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Elmasry, Moustafa
Publications (10 of 45) Show all publications
Nööjd, M., Wyckman, A., Steinvall, I. & Elmasry, M. (2023). Flap Survival after Reconstructive Surgery for Pressure Ulcers: A Cohort Study. Plastic and Reconstructive Surgery - Global Open, 11(12), e5451-e5451
Open this publication in new window or tab >>Flap Survival after Reconstructive Surgery for Pressure Ulcers: A Cohort Study
2023 (English)In: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 11, no 12, p. e5451-e5451Article in journal (Refereed) Published
Abstract [en]

Background: Pressure ulcers are troublesome for patients and require considerable resources to resolve. Previous studies have focused on recurrence, whereas there are few studies on flap survival. The aim was to describe the group and to analyze possible factors for flap survival.

Method: A descriptive retrospective analysis of all operations between 2008 and 2020 was carried out. Flap survival at 40 days was assessed. A flap was classified as a failure if a reoperation with removal or replacement was planned before, or in connection with, the first return visit. Variables of patient demographics, details of the pressure ulcers, and surgical treatment and care were analyzed with multivariable logistic regression for their effect on flap survival.

Results: A total of 111 flaps were included [78 (70%) with random blood supply and 33 (30%) with axial or perforator-based blood supply]; 54 (49%) of the flaps were fasciocutaneous. Body mass index was 25 (IQR 22–28). Flap survival rate was 90%. Variables associated with flap failure were higher body mass index, congenital spinal cord injury, type of blood supply to the flap, and the use of methylene blue to guide debridement of the wound.

Conclusions: The findings show factors that can be modified to improve future results, including a normalized body mass index and use of methylene blue in surgery to outline wound edges and depth, as this has been shown to protect against flap failure. Our data suggest that random flaps, such as V-Y, are preferable to axial flaps in the studied group.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-199650 (URN)10.1097/gox.0000000000005451 (DOI)001125354000008 ()38098948 (PubMedID)
Available from: 2023-12-15 Created: 2023-12-15 Last updated: 2024-02-09Bibliographically approved
Karlsson, M., Steinvall, I. & Elmasry, M. (2023). Suprathel® or Mepilex® Ag for treatment of partial thickness burns in children: A case control study. Burns, 49(7), 1585-1591
Open this publication in new window or tab >>Suprathel® or Mepilex® Ag for treatment of partial thickness burns in children: A case control study
2023 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 7, p. 1585-1591Article in journal (Refereed) Published
Abstract [en]

Aim

The study aim was to investigate if Suprathel® can be an adequate alternative to Mepilex® Ag for the treatment of partial-thickness scalds in children.

Methods

A retrospective study including 58 children admitted to The Burn Centre in Linköping, Sweden between year 2015 and 2022. Of the 58 children, 30 were dressed with Suprathel ® and 28 with Mepilex ® Ag. Outcomes investigated were healing time, burn wound infection (BWI), need for operations and number of dressing changes.

Results

We found no significant differences in any of the outcomes. In the Suprathel ® group 17 children and in the Mepilex ® Ag group 15 children were healed within 14 days. Ten children from each group received antibiotics for suspected BWI and two from each group underwent an operation with skin grafting. Each group had on median four dressing changes.

Conclusions

Two different treatments were compared for children with partial-thickness scalds, and the data indicates that similar results are received with both dressings.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2023
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-199651 (URN)10.1016/j.burns.2023.03.003 (DOI)001110413700001 ()36933986 (PubMedID)
Available from: 2023-12-15 Created: 2023-12-15 Last updated: 2023-12-21Bibliographically approved
Karlsson, M., Östholm Balkhed, Å., Steinvall, I. & Elmasry, M. (2023). Wound infection among children with moderate burns – An explorative review of the association between reported frequency and diagnosis. Burns
Open this publication in new window or tab >>Wound infection among children with moderate burns – An explorative review of the association between reported frequency and diagnosis
2023 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409Article in journal (Refereed) In press
Abstract [en]

Introduction: The Linkoping burn centre in Sweden has, even though being a high income country, reported high burn wound infections (BWI) frequencies in scalded children compared to similar populations in other parts of the world.

