Schedule Slot

Biodegradable synthetic dermal substitutes have expanded reconstructive options in complex wounds where autologous tissue is limited or local conditions are suboptimal. NovoSorb® is a fully synthetic, temporizing dermal matrix designed to support neovascularization and staged reconstruction. While its use is increasing, real-world data across heterogeneous indications remain limited. We report our five-year single-center experience.

We performed a retrospective analysis of all adult patients treated with NovoSorb® at Cantonal Hospital Aarau, Switzerland, between November 2020 and December 2025. Wound etiology, indication, need for repeated surgical debridement, use of adjunctive therapies such as negative pressure wound therapy (NPWT), time to definitive coverage, were recorded. The primary endpoint was successful matrix integration enabling definitive closure with split-thickness skin grafting. Secondary endpoints included complications such as infection, non-adherence, incomplete vascularization, hematoma, and graft loss.

A total of 146 cases were included: 94 males, 52 females, with a mean age of 69.8 years. Indications included infection (42%), oncologic resection (27%), trauma (21%), coverage of donor-site defects (9%), and burns (1%). The mean interval between NovoSorb® implantation and definitive split-thickness skin grafting was 41.8 ± 24.3 days. Cases were stratified into early/standard (n = 44, 30%) and delayed grafting groups (n = 102, 70%). Mean time to grafting was 24.0 ± 6.0 days in the early group and 49.8 ± 25.1 days in the delayed group, the latter mainly involving scalp and complex extremity defects with exposed bone. Successful matrix integration permitting definitive split-thickness skin grafting and subsequent complete wound healing was achieved in 94% of patients. The overall complication rate was 14%. Minor complications (Clavien–Dindo grade II) occurred in 6 cases (4%), while 15 cases (10%) required surgical revision (Clavien–Dindo grade III), most commonly due to infection. Matrix failure was observed in 6% of cases.

In this heterogeneous cohort of complex wounds, NovoSorb® showed favorable integration rates and acceptable complication profile. Our five-year experience provides practical guidance for incorporating synthetic dermal matrices into staged reconstructive algorithms.

Primary cutaneous squamous cell carcinoma (cSCC) of the head and neck with close or involved deep excision margins carries high risk of recurrence, necessitating adjuvant radiotherapy or bone burring and subsequent reconstruction. Minimal work has been published examining the efficacy of burring. We describe a cohort of patients and assess their recurrence rate.

Retrospective chart review to obtain patient demographics and tumour characteristics. Patients with primary disease only with either close (<1mm) or involved deep excision margin at their initial operation were included. Patients had been managed with burring, radiotherapy or observation alone. Logistic regression was used to examine the association between burring and recurrence, reported as odds ratio (OR) with 95% confidence intervals (95% CI).

Data for 200 patients were collected. 167 were male (83.5%), mean age of cohort 81 years (SD 8.51). Burring was done in 112 patients (56%), of which 12 had radiotherapy. Radiotherapy was the sole modality in 39 patients (19.5%) and observation alone in 49 (24.5%). In burred patients, 9 developed local recurrence or new nodal disease (8%). This is lower than rates demonstrated in other case series (11.8-50%). In patients that received radiotherapy alone, incidence of recurrence was seen in 6 cases (11.8%) and in patients that had no intervention, recurrence was observed in 8 cases (16.3%).

In logistic regression models, burring is strongly inversely associated with local disease recurrence (OR 0.24, 95% CI 0.06-0.90). This was statistically significant (p=0.03), following multivariate adjustment for age, sex, radiotherapy, tumour characteristics, perineural invasion and staging.

Our results demonstrate that outer table bone burring appears to be strongly protective against local SCC disease recurrence in the head and neck, displaying a significant inverse association. As such it should be considered as a primary treatment modality in patients with close/involved deep margins, offering robust local disease control and deep margin management. Our MDT approach appears to have lower recurrence rates than other reported series, perhaps due to our extensive use of burring, however prior series have been limited in their scope.

To describe the epidemiological, clinical, histopathological, and therapeutic characteristics of malignant degeneration arising on burn scars, with a particular focus on surgical management and reconstructive strategies.

A retrospective descriptive study was conducted between January 2019 and March 2026 in the Department of Burn, Plastic, Reconstructive, and Aesthetic Surgery at Mohammed VI University Hospital, Oujda. Patients with histologically confirmed malignant tumors arising on burn scars were included. Demographic, clinical, histological, and therapeutic data were analyzed using descriptive statistics.

Nine patients were included, with a mean age of 58.6 years (range 47–71). A marked male predominance was observed (88.9%). The lower extremities were the most frequently affected sites (55.6%). The mean latency period was 24.8 years.

Clinically, lesions presented as chronic non-healing ulcers with exophytic or ulcerative features, bleeding, and foul odor. Histologically, squamous cell carcinoma predominated (88.9%), including verrucous variants (33.3%). One patient developed a high-grade sarcomatous transformation on a recurrent lesion.

All patients underwent wide surgical excision. Reconstruction included split-thickness skin grafts, local flaps, and free flaps such as the anterolateral thigh flap. Two patients required amputation (22.2%). Adjuvant radiotherapy was administered in 44.4% of cases.

Malignant degeneration of burn scars remains a rare but aggressive condition characterized by long latency and advanced presentation. Early diagnosis and prompt surgical excision are essential. Reconstruction should be individualized based on defect characteristics, with flap-based techniques playing a key role in advanced cases. Awareness and early management of unstable burn scars are crucial to improve outcomes.

