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Predicting skin graft failure on the scalp by intraoperative laser speckle analysis
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As imagens de LSCI mostram diferenças na perfusão em escala semiquantitativa, do preto (sem perfusão) ao vermelho (perfusão intensa). O paciente 1 apresentava leito receptor azulado a preto no D0, e o enxerto permaneceu mal perfundido até o D28, culminando com necrose subtotal do enxerto. O paciente 2 apresentava leito de enxerto azulado (baixa perfusão), mas recuperou‐se gradualmente ao longo de quatro semanas, e a área de necrose do enxerto foi inferior a 50%. Os pacientes 3 e 4 apresentaram leitos de enxerto melhor perfundidos e apresentaram perfusão acentuada a partir do D14. No D28, a extensão da necrose era de 16% e 9%, respectivamente. LSCI, <span class="elsevierStyleItalic">laser speckle contrast imaging</span>; UPA, unidades de perfusão arbitrária.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "André Pinho, Ana Brinca, Carolina Figueiredo, Duarte Flor, Ricardo Vieira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "André" "apellidos" => "Pinho" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Brinca" ] 2 => array:2 [ "nombre" => "Carolina" "apellidos" => "Figueiredo" ] 3 => array:2 [ "nombre" => "Duarte" "apellidos" => "Flor" ] 4 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Vieira" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059624000631" "doi" => "10.1016/j.abd.2023.05.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000631?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000675?idApp=UINPBA00008Z" "url" => "/26662752/0000009900000004/v1_202406100414/S2666275224000675/v1_202406100414/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059624000709" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.12.013" "estado" => "S300" "fechaPublicacion" => "2024-07-01" "aid" => "941" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Research</span>" "titulo" => "Prognostic factors and survival of patients with melanoma treated at a reference hospital in the Brazilian Amazon region" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "594" "paginaFinal" => "597" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1156 "Ancho" => 2508 "Tamanyo" => 170490 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Survival according to the presence of lymph node involvement in melanoma patients treated at a reference service, Belém – Pará, 2015 to 2020.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Amanda Gabay Moreira, Antonio Vitor da Silva Freitas, Carla Andrea Avelar Pires" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Amanda Gabay" "apellidos" => "Moreira" ] 1 => array:2 [ "nombre" => "Antonio Vitor da Silva" "apellidos" => "Freitas" ] 2 => array:2 [ "nombre" => "Carla Andrea Avelar" "apellidos" => "Pires" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275224000730" "doi" => "10.1016/j.abdp.2024.04.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000730?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000709?idApp=UINPBA00008Z" "url" => "/03650596/0000009900000004/v2_202407191005/S0365059624000709/v2_202407191005/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0365059624000710" "issn" => "03650596" "doi" => "10.1016/j.abd.2023.07.012" "estado" => "S300" "fechaPublicacion" => "2024-07-01" "aid" => "942" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Research</span>" "titulo" => "Insulin inhibits melanoma tumor growth through the expression of activating transcription factor 4, without detectable expression of transcription factor CHOP: an <span class="elsevierStyleItalic">in vivo</span> model" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "587" "paginaFinal" => "591" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2153 "Ancho" => 3341 "Tamanyo" => 721432 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical analysis of ATF4 and TFCHOP expression. Tissues obtained from tumor material from the control (A and C) and 4 IU/kg (B and D) groups were evaluated based on the immunohistochemical expression of these proteins. The photographs were obtained using an Axiolab 5 microscope (Zeiss) and analyzed using the ImageJ FIJI software program. The control and 4 IU/kg groups were chosen to represent dose extremes.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel do Prado, Marianna Boia-Ferreia, Hanna Camara da Justa, Andrea Senff-Ribeiro, Sérgio Lunardon Padilha" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Daniel" "apellidos" => "do Prado" ] 1 => array:2 [ "nombre" => "Marianna" "apellidos" => "Boia-Ferreia" ] 2 => array:2 [ "nombre" => "Hanna Camara" "apellidos" => "da Justa" ] 3 => array:2 [ "nombre" => "Andrea" "apellidos" => "Senff-Ribeiro" ] 4 => array:2 [ "nombre" => "Sérgio Lunardon" "apellidos" => "Padilha" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275224000742" "doi" => "10.1016/j.abdp.2024.04.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000742?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000710?idApp=UINPBA00008Z" "url" => "/03650596/0000009900000004/v2_202407191005/S0365059624000710/v2_202407191005/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Research</span>" "titulo" => "Predicting skin graft failure on the scalp by intraoperative laser speckle analysis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "591" "paginaFinal" => "593" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "André Pinho, Ana Brinca, Carolina Figueiredo, Duarte Flor, Ricardo Vieira" "autores" => array:5 [ 0 => array:4 [ "nombre" => "André" "apellidos" => "Pinho" "email" => array:2 [ 0 => "andrecastropinho@gmail.com" 1 => "10648@ulscoimbra.min-saude.pt" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana" "apellidos" => "Brinca" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Carolina" "apellidos" => "Figueiredo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Duarte" "apellidos" => "Flor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Vieira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatology Department, Coimbra Hospital and University Centre, Coimbra, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine, University of Coimbra, Coimbra, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1086 "Ancho" => 1675 "Tamanyo" => 116038 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of full-thickness skin grafts perfusion on the scalp. Skin graft perfusion on day 7 was lower than baseline graft bed perfusion in all patients. Patients 3 and 4 had higher baseline perfusion and reached peak values on day 21 and day 28, respectively. Patient 1, with the worst clinical outcome, had an ascending curve until day 28 but with persistently lower perfusion values.