aiding clinicians in capturing high-fidelity images. TARGET AUDIENCE/BACKGROUND:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES/OBJECTIVE:After participating in this educational activity, the participant will be able to:1. Discriminate the components of high-quality wound photography.2. Identify the technological innovations that can augment clinical decision-making capacity.3. Choose strategies that can help clinicians avoid adverse medicolegal outcomes.

Importance/UNASSIGNED:Accurate assessment of wound area and percentage of granulation tissue (PGT) are important for optimizing wound care and healing outcomes. Artificial intelligence (AI)-based wound assessment tools have the potential to improve the accuracy and consistency of wound area and PGT measurement, while improving efficiency of wound care workflows. Objective/UNASSIGNED:To develop a quantitative and qualitative method to evaluate AI-based wound assessment tools compared with expert human assessments. Design, Setting, and Participants/UNASSIGNED:This diagnostic study was performed across 2 independent wound centers using deidentified wound photographs collected for routine care (site 1, 110 photographs taken between May 1 and 31, 2018; site 2, 89 photographs taken between January 1 and December 31, 2019). Digital wound photographs of patients were selected chronologically from the electronic medical records from the general population of patients visiting the wound centers. For inclusion in the study, the complete wound edge and a ruler were required to be visible; circumferential ulcers were specifically excluded. Four wound specialists (2 per site) and an AI-based wound assessment service independently traced wound area and granulation tissue. Main Outcomes and Measures/UNASSIGNED:The quantitative performance of AI tracings was evaluated by statistically comparing error measure distributions between test AI traces and reference human traces (AI vs human) with error distributions between independent traces by 2 humans (human vs human). Quantitative outcomes included statistically significant differences in error measures of false-negative area (FNA), false-positive area (FPA), and absolute relative error (ARE) between AI vs human and human vs human comparisons of wound area and granulation tissue tracings. Six masked attending physician reviewers (3 per site) viewed randomized area tracings for AI and human annotators and qualitatively assessed them. Qualitative outcomes included statistically significant difference in the absolute difference between AI-based PGT measurements and mean reviewer visual PGT estimates compared with PGT estimate variability measures (ie, range, standard deviation) across reviewers. Results/UNASSIGNED:A total of 199 photographs were selected for the study across both sites; mean (SD) patient age was 64 (18) years (range, 17-95 years) and 127 (63.8%) were women. The comparisons of AI vs human with human vs human for FPA and ARE were not statistically significant. AI vs human FNA was slightly elevated compared with human vs human FNA (median [IQR], 7.7% [2.7%-21.2%] vs 5.7% [1.6%-14.9%]; P < .001), indicating that AI traces tended to slightly underestimate the human reference wound boundaries compared with human test traces. Two of 6 reviewers had a statistically higher frequency in agreement that human tracings met the standard area definition, but overall agreement was moderate (352 yes responses of 583 total responses [60.4%] for AI and 793 yes responses of 1166 total responses [68.0%] for human tracings). AI PGT measurements fell in the typical range of variation in interreviewer visual PGT estimates; however, visual PGT estimates varied considerably (mean range, 34.8%; mean SD, 19.6%). Conclusions and Relevance/UNASSIGNED:This study provides a framework for evaluating AI-based digital wound assessment tools that can be extended to automated measurements of other wound features or adapted to evaluate other AI-based digital image diagnostic tools. As AI-based wound assessment tools become more common across wound care settings, it will be important to rigorously validate their performance in helping clinicians obtain accurate wound assessments to guide clinical care.

Objective/UNASSIGNED:Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress. Methods/UNASSIGNED:This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation. Results/UNASSIGNED:We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046). Conclusion/UNASSIGNED:Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.

Chronic nonhealing wounds cause significant morbidity and mortality and remain a challenging condition to treat. Regenerative wound surgery involves operative debridement of wounds to remove dead and healing-impaired tissue and bacterial contamination and, subsequently, the application of regenerative medicine treatments to accelerate healing. Regenerative treatments aim to restore native tissue structure and function by targeting biological mechanisms underlying impaired healing. A wide range of regenerative modalities are used for treating chronic and complex wounds, including decellularized scaffolds, living engineered donor tissues, autologous stem cells, and recombinant growth factors. Each of these modalities has specific and sometimes complex requirements for implementation. The advanced wound care team, including OR staff members, should be aware of how these products are used and regulated. This article highlights some of the common and emerging regenerative treatments that are applied in wound surgery and focuses on how the products are used practically in the OR.