Background and Objectives: The susceptibility of burn patients to infections with multidrug-resistant organisms (MDROs) is high. The aim of this study is to describe the local patterns of antimicrobial resistance in a Romanian burn unit and to identify risk factors associated with the acquisition of extensively drug-resistant (XDR) pathogens. Materials and Methods: We conducted a one-year, observational, retrospective single-centre cohort study including all burn patients with at least one positive culture admitted to our unit during 2024. In order to identify the pathogens and perform antibiograms, we used routine microbiological diagnostic tests. A multivariable logistic regression model was used to identify XDR risk factors. We also compiled a cumulative antibiogram using the first non-duplicate isolate per patient, following the CLSI M39 guidelines. Results: Among the 180 total admissions, 128 (71.1%) had at least one positive microbiological culture, resulting in 643 bacterial isolates out of 559 samples. The most frequently identified species were A. baumannii, P. aeruginosa, S. aureus, and K. pneumoniae. We isolated MDROs in 59.37% of patients, and 26.56% had at least one XDR pathogen isolated during hospitalisation. We identified three independent predictors for the isolation of XDR pathogens: a higher Abbreviated Burn Severity Index (ABSI) score (aOR 6.12; p = 0.001), hospital length of stay (LOS) (aOR 1.02; p = 0.030), and the number of bacterial species identified per sample, representing polymicrobial growth (aOR 5.91; p = 0.001). Conclusions: Our findings highlight a significant percentage of MDR and XDR pathogens and provide the foundation for antimicrobial stewardship measures, using the local cumulative antibiogram for empirical therapy.

Background/Objectives: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and aggressive cutaneous lymphoma, often misdiagnosed due to nonspecific clinical features. Early diagnosis and treatment remain challenging. Methods: We report the case of a 31-year-old female with a chronic non-healing gluteal wound initially treated as an abscess. The lack of improvement prompted repeated investigations, culminating in the diagnosis of SPTCL with an alpha–beta T-cell phenotype. Results: Management involved combined chemotherapy and surgical wound reconstruction. Six cycles of CHOEP-21 chemotherapy led to complete clinical remission. A soft tissue defect superinfected with multidrug-resistant organisms was successfully reconstructed using Integra Dermal Regeneration Template followed by split-thickness skin grafting. Conclusions: This case highlights the diagnostic complexity of SPTCL and the therapeutic potential of dermal matrix application in complex wound management, especially in immuno-compromised patients.

Acellular dermal matrices (ADMs) are widely used in soft-tissue reconstruction, yet the optimal timing for split-thickness skin grafting (STSG) remains unsettled. We conducted a single-center retrospective cohort study (January 2023–August 2025) of adults undergoing ADM-based reconstruction with Integra^® Double Layer (IDL), Integra^® Single Layer (ISL), or Nevelia^®. Primary endpoints included length of stay (LOS), STSG requirement and timing, and in-hospital complications; secondary endpoints included spontaneous epithelialization. Prespecified adjusted analyses (linear/logistic models) controlled for age, sex, etiology, anatomical site, diabetes/PAOD, smoking, wound size (when available), wound contamination, and matrix type. Histology and immunohistochemistry (H&E, Masson trichrome, CD105, D2-40) assessed matrix integration and vascular/lymphatic maturation. Seventy-five patients were included (IDL n = 40; ISL n = 20; Nevelia n = 15). On multivariable analysis, matrix type was not an independent predictor of LOS (ISL vs. IDL β = +2.84 days, 95% CI −17.34 to +23.02; Nevelia vs. IDL β = −4.49 days, 95% CI −16.24 to +7.26). Complications were infrequent (6/75, 8.0%) and comparable across matrices; spontaneous epithelialization occurred in 3/75 patients (4.0%). A day-14 grafting strategy, applied only after documented clinical integration, was feasible in 30/75 (40.0%) patients without excess complications. Histology/IHC at 3–4 weeks demonstrated CD105-positive, perfused capillary networks with abundant collagen; at 4–6 weeks, D2-40-positive lymphatic structures confirmed progressive neo-dermis maturation, supporting the biological plausibility of earlier grafting once integration criteria are met. In this cohort, outcomes were broadly similar across matrices after adjustment. A criteria-based early STSG approach (~day 14) appears safe and operationally advantageous when integration is confirmed, while a minority of defects may heal without grafting. Prospective multicenter studies with standardized scar/functional measures and cost analyses are needed to refine patient selection and graft timing strategies.