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Reconstruction with skin grafts after cutaneous malignancy excision might carry some graft failure despite the best surgical practice.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is well-established that a poorly perfused recipient bed has a higher risk of skin graft failure.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The vascular supply for skin grafts on the scalp derives mainly from aponeurotic galea, but in a dermato-oncologic setting, its integrity is often compromised.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> By week four, the failure rate of full-thickness skin grafts (FTSG) on the scalp can reach 22%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The impact of the perfusion status of the recipient bed on graft viability at week four still needed to be quantified in humans <span class="elsevierStyleItalic">in vivo</span>.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Laser speckle contrast imaging (LSCI) is a non-invasive, real-time, contactless technique that allows the study of microcirculation on large surface areas intra- and perioperatively.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In previous research, we validated the study of microcirculation of distinct types of skin grafts by LSCI analysis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Its role in identifying high-risk patients for graft necrosis still needs to be explored.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this pilot study, we aim to compare the outcomes of FTSG on the scalp with the baseline graft bed perfusion assessed by LSCI. We will also describe the changes in FTSG perfusion over four weeks.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After local ethics committee approval and informed consent, four consecutive patients with non-melanoma skin cancer of the scalp were enrolled: all male gender with 71y/o (patient 1), 90y/o (patient 2), 81y/o (patient 3) and 78y/o (patient 4). The main characteristics and comorbidities of the patients are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The tumors were excised after lidocaine with epinephrine infiltration, and FTSG were harvested from the infraclavicular area. Twenty minutes after lesion removal and before skin graft suture, baseline wound bed perfusion (in arbitrary perfusion units, APU) was measured with LSCI for 1 minute, and mean arterial pressure (MAP, in mmHg) was registered. The ratio APU/MAP yielded cutaneous vascular conductance (CVC, in APU/mmHg), allowing the comparison of patients' perfusion values. FTSG was ultimately sutured, and tie-over-dressing was applied for one week.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">By day (D) 7, D14, D21, and D28, graft perfusion was assessed and compared with baseline perfusion of graft bed on D0. Clinical pictures were also registered. Necrosis areas were calculated with SketchAndCalc Area Calculator™ (version 6.2.5, 2018).</p><p id="par0040" class="elsevierStylePara elsevierViewall">In all patients, skin cancer removal allowed the preservation of some underlying aponeurotic galea for skin graft vascular supply. No patient developed a postoperative infection, hematoma, or hemorrhage.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The primary defect areas were 8.4 cm<span class="elsevierStyleSup">2</span> (patient 1), 12.3 cm<span class="elsevierStyleSup">2</span> (patient 2), 5.8 cm<span class="elsevierStyleSup">2</span> (patient 3), and 8.7 cm<span class="elsevierStyleSup">2</span> (patient 4). The evolution of CVC values over the four weeks is represented in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The sequential clinical and LSCI images registered during the same period are presented in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Baseline CVC values of the recipient bed were 0.22 APU/mmHg, 0.43 APU/mmHg, 0.51 APU/mmHg, and 0.70 APU/mmHg, respectively, on patients 1, 2, 3, and 4. The graft necrosis extension on day 28 decreased with increased recipient bed perfusion (CVC) on day 0. It was 82% on patient 1, 48% on patient 2, 16% on patient 3, and 9% on patient 4.</p><p id="par0055" class="elsevierStylePara elsevierViewall">After an initial decrease from day 0 to 7, by day 14, graft CVC overcame baseline recipient bed CVC in all patients. The increase in graft perfusion was more remarkable from day seven until day 21, with a posterior tendency to decrease (in patients 2 and 4) or a slight increase (in patients 1 and 3). The lower the area under the perfusion curves, the higher the graft necrosis extension on day 28 in all patients.</p><p id="par0060" class="elsevierStylePara elsevierViewall">From the analysis of LSCI images, we observed that from day 14 onwards, the regions of skin graft poorly perfused (black to bluish) remained relatively stable in extension. These poorly perfused regions on day 14 overlapped with the regions of clinical necrosis on day 28.</p><p id="par0065" class="elsevierStylePara elsevierViewall">There are a few ways of evaluating skin perfusion non-invasively, but the evidence supporting their use in skin graft vascularisation monitoring is lacking. Optical coherence tomography requires sequential assessments of less than 1 cm<span class="elsevierStyleSup">2</span> along the skin graft surface. Also, direct contact with the skin graft might be inappropriate in an aseptic intraoperative setting.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Laser Doppler Imaging (LDI) allows non-contact assessment of cutaneous blood flow, with excellent spatial resolution but poor temporal resolution, especially when assessing extensive areas.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> LDI has a penetration depth of 0.5‒1.0 mm, more profound than the superficial dermal plexus that composes the cutaneous microcirculation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> LSCI overcomes most of the limitations of these techniques. It allows the quick acquisition of high-resolution perfusion images of extensive areas of graft surface without contact.