Understanding and addressing populations whose prior experience has led to mistrust in healthcare

Even, Dan; Shvarts, Shifra

doi:10.1186/s13584-023-00565-w

Cited by 2 publications

(1 citation statement)

References 56 publications

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“…Serbia is found to have one of the highest numbers of screened and treated children in Europe and North America (878,659 and 49,389 children, respectively) [ 4 ]. Before the introduction of griseofluvin, an antimycotic able to penetrate the hair follicle, the use of X-ray radiation (also known as the Kienboch–Adamson method) to remove hair followed by the application of topical antimycotics was the treatment of choice for tinea capitis [ 5 , 6 ]. The x-ray irradiation was found to be an effective way of epilation following 2–3 weeks of exposure.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Nikolić Živanović,

Jurišić,

Marinković

et al. 2023

Medicina

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Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients’ characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors’ experience in managing these patients.

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Section: Introductionmentioning

confidence: 99%

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Nikolić Živanović,

Jurišić,

Marinković

et al. 2023

Medicina

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Bilaminar dermal regeneration template for the coverage of exposed dura in a patient irradiated for tinea capitis

Stojičić,

Jurišić,

Nikolić-Živanović

et al. 2024

Medicinska istraživanja

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Introduction: Before the discovery of antimycotics powerful enough to penetrate the hair follicle, the use of X ray radiation was a worldwide accepted method for scalp epilation as part of the treatment for tinea capitis in children. More than five decades later, the consequences of radiation in ringworm therapy became evident and included high rates of recurrent and aggressive forms of non-melanoma skin tumors, brain tumors and meningiomas, as well as osteoradionecrosis. Scalp reconstruction presents a challenge due to the unique anatomic characteristics of the scalp as well as tissue inelasticity. Cases of bilaminar dermal regeneration templates applied directly on dura in the literature are seldom described. Case report: A male patient irradiated due to tinea capitis as a child, presented at our institution for the management of multiple recurrent infiltrative basocellular carcinomas (BCC) and osteoradionecrosis of the scalp. Severe skin atrophy affected all areas of the scalp except for the forehead, which showed moderate atrophy. The patient had multiple surgeries over the next few years due to the emergence of new and recurrent BCCs as well as zones of osteoradionecrosis of the scalp. Post-surgical defects were commonly reconstructed using local fasciocutaneous flaps and skin autografts. Surgical site complications, including partial flap necrosis or autograft loss, frequently followed the procedures. After exhausting all reconstructive options by repeated previous surgeries, a post-surgical defect following ostectomy of newly developed ORN in the occipital region was reconstructed using a dermal substitute applied directly on the dura and covered with a skin autograft, in a two-step procedure. Due to a high perioperative risk for general anesthesia, the intervention was performed under local anesthesia with anesthesiologic monitoring. The postoperative period was uneventful and the skin autograft had a 100% take. Conclusion: The use of bilaminar dermal regeneration template Integra® can be efficiently utilized for the reconstruction of full thickness skin and calvaria defects in complex cases when all other reconstructive methods are exhausted.

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Understanding and addressing populations whose prior experience has led to mistrust in healthcare

Cited by 2 publications

References 56 publications

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Bilaminar dermal regeneration template for the coverage of exposed dura in a patient irradiated for tinea capitis

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