Background and objectives: Early recovery after major head-and-neck reconstruction is shaped by nutritional vulnerability and functional decline. We evaluated whether preoperative CT-defined low skeletal muscle mass—considered here as an imaging-derived muscle-depletion phenotype rather than the full consensus syndrome of sarcopenia—predicts swallowing milestones, weight trajectory, and patient-reported outcomes at 12 weeks. Methods: In a prospective longitudinal cohort of 74 adults undergoing oncologic resection with reconstruction, low skeletal muscle mass was derived from preoperative cervical CT-based skeletal muscle measurements and nutritional risk was screened with NRS-2002. Outcomes included FOIS, PEG dependence, percent weight loss, MDADI, and European Organisation for Research and Treatment of Cancer QLQ-C30/QLQ-H&N35 at 12 weeks. A multivariable logistic regression explored a composite poor-recovery endpoint (PEG at 12 weeks and/or FOIS ≤ 3 and/or MDADI < 55). Results: Low skeletal muscle mass (32/74, 43.2%) was associated with longer length of stay (13.4 ± 4.1 vs. 10.3 ± 3.3 days; p < 0.001) and more major complications (31.2% vs. 11.9%; p = 0.04). At 12 weeks, affected patients had greater weight loss (10.9 ± 3.4% vs. 8.6 ± 2.6%; p = 0.003), lower FOIS (3.9 ± 1.1 vs. 4.6 ± 1.1; p = 0.01), lower MDADI (57.1 ± 10.9 vs. 66.6 ± 11.9; p = 0.001), and higher PEG dependence (31.2% vs. 9.5%; p = 0.018). Low skeletal muscle mass remained associated with poor recovery after adjustment (aOR 5.4; 95% CI 1.4–24.0; p = 0.016); adjuvant radiotherapy was also associated (aOR 4.3; p = 0.049). Model discrimination was good (AUC 0.81). Conclusions: Preoperative CT-defined low skeletal muscle mass was associated with impaired early recovery after major head-and-neck reconstruction, particularly when adjuvant radiotherapy was anticipated; however, these findings should be interpreted as exploratory and hypothesis-generating.

Background: Recovery after major head-and-neck reconstruction extends beyond flap survival and wound closure, involving swallowing, psychological adaptation, body image, and overall quality of life. Integrated multidimensional assessments remain limited in routine reconstructive outcomes research. Aim: The aim of this study was to characterize and compare six-month multidimensional recovery—clinical, functional, nutritional, psychological, and body-image outcomes—between microvascular free-flap and regional pedicled-flap reconstruction and to identify factors that stratify risk for persistent functional and psychosocial impairment. Methods: We conducted a single-center prospective cohort study at the “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania, enrolling 87 adults undergoing major reconstructive surgery after ablative treatment of head-and-neck defects (52 microvascular free flaps; 35 regional pedicled flaps). Patients were assessed at baseline and 6 months using the SF-36, WHOQOL-BREF, Body Image Scale (BIS), HADS, PHQ-9, GAD-7, Functional Oral Intake Scale (FOIS), speech intelligibility, and PEG/tracheostomy dependence. Results: At 6 months, most SF-36 and WHOQOL-BREF domains improved with moderate effect sizes (d = 0.3–0.7; all p ≤ 0.009), and body image distress decreased significantly (ΔBIS −2.9 ± 4.6; p < 0.001), whereas social functioning showed no robust gain (p = 0.098; not surviving false-discovery-rate correction). Pedicled reconstruction was associated with higher PEG dependence (37.1% vs. 9.6%; p = 0.005) and worse FOIS (4.7 ± 1.4 vs. 5.6 ± 1.2; p = 0.003). Major complications were linked to blunted or worsening psychological trajectories and a threefold higher rate of clinically significant depression (HADS-D ≥ 11: 66.7% vs. 18.7%; p = 0.001). In a reduced four-predictor multivariable model, pedicled flap (aOR 4.6), adjuvant radiotherapy (aOR 2.8), major complication (aOR 3.3), and lower baseline FOIS (aOR 0.5 per point) were independently associated with PEG dependence (optimism-corrected AUC 0.79). Clustering identified three recovery phenotypes—functional/emotional responders, psychological/body-image responders, and global slow recovery—with significantly different PEG rates (5.9%, 21.4%, 40.0%; p = 0.006). Exploratory mediation analysis suggested that the association between reconstruction technique and mental quality-of-life recovery was partly statistically accounted for by swallowing and body-image improvement. Conclusions: Recovery after major head-and-neck reconstruction is multidimensional and heterogeneous. Baseline swallowing function, reconstruction technique, radiotherapy, and major complications jointly stratify risk for persistent functional and psychosocial impairment, supporting risk-adapted multidisciplinary rehabilitation and early psycho-oncologic screening.

Background/Objectives: Early recovery after major head-and-neck reconstruction is not determined by flap survival alone. This exploratory study examined whether preoperative frailty-inflammatory phenotypes are associated with delayed swallowing recovery, persistent nutritional dependence, and poorer quality of life at 12 weeks. Methods: In a prospective single-center cohort study, 84 adults undergoing major head-and-neck oncologic reconstruction were assigned to three clinically defined phenotypes: low-risk (n = 28), intermediate (n = 29), and combined frailty-inflammatory (n = 27). Twelve-week outcomes included the Functional Oral Intake Scale (FOIS), MDADI, EORTC global health, PEG dependence, and a composite poor-recovery endpoint. Because of the small sample size, all estimates are reported to two significant figures, and every analysis is regarded as hypothesis-generating. Results: Compared with the low-risk group, the combined phenotype was older (63 ± 9 vs. 55 ± 9 years) and had a higher mFI-5 (3.2 ± 0.6 vs. 1.0 ± 0.7) and CRP/albumin ratio (2.2 ± 0.6 vs. 0.6 ± 0.2; all p < 0.001). At 12 weeks the combined phenotype showed greater weight loss (12 ± 2%), lower FOIS (3.2 ± 1.3), lower MDADI (51 ± 7), and PEG dependence in 52% (all p ≤ 0.002). A higher mFI-5 was associated with poor recovery (adjusted OR 2.1 per point; 95% CI 1.0–4.1; p = 0.04), an estimate whose confidence interval is wide and imprecise. Conclusions: In this small cohort a frailty-inflammatory framework was associated with clinically meaningful heterogeneity in early recovery. The findings are preliminary and require prospective, adequately powered, multicenter validation before any clinical use.