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The short penetration of the laser radiation (0.3 mm) embraces capillaries, venules, and arterioles of the superficial papillary plexus, including the graft vasculature.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Regardless of the individual variables not analyzed and the small sample size not allowing any statistical correlation estimation, we showed that the area of FTSG necrosis increased with decreasing baseline perfusion. The grafts with the worst outcomes, 82% and 48% of necrosis, had the lowest baseline perfusions, as observed in patients 1 and 2, respectively. Moreover, in patient 1, with subtotal graft necrosis, the perfusion curve slope was more downward than the others.</p><p id="par0090" class="elsevierStylePara elsevierViewall">We demonstrate that the perfusion status of the graft bed can affect the outcome of FTSG, thus corroborating the established empirical knowledge. From our knowledge, this is the first report of using LSCI intraoperatively to identify patients with poorly perfused recipient graft beds who are, in theory, at increased risk of graft necrosis. This methodology must be expanded in larger samples and high-risk areas for skin graft necrosis other than the scalp, such as plantar or leg surfaces.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> With more robust data, identifying a perfusion (CVC) threshold might make the skin graft delay a better option than immediate skin grafting after tumor excision. We also speculate that the differences in CVC curves along the first graft healing might help to predict a higher risk of late necrosis.</p><p id="par0095" class="elsevierStylePara elsevierViewall">LSCI can be promising in selecting the best candidates for surgical reconstruction with FTSG and in the intraoperative prediction of late necrosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0100" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0105" class="elsevierStylePara elsevierViewall">André Pinho: Conceptualization (equal), investigation (lead), formal analysis (equal), and writing-original draft (lead).</p><p id="par0110" class="elsevierStylePara elsevierViewall">Ana Brinca: Conceptualization (equal) and writing-review & editing (lead).</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ana Figueiredo: Investigation (supporting).</p><p id="par0120" class="elsevierStylePara elsevierViewall">Duarte Flor: Investigation (supporting), formal analysis (supporting).</p><p id="par0125" class="elsevierStylePara elsevierViewall">Ricardo Vieira: Conceptualization (supporting) and writing-review & editing (supporting).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-03-25" "fechaAceptado" => "2023-05-09" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Dermatology Department of Hospital and University Centre of Coimbra, Coimbra, Portugal.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1086 "Ancho" => 1675 "Tamanyo" => 116038 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of full-thickness skin grafts perfusion on the scalp. Skin graft perfusion on day 7 was lower than baseline graft bed perfusion in all patients. Patients 3 and 4 had higher baseline perfusion and reached peak values on day 21 and day 28, respectively. Patient 1, with the worst clinical outcome, had an ascending curve until day 28 but with persistently lower perfusion values.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1981 "Ancho" => 3341 "Tamanyo" => 1588086 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical (left panels) and LSCI (right panels) images of full-thickness skin grafts on the scalp of the four patients. LSCI images show differences in perfusion in a semiquantitative scale, from black (meaning no perfusion), to red (intense perfusion). Patient 1 had a bluish-to-black recipient bed on day 0, and the graft remained poorly perfused until day 28, culminating in subtotal graft necrosis. Patient 2 had a bluish graft bed (meaning low perfusion) but gradually recovered over four weeks, and the graft necrosis area was less than 50%. Patients 3 and 4 had better-perfused graft beds and showed intense perfusion after day 14 onwards. By day 28, necrosis extensions were 16% and 9%, respectively. LSCI, laser speckle contrast Imaging; APU, arbitrary perfusion units.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AHT, Arterial Hypertension; BCC, Basal Cell Carcinoma; CAD, Coronary Arterial Disease; LM, Lentigo Maligna; LMS, Leiomyosarcoma; SCC, Squamous Cell Carcinoma; T2DM, Type 2 Diabetes Mellitus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Excised tumour \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cardiovascular risk factors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antiplatelets or anticoagulants \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other comorbidities \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LM</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AHT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aspirin</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inguinal hernia</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LMS</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AHT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glaucoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Osteoarthritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SCC</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AHT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transplanted kidney</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCC</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AHT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CAD</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T2DM \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3599879.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics and comorbidities of the (male) patients submitted to skin graft on the scalp.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of split vs full-thickness skin grafts in scalp reconstruction in outpatient local anaesthetic theatre" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. 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| 2024 Novembro | 21 | 8 | 29 |
| 2024 Outubro | 130 | 77 | 207 |
| 2024 Setembro | 186 | 89 | 275 |
| 2024 Agosto | 194 | 112 | 306 |
| 2024 Julho | 288 | 119 | 407 |
| 2024 Junho | 298 | 82 | 380 |
| 2024 Maio | 115 | 78 | 193 |
| 2024 Abril | 64 | 77 | 141 |
