Dani Kruchevsky

Bio: Dani Kruchevsky is an academic researcher from Rambam Health Care Campus. The author has contributed to research in topics: Lightning strike & Mastectomy. The author has an hindex of 1, co-authored 5 publications receiving 15 citations.

Trends in Burn Injuries in Northern Israel during the COVID-19 Lockdown.

Abstract: Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P < .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.

Biplanar Technique for Breast Implant Replacement through Mastectomy Scar.

Abstract: Background Implant-based breast reconstruction is the most commonly used modality for breast reconstruction. A 2-stage reconstruction is employed when the skin envelope is insufficient. In the first stage, a tissue expander is placed in a pocket created beneath the pectoralis major muscle and an acellular dermal matrix (ADM). In the second stage, the expander is replaced with a permanent implant. Though the second stage is safer, some studies have published an immediate complication rate of up to 11.4%, and even higher in the event of prior radiotherapy. Methods We present a novel biplanar technique for implant replacement through the mastectomy scar. The goal of our technique is to make incisions of the skin and the incorporated ADM in 2 separate planes, hopefully lowering the risk for dehiscence, deep infection, and reconstruction failure. We conducted a retrospective review of patients who underwent tissue expander or implant replacement surgery using the biplanar technique between January 2012 and January 2018 by the senior author. Results Eleven consecutively presenting patients underwent 8 tissue expanders and 6 silicone implant replacement surgeries. Three patients had received prior radiation therapy in the operated breast. None of the patients had complications nor needed a revision surgery. Conclusions The biplanar technique for implant or tissue expander replacement through the mastectomy scar following breast reconstruction shows promising results in our series of patients and may prove useful in reducing postoperative incisional dehiscence, deep infection, and implant exposure. Nonetheless, further large-scale studies are required to evaluate the effectiveness of this technique.

Case Report: Burns Through Metal - Unique Pattern Of First Lightning Strike Injury In Israeli Army.

Abstract: This case report presents a 19-year-old Israeli soldier who sustained injury as a result of a lightning strike during an outdoor military activity. The patient was found in a state of altered consciousness and respiratory distress. He suffered multiple second-degree burns to the neck, chest and abdomen area, corresponding to the locations of his metal identification tag, rifle and belt buckle. Lightning transmission through these metal objects caused considerable thermal burns at contact sites. The patient was treated conservatively until wound healing and stabilization of respiratory function. This is the first reported case of military personnel injured by lightning strike in Israel. Although rare in the Mediterranean region, safety guidelines and regulations should be implemented to avoid the associated serious and permanent injuries that may be caused by lightning strikes.

Optimizing the use of Aquacel Ag® for pediatric burns - When to start?

Abstract: Most pediatric burns are 2nd degree partial thickness, and most will heal spontaneously by providing a good healing environment, though there is no standardized treatment protocol. Aquacel Ag® has shown good clinical results in reducing the need for frequent dressing changes in the pediatric population. This study's goal was to review our experience using this dressing for pediatric partial thickness burns in order to optimize and customize its use. A retrospective study included all pediatric patients suffering from burns, admitted to our institution between July 2013 and May 2018. We investigated a total of 705 dressing changes in our cohort of 276 patients. The most prevalent dressing material was Aquacel Ag®, used in 48% of cases. We examined the pattern of using Aquacel Ag® dressings. The average time until dressing change was required proved to be much longer when applied on the 1st day after burn and onward in comparison to the day of injury (4.85 vs. 2.21 days, p<0.001). Moreover, when it was applied on the 1st day after burn, a dressing used on a superficial 2nd degree burn needed to be changed less often than when it was applied on a deep 2nd degree burn (4.95 vs. 2.29 days, p=0.024). To optimize its use and cost effectiveness, dressing with Aquacel Ag® should be initiated on the 1st day after burn, or on the 2nd day when a deep 2nd degree burn is suspected; until then a standard topical preparation should be used.

Triggers of Preoperative Anxiety in Patients Undergoing Mohs Micrographic Surgery.

