Faculty Bibliography

GENERAL PURPOSE/OBJECTIVE:To present a study that investigated sacrococcygeal skeletal structure as a possible nonmodifiable intrinsic risk factor for pressure injury and identify possible issues caused by its morphology. 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:1. Recognize the background information the authors considered when planning and conducting their study of sacrococcygeal skeletal structure as a possible pressure injury risk factor.2. Identify the characteristics of the two groups of study participants.3. Choose the results of the study clinicians may consider when implementing evidence-based practice.

OBJECTIVE:Aloe vera is a cost-effective, accessible wound care adjunct with a minimal risk profile. Despite its centuries-long history being used to treat varying wound types, published reports remain inconclusive on its efficacy. In this article, the authors report the results of a systematic review assessing the efficacy of topical aloe vera products in wound care applications, as well as a meta-analysis of its utility in burn healing where data are most robust. DATA SOURCES/METHODS:In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched PubMed, EMBASE, and Cochrane CENTRAL for randomized controlled trials assessing the use of aloe vera in healing various wound types. STUDY SELECTION/METHODS:The database search identified 91 articles. After duplicates were removed, 74 articles were screened, and of those, 47 were assessed for eligibility. Ultimately, 28 articles were included in the qualitative synthesis, and 4 studies assessing second-degree burns were included in the meta-analysis. DATA EXTRACTION/METHODS:The following data points were collected from each study: number of participants/wounds, treatment type, adjunctive therapy (if any), and primary outcomes. DATA SYNTHESIS/RESULTS:Risk-of-bias analysis was conducted on included articles, and results were compiled. A meta-analysis was undertaken for studies focusing on the treatment of burns. Cumulatively, these studies had a total of 133 patients with 163 wounds being assessed. Analysis revealed a statistically significant mean difference in time to healing of 4.44 days in favor of aloe vera treatment (P = .004). CONCLUSIONS:Topical aloe vera usage for second-degree burn wound healing demonstrated significantly faster time to healing compared with other treatments.

Liposuction is a relatively safe surgical procedure, with most complications being minor in nature. However, there are a few life-threatening complications that should not be underestimated. We present a case of a patient who developed bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after combined liposuction and abdominoplasty. Although this presentation is rare, clinicians should keep a high index of suspicion in patients presenting with shortness of breath, chest pain, and/or abdominal pain after liposuction.

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.

OBJECTIVE:To provide a critical overview of current radiation modalities for keloid management. BACKGROUND:Despite multimodal therapies, keloids that can develop following injury are poorly controlled. A number of studies have suggested that post-excisional radiation therapy can reduce rates of keloid recurrence. However, existing reports span multiple radiation modalities, including brachytherapy, electron beam radiation, and photon radiation. In this review, we describe the advantages and disadvantages of commonly used radiation techniques and highlight their efficacy in keloid management. RESULTS:Electron beam radiation and high-dose rate brachytherapy are the two most commonly used modalities for adjuvant radiotherapeutic management of keloids and can provide effective keloid control but may be suited for different kinds of keloid growth patterns. Increasing biologically equivalent dose (BED) likely improves rates of control, though the clinical significance of this finding remains to be elucidated. Though radiation treatments are associated with acute and chronic side effects, the risk of developing a secondary malignancy is minimal. CONCLUSIONS:While radiation therapy is a promising modality for treating keloids, more studies of a prospective, randomized nature are needed to standardize its utility.

Current breast cancer care involves a multidisciplinary clinical approach for diagnosis and treatment including input from radiology, surgery, pathology, radiation, and medical oncology. Radiation is an integral part of the treatment for locoregionally confined breast cancer, and has well-recognized long-term risks of secondary malignancies, such as angiosarcomas. Basal cell carcinoma (BCC), a common skin malignancy, is not typically considered a radiation-induced carcinoma following breast cancer treatment. Our recent experience with 4 patients with vastly different presentations of BCC in previous radiation fields prompts the current report in order to alert clinicians to this entity.