Aim: The aim was to investigate possible explanations for differences in frequency of BWI among children with partial thickness burns treated at the Linköping burn centre in Sweden, and that reported in other studies.

Method: In order to investigate what BWI criteria that were used in similar studies a literature search on PubMed Central was done along with a retrospective analysis of children previously diagnosed as infected to confirm or reject the high infection frequency reported earlier.

Result: Of the 34 selected publications reporting on BWI frequency 16 (47%) did not define a criteria for the BWI diagnosis and almost a third did not report on wound culturing. Of those who did report the use a third do not mention any bacterial growth found is these cultures. The retrospective analysis on children at the centre did not show any decrease in infection frequency even with some disagreement on onset for the BWI.

Conclusion: The reporting of criteria and diagnosis of burn wound infection is highly variable making it difficult to interpret results and come to conclusions. The high frequency of BWI at the centre might be a result of close monitoring due to study participation, use of clean instead of sterile routine at dressing changes or low thresholds for the diagnosis in respect to changes in infection markers.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Burns; Children; Infection; Partial thickness burns; Scalds
National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-200889 (URN)10.1016/j.burns.2023.12.008 (DOI)38245392 (PubMedID)2-s2.0-85183153628 (Scopus ID)
Available from: 2024-02-15 Created: 2024-02-15 Last updated: 2024-03-22Bibliographically approved
Dogan, S., Elmasry, M., Elserafy, A. T., Sjöberg, F., Vuola, J., Kankuri, E., . . . Lindford, A. (2022). A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft. Scientific Reports, 12(1), Article ID 21666.
Open this publication in new window or tab >>A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft
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2022 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 21666Article in journal (Refereed) Published
Abstract [en]

To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns. Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022. © 2022, The Author(s).

Keywords
burns, cicatrix, dermis, humans, prospective studies, skin transplantation
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-190855 (URN)10.1038/s41598-022-25346-4 (DOI)001015461100020 ()36522434 (PubMedID)2-s2.0-85144147270 (Scopus ID)
Note

Funding: Linkoping University; Department of Plastic and Hand Surgery Linkoping University Hospital; Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping

Available from: 2023-01-03 Created: 2023-01-03 Last updated: 2024-01-10
Steinvall, I., Elmasry, M., Abdelrahman, I., El-Serafi, A. T., Fredrikson, M. & Sjöberg, F. (2022). ABO blood group and effects on ventilatory time, length of stay and mortality in major burns a retrospective observational outcome study. Burns, 48(4), 785-790
Open this publication in new window or tab >>ABO blood group and effects on ventilatory time, length of stay and mortality in major burns a retrospective observational outcome study
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2022 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 4, p. 785-790Article in journal (Refereed) Published
Abstract [en]

Blood group has been found to be important in the development of many diseases and the outcome of several disease processes, especially cardiovascular morbidity and mortality, such as caused by trauma and sepsis. The main reason is claimed to be related to glycobiology and effects mediated through the endothelium. This study investigated the possible effect of blood group (ABO) on burn care outcome. Burn outcome prediction models are extremely accurate and as such can be used to identify outcome effects even in single centre settings. In this retrospective risk adjusted observational study, we investigated the effect of ABO blood group on ventilatory time, length of hospital stay (LOS), and 90 day mortality among patients with burns. RESULTS: A total of 225 patients were included (2008-2019) with median TBSA of 26%; interquartile range (IQR) of 20-37%; median age 45 years (IQR 22-65 years); median Baux score (age + TBSA%); 76 (IQR 53- 97); 168 (75%) were male; median duration of hospital stay was 31 days (IQR 19-56); a total of 138 (61%) received treatment with mechanical ventilation; and 29 (13%) died. In a multivariable regression model, we were unable to isolate any significant effect of any blood group (O, A, B, AB) on the outcome measures studied (ventilatory time, LOS, and mortality). IN SUMMARY: contrary to many other major areas of disease in which ABO blood groups affect outcome, we were unable to find any such effect on patients with burns. Given the precision of the outcome models presented (AUC 0.93) any such an effect, if missed due to the limited study cohort, may be considered limited and to have only a minor clinical impact.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Elsevier, 2022
Keywords
ICU; Large burns; Mortality prediction; Survival; Total Body Surface area burned (TBSA %)
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-183534 (URN)10.1016/j.burns.2022.02.001 (DOI)000833489400007 ()35227532 (PubMedID)2-s2.0-85125505549 (Scopus ID)
Note