Abstract: We collected and documented patient data, surgical demographics and preoperative anxiety level for all patients. Quantification of preoperative anxiety was determined using the visual analogue scale (measuring ranged from 1 “no anxiety at all” to 10 “extremely anxious”), a validated and reliable tool used to quantify subjective data and has been applied to enumerate perioperativeMMSpatient anxiety in previous studies. The Visual Analogue Scale was obtained by the senior author after explaining the surgical course, anticipated aesthetic results and associated complications, and signing the informed consent. Results

625 The Impact of COVID-19 on Burn Care at a Regional Burn Center

Abstract: Introduction The COVID-19 pandemic has had a profound global impact, not least on hospital functioning Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant;it may be some time before we know the full extent of this While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care Methods A review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center These data were compared with the same five-month period in the preceding two years Results Selected data highlights are tabulated (Table 1) During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121) The mean total body surface area was slightly higher this year (13 7%), and the mean length of hospital stay longer (18 days) The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2 9:1, compared to 1 7:1 No significant differences in terms of etiology were detected, however As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes) The total time utilised for burn surgery was similar to previous years (572 hours) Table 1 Selected burn center data comparing 2020 with 2019 and 2018 Conclusions This study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist

The impact of COVID-19 pandemic lockdown on the incidence and outcome of complicated appendicitis.

Abstract: Patient attendance at emergency departments (EDs) during the COVID-19 pandemic outbreak has decreased dramatically under the “stay at home” and “lockdown” restrictions. By contrast, a notable rise in severity of various surgical conditions was observed, suggesting that the restrictions coupled with fear from medical facilities might negatively impact non-COVID-19 diseases. This study aims to assess the incidence and outcome of complicated appendicitis (CA) cases during that period. A retrospective study comparing the rate and severity of acute appendicitis (AA) cases during the COVID-19 initial outbreak in Israel during March and April of 2020 (P20) to the corresponding period in 2019 (P19) was conducted. Patient data included demographics, pre-ED status, surgical data, and postoperative outcomes. Overall, 123 patients were diagnosed with acute appendicitis, 60 patients during P20 were compared to 63 patients in P19. The rate of complicated appendicitis cases was significantly higher during the COVID-19 Lockdown with 43.3% (26 patients) vs. 20.6% (13 patients), respectively (p < 0.01). The average delay in ED presentation between P20 and P19 was 3.4 vs. 2 days (p = 0.03). The length of stay was 2.6 days in P20 vs. 2.3 days in P19 (p = 0.4), and the readmission rate was 12% (7 patients) vs. 4.8% (3 patients), p = 0.17, respectively. Logistic regression demonstrated that a delay in ED presentation was a significant risk factor for complicated appendicitis (OR 1.139, CI 1.011–1.284). The effect of the COVID-19 initial outbreak and Lockdown coupled with hesitation to come to medical facilities appears to have discouraged patients with acute appendicitis from presenting to the ED as complaints began, causing a delay in diagnosis and treatment, which might have led to a higher rate of complicated appendicitis cases and a heavier burden on health care systems.

The Impact of the COVID-19 Pandemic on Burn Admissions at a Major Metropolitan Burn Center.

Abstract: The impact of the coronavirus disease 2019 (COVID-19) pandemic on admission patterns and outcomes at a burn center is still largely unknown. The aim of this study was to determine how the COVID-19 pandemic affected the epidemiology of burn admissions at a major metropolitan burn center. This retrospective cohort study examined how the COVID-19 pandemic affected burn volumes and time to presentation. All burn admissions were included from January 20 to August 31 for the years 2020, 2019, and 2018. The COVID-19 pandemic group included admissions from January 20, 2020 to August 31, 2020 and was compared to the nonpandemic group comprised of admissions from January 20 to August 31 in 2018 and 2019. Subgroup analysis was performed according to meaningful dates during the COVID-19 pandemic including the first U.S. COVID-19 case, shelter-in-place, and state reopening orders. Admission volumes were 403 patients in the COVID-19 pandemic group compared to a mean of 429 patients in the nonpandemic group, which correlated to a 5.8% decrease in volume during the pandemic. The pandemic group showed an increase in time to presentation of 1 day (P < .0001). Subgroup analysis demonstrated stable admission volumes and an increase in time to presentation of 1 day (P < .0001) at each time point. During shelter-in-place orders, there were higher rates of second/third-degree burns and operative burns (94.7 vs 56.3% and 45.6 vs 27%, P < .0001, P = .013). During the pandemic, there were stable admission volumes, delayed time to admission, and an increase in operative burns during shelter-in-place orders. This reinforces the need to maintain appropriate burn center staffing and resources during the COVID-19 pandemic.