Keloids are a therapeutic challenge due to frequent resistance to conventional treatments and high recurrence rates. Current management strategies range from non-invasive approaches, such as silicone sheeting and compression therapy, to surgical excision and adjuvant radiotherapy. Intralesional cryotherapy has emerged as a minimally invasive alternative, enabling controlled intralesional freezing using Argon gas to achieve homogeneous scar tissue necrosis. Following our preliminary evaluation in 2019, we report our five-year clinical experience with this technique.

In this retrospective cohort study all consecutive patients who underwent intralesional cryotherapy for keloids at our department between 04/2021 and 01/2026 were included. Demographic data, lesion characteristics, treatment details, complications and patient-reported outcomes were analyzed based on standardized follow-up visits up to 1 year postoperatively.

A total of 46 keloids in 23 patients (16 female) were treated. Median patient age was 30 years (range 19–68). The most common localization was the ear (46%), followed by the trunk (22%). All patients were otherwise healthy. Most patients reported pruritus, pain and discomfort related to scar volume. 87.5% of patients were suffering from recurrent keloids, having previously undergone unsuccessful therapies, most commonly silicone sheathing, intralesional corticosteroid injections or resection followed by radiotherapy. Repeat cryotherapy was required in 17 keloids (16 underwent two sessions, one underwent three). One patient developed a localized infection, which was managed conservatively. Complete symptom resolution was achieved in 18 keloids, 10 of which localized on the ear. Partial response with volume reduction but persistent residual scar tissue was observed in 9 keloids, exclusively in the ear localization. Recurrence after 2-3 years occurred in 5 keloids. Persistent pain and pruritus despite treatment were reported in 14 keloids, 13 of which in the sterno-pectoral area.

Intralesional cryotherapy represents an effective and safe minimally invasive option within the therapeutic armamentarium for keloid management. In most cases, satisfactory long-term outcomes were achieved after a single treatment session. Ear keloids demonstrated the most favorable response, whereas presternal lesions appeared to be the most resistant to treatment.

Keloids are often associated with pain and pruritus, resulting in significant cosmetic and functional impairment. They have limited conservative treatment options with unpredictable outcomes, and recurrence rates following surgery remain high. Surgical excision combined with postoperative high-dose-rate (HDR) brachytherapy has been reported as an effective treatment; however, indications, timing, and radiation protocols remain heterogeneous across the literature.

We conducted a literature review on postoperative brachytherapy for keloid treatment using the search term “keloid AND brachytherapy” in PubMed, evaluating reported indications, radiation protocols, and clinical outcomes. In parallel, we performed an observational case series. Patients underwent a surgical excision of a keloid in an outpatient setting under local anesthesia (n=9, 90%) or general anesthesia (n=1, 10%) with placement of 1-2 catheters. This was followed by 3 brachytherapy fractions of 500-600Gy, administered directly after surgery and twice the day following surgery with a 6-hour interval. Early outcomes included symptom relief, patient satisfaction, complications and early recurrence using the POSAS and DLQI scales.

The literature review identified 19 studies published over the last decade. Reported total radiation doses ranged from 10-20 Gy, delivered in 2-3 fractions, initiated within 1-48h postoperatively. Follow-up duration ranged from 3 months to 8 years. Reported success and recurrence rates varied widely, reflecting a lack of consensus on treatment protocols. Our case series included 10 patients with symptomatic keloids, most commonly involving the ear (n = 4, 40%) and thorax (n = 5, 50%). Median follow-up was 7 months (range 6–12months). No recurrences were observed during early follow-up. Resolution of pain and pruritus was reported by all patients (100%). Two patients (20%) developed minor complications (one wound dehiscence and one hematoma), both managed conservatively without surgical revision (Clavien-Dindo Grade I).

Postoperative HDR brachytherapy following excision may benefit patients suffering from keloids as supported by published literature and our preliminary clinical experience. While early outcomes appear favorable, standardization of treatment protocols and longer-term follow-up are needed.

After cutaneous injury, abnormal wound healing can lead to the development of hypertrophic scars and keloids. Dysregulated collagen synthesis, persistent inflammation, and impaired remodeling drive pathological scarring. Keloids exhibit excessive fibroproliferative activity, characterized by high recurrence rates, growth beyond initial wound borders, and persistent collagen deposition. Given the complex pathobiology of pathological scarring, multimodal approaches
integrating energy-based technologies with regenerative therapies have gained increasing interest.

A narrative review of recent English-language literature was conducted, focusing on multimodal scar revision strategies combining regenerative therapies with energy-based technologies, such as adjunctive laser-based treatments, radiofrequency microneedling, and stem-cell enriched fat grafting.

Through controlled thermal injury, radiofrequency microneedling enhances skin architecture and biomechanical characteristics by promoting collagen synthesis and dermal remodeling. Through angiogenesis and extracellular matrix (ECM) remodeling, adipose-derived stem cells (ADSCs) improve tissue repair; when paired with fat grafting, they demonstrate synergistic effects. Scar modulation is supported by fractional CO2 and Er:YAG lasers, which cause microthermal damage and increase fibroblast activity. Growth factor-mediated regeneration assistance is offered by adjuvant therapies such as platelet-rich plasma, and silicone gel supports fibroblast hydration and regulation. When compared to monotherapy, multimodal treatments that target both regenerative and energy-based pathways demonstrate improved clinical outcomes.

Multiple biological pathways that contribute to pathological scarring are addressed by multimodal scar revision techniques, which also enable customized treatment planning according to patient and scar characteristics. Integration of energy-based technologies with regenerative therapies may enhance both functional and aesthetic outcomes. To optimize evidence-based management and standardize techniques, more comparative and prospective research is needed.