Funding agencies: Carnegie foundation (Stockholm, Sweden); Queen Victoria Foundation (Stockholm, Sweden); Department of Hand Surgery, Plastic Surgery and Burns, Linkoping University Hospital; Linkoping University Linkoping, Sweden

Available from: 2022-03-17 Created: 2022-03-17 Last updated: 2024-01-10Bibliographically approved
Ellabban, M. A., Elmasry, M., Abdelrahman, I., Abdel Kader, G., Steinvall, I., Sjöberg, F., . . . Abdel Fattah, I. O. (2022). Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival.. Scientific Reports, 12(1), Article ID 20891.
Open this publication in new window or tab >>Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival.
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2022 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 20891Article in journal (Refereed) Published
Abstract [en]

Beneficial effects could be achieved by various agents such as nitroglycerin, botulinum toxin A (BoTA), and clopidogrel to improve skin flap ischaemia and venous congestion injuries. Eighty rats were subjected to either arterial ischaemia or venous congestion and applied to a bipedicled U-shaped superficial inferior epigastric artery (SIEA) flap with the administration of nitroglycerin, BoTA, or clopidogrel treatments. After 7 days, all rats were sacrificed for flap evaluation. Necrotic area percentage was significantly minimized in flaps treated with clopidogrel (24.49%) versus the ischemic flaps (34.78%); while nitroglycerin (19.22%) versus flaps with venous congestion (43.26%). With ischemia, light and electron microscopic assessments revealed that nitroglycerin produced degeneration of keratinocytes and disorganization of collagen fibers. At the same time, with clopidogrel administration, there was an improvement in the integrity of these structures. With venous congestion, nitroglycerin and BoTA treatments mitigated the epidermal and dermal injury; and clopidogrel caused coagulative necrosis. There was a significant increase in tissue gene expression and serum levels of vascular endothelial growth factor (VEGF) in ischemic flaps with BoTA and clopidogrel, nitroglycerin, and BoTA clopidogrel in flaps with venous congestion. With the 3 treatment agents, gene expression levels of tumor necrosis factor-α (TNF-α) were up-regulated in the flaps with ischemia and venous congestion. With all treatment modalities, its serum levels were significantly increased in flaps with venous congestion and significantly decreased in ischemic flaps. Our analyses suggest that the best treatment option for ischemic flaps is clopidogrel, while for flaps with venous congestion are nitroglycerin and BoTA.

Place, publisher, year, edition, pages
Nature Publishing Group, 2022
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-192151 (URN)10.1038/s41598-022-24898-9 (DOI)000969757300018 ()36463303 (PubMedID)
Available from: 2023-03-06 Created: 2023-03-06 Last updated: 2024-01-10Bibliographically approved
Pompermaier, L., Drake Af Hagelsrum, E., Ydenius, V., Sjöberg, F., Steinvall, I. & Elmasry, M. (2022). Patient Reported Experiences at a Swedish National Burn Centre. Journal of Burn Care & Research, 43(1), 249-254
Open this publication in new window or tab >>Patient Reported Experiences at a Swedish National Burn Centre
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2022 (English)In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 43, no 1, p. 249-254Article in journal (Refereed) Published
Abstract [en]

Previous studies have shown that burn patients were satisfied with the received care. Satisfaction was not strongly associated to burns or to psycho-social characteristics, suggesting that other factors, related to burn care specific aspects, may be important. The aim of this study was to analyze the independent effect of provided workload on the general satisfaction in adult patients at a Swedish national Burn Centre. The study population (n = 122) included patients ≥18 years, treated at the Linköping Burn Centre between 2016 and 2017. Experienced burn care was evaluated with the PS-RESKA survey (score range: 0-4), and provided workload was scored with the Burn Scoring System (BSC). Groups were compared with χ 2 test, MW test, or Fisher´s exact test. Multivariable logistic regression analyzed the independent effect of BSC on the outcome High Satisfaction (= score ≥3 to the survey-question: "How would you score your global experience at the Burn Centre?"). In-patients (n = 60) had more often larger burns and required more workload than out-patients (median[IQR]: TBSA% = 6.3 [3-12.3] % vs. 0.7 [0.3-2] %, p < .001; BSC = 65 [25.5-135.5] vs. 6 [4-9], p < .001). Both groups were highly satisfied with the experienced care (mean score [SD] = 3.68 [0.57] vs. 3.41 [0.77], p = .03). Neither characteristics of the patients (age, sex), nor TBSA% nor provided workload (BSC) were independently associated with High Satisfaction. Regardless of burn severity, demographics and provided workload, adult patients with burns were highly satisfied with the experienced burn care. This finding suggested that the reason of the satisfaction was multifactorial.

Place, publisher, year, edition, pages
Oxford University Press, 2022
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-178803 (URN)10.1093/jbcr/irab091 (DOI)000744007600034 ()34131732 (PubMedID)
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery and Burns; Linkoping University, Linkoping, Sweden

Available from: 2021-08-30 Created: 2021-08-30 Last updated: 2022-05-19Bibliographically approved
Abdelrahman, I., Steinvall, I., Sjöberg, F., Ellabban, M. A., Zdolsek, J. & Elmasry, M. (2022). Pros and Cons of Early and Late Skin Grafting in Children with Burns—Evaluation of Common Concepts. European Burn Journal, 3(1), 180-187
Open this publication in new window or tab >>Pros and Cons of Early and Late Skin Grafting in Children with Burns—Evaluation of Common Concepts
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2022 (English)In: European Burn Journal, E-ISSN 2673-1991, Vol. 3, no 1, p. 180-187Article in journal (Refereed) Published
Abstract [en]

Background: There is no consensus regarding the timing of surgery in children with smallerburn size, specifically in deep dermal burns. Delayed surgery has risks in terms of infection anddelayed wound healing. Early surgery also risks the removal of potentially viable tissue. Our aim wasto investigate the effect of the timing of surgical intervention on the size of the area operated on andthe time to wound healing. Methods: A retrospective analysis for all children (<18 years) with burnsize <20% body surface area (BSA%) during 2009–2020 who were operated on with a split-thicknessskin graft. The patients were grouped by the timing of the first skin graft operation: early = operatedon within 14 days of injury; delayed = operated on more than two weeks after injury. Results: A totalof 84 patients were included in the study, 43 who had an early operation and 41 who had a delayedoperation. There were no differences between the groups regarding burn size, or whether the burnswere superficial or deep. The mean duration of healing time was seven days longer in the group withdelayed operation (p = 0.001). The area operated on was somewhat larger (not significantly so) in thegroup who had early operation. Nine children had two skin graft operations, eight in the early groupand one in the delayed group (p = 0.03). Conclusion: The patients who were operated on early hadthe advantage of a shorter healing time, but there was a higher rate of complementary operationsand a tendency towards a larger burn excision.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
burns; children; healing time; burn surgery; skin graft
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-183535 (URN)10.3390/ebj3010015 (DOI)
Available from: 2022-03-17 Created: 2022-03-17 Last updated: 2024-01-10Bibliographically approved
Ellabban, M. A., Elsayed, M. A., Zein, A. B., Ghorab, M., Elmasry, M., Masadeh, S., . . . Sadek, A. F. (2022). Virtual planning of the anterolateral thigh free flap for heel reconstruction. Microsurgery, 42(5), 460-469
Open this publication in new window or tab >>Virtual planning of the anterolateral thigh free flap for heel reconstruction
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2022 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 42, no 5, p. 460-469Article in journal (Refereed) Published
Abstract [en]

Purpose three dimensional (3-D) virtual planning is an example of computer assisted surgery that improved management of composite tissue defects. However, converting the 3-D construct into two dimensional format is challenging. The purpose of this study was to assess 3-D virtual planning of complex heel defects for better optimized reconstruction. Patients and methods a prospective analysis of 10 patients [9 male and 1 female; mean age = 27.9 years] with post-traumatic heel defects was performed. Heel defects comprised types II (three patients) or III (seven patients) according to Hidalgo and Shaw and were managed using anterolateral thigh (ALT) free flap adopting 3-D virtual planning of the actual defect which was converted into a silicone two dimensional mold. The mean definitive size of the defects was 63.4 cm(3). Functional, aesthetic, and sensory evaluations of both donor and recipient sites were performed 1 year after surgery. Results Six patients received thinned ALT (mean size = 139 cm(3)) while four patients received musculofasciocutaneous ALT flap (mean size = 199 cm(3)). One flap exhibited partial skin flap necrosis. Another flap was salvaged after re-exploration secondary to venous congestion. The mean follow-up was 20.2 months. The Maryland foot score showed 4 excellent, 5 good, and 1 fair cases. The mean American Orthopedic Foot and Ankle hind foot scoring was 76.3 (range: 69-86). All patients regained their walking capability. Conclusions 3-D virtual planning of complex heel defects facilitates covering non-elliptical defects while harvesting a conventional elliptical flap with providing satisfactory functional outcomes and near-normal contour, volume, and sensibility.

Place, publisher, year, edition, pages
WILEY, 2022
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-184371 (URN)10.1002/micr.30886 (DOI)000776544800001 ()35362110 (PubMedID)
Available from: 2022-04-21 Created: 2022-04-21 Last updated: 2023-03-10Bibliographically approved
Steinvall, I., Elmasry, M., Abdelrahman, I., Elserafy, A. T. & Sjöberg, F. (2021). Addition of admission lactate levels to Baux score improves mortality prediction in severe burns.. Scientific Reports, 11(1), Article ID 18038.
Open this publication in new window or tab >>Addition of admission lactate levels to Baux score improves mortality prediction in severe burns.
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2021 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 18038Article in journal (Refereed) Published
Abstract [en]

Risk adjustment and mortality prediction models are central in optimising care and for benchmarking purposes. In the burn setting, the Baux score and its derivatives have been the mainstay for predictions of mortality from burns. Other well-known measures to predict mortality stem from the ICU setting, where, for example, the Simplified Acute Physiology Score (SAPS 3) models have been found to be instrumental. Other attempts to further improve the prediction of outcome have been based on the following variables at admission: Sequential Organ Failure Assessment (aSOFA) score, determinations of aLactate or Neutrophil to Lymphocyte Ratio (aNLR). The aim of the present study was to examine if estimated mortality rate (EMR, SAPS 3), aSOFA, aLactate, and aNLR can, either alone or in conjunction with the others, improve the mortality prediction beyond that of the effects of age and percentage total body surface area (TBSA%) burned among patients with severe burns who need critical care. This is a retrospective, explorative, single centre, registry study based on prospectively gathered data. The study included 222 patients with median (25th-75th centiles) age of 55.0 (38.0 to 69.0) years, TBSA% burned was 24.5 (13.0 to 37.2) and crude mortality was 17%. As anticipated highest predicting power was obtained with age and TBSA% with an AUC at 0.906 (95% CI 0.857 to 0.955) as compared with EMR, aSOFA, aLactate and aNLR. The largest effect was seen thereafter by adding aLactate to the model, increasing AUC to 0.938 (0.898 to 0.979) (p < 0.001). Whereafter, adding EMR, aSOFA, and aNLR, separately or in combinations, only marginally improved the prediction power. This study shows that the prediction model with age and TBSA% may be improved by adding aLactate, despite the fact that aLactate levels were only moderately increased. Thereafter, adding EMR, aSOFA or aNLR only marginally affected the mortality prediction.

Place, publisher, year, edition, pages
Nature Publishing Group, 2021
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-179204 (URN)10.1038/s41598-021-97524-9 (DOI)000694868000037 ()34508143 (PubMedID)
Note

Fundin agencies: Open access funding provided by Linköping University. This study was funded by the department of Hand Surgery, Plastic Surgery and Burns, and Linköping University, Linköping, Sweden; The Carnegie Foundation; and the research fund of King Gustaf the 5th and Queen Victoria, Stockholm, Sweden.

Available from: 2021-09-13 Created: 2021-09-13 Last updated: 2024-01-10Bibliographically approved
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