Emergency department visits for electric scooter-related injuries after introduction of an urban rental program.

BACKGROUND: Providers in Salt Lake City emergency departments (EDs) anecdotally noted a significant number of electronic scooter (e-scooter)-related injuries since the launch of e-scooter rentals in the downtown area in June 2018. The aim of this study was to quantify and characterize these injuries. METHODS: We reviewed the electronic medical records of the University of Utah ED and the Salt Lake Regional Medical Center ED. Using a broad keyword search for "scooter," we examined all notes for ED visits between June 15-November 15, 2017, and June 15-November 15, 2018, and identified e-scooter related injuries. The 2017 data pre-dated the launch of the e-scooter share programs in Salt Lake City and served as a control period. RESULTS: We noted 8 scooter-related injuries in 2017 and 50 in 2018. Injury types from the 2018 period included: major head injury (8%); major musculoskeletal injury (36%); minor head injury (12%); minor musculoskeletal injury (34%); and superficial soft tissue injury (40%). 24% of patients presented via ambulance and 6% presented as a trauma activation. 16% of patients required hospital admission and 14% had an injury requiring operative repair. 16% reported alcohol intoxication and none of the patients reported wearing a helmet at the time of the injury. CONCLUSION: Since the launch of e-scooter share programs in Salt Lake City, we have seen a substantial increase in e-scooter related trauma in our EDs. Of particular note is the number of patients with major head injuries and major musculoskeletal injuries.

Readability of online materials for Dupuytren's contracture.

STUDY DESIGN: Descriptive. BACKGROUND: Dupuytren's contracture is a common disorder involving fibrosis of the palmar fascia. As patients are increasingly using online materials to gather health care information, it is imperative to assess the readability and appropriateness of this content. The recommended grade level for patient educational materials is seventh to eighth grade according to the National Institutes of Health. This study aims to assess the readability and content of online patient resources for Dupuytren's contracture. PURPOSE OF THE STUDY: Evaluate readability of online patient education materials for Dupuytren's contracture. METHODS: The largest public search engine, Google, was queried using the term "Dupuytren's contracture surgery" on February 26, 2016. Location filters were disabled, and sponsored results were excluded to avoid any inadvertent search bias. The 10 most popular Web sites were identified, and all relevant patient-directed information within 1 click from the original site was downloaded and saved as plain text. Readability was analyzed using 6 established analyses (Readable.io, Added Bytes, Ltd, UK). RESULTS: Analysis of 10 Web sites demonstrates an average grade level of at least 11th grade (Flesch-Kincaid grade level, 10.2; Gunning-Fog grade level, 13.1; Coleman-Liau grade level, 14.4; Simple Measure of Gobbledygook grade level, 10.0; automated readability grade level, 9.7; and average grade level, 11.5). Overall Flesch-Kincaid reading ease index was 46.4, which is difficult. No single article was at the recommended reading level. CONCLUSIONS: Online materials available for treatment of Dupuytren's contracture are above recommended reading levels and do not include a comprehensive explanation of treatment options, which may negatively impact decision making in patients seeking treatment for this condition. Surgeons and hand therapists alike should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials. LEVEL OF EVIDENCE: V.

Management of Complex Facial Lacerations in the Emergency Department.

Laceration injuries comprise over 8% of all emergency department (ED) visits annually.1 Given that laceration injuries represent a significant volume of ED visits, emergency physicians (EP) should be comfortable treating these types of injuries. We present the case of a 34-year-old male who presented to the ED as a trauma activation who suffered multiple injuries including complex full-thickness lacerations to his face. While there are scenarios in which consulting a specialist is necessary, knowledge and application of basic wound closure principles allows for many complex lacerations to be repaired by EPs. We provide a helpful systematic approach to evaluating and treating complex facial lacerations in the ED.

Supercharging and augmenting venous drainage of an anterolateral thigh free flap: options and indications.

SUMMARY: This study introduces the options for supercharging and augmenting venous drainage of an anterolateral thigh free flap. Clinical indications and options for additional microvascular anastomoses are reviewed in 5 consecutive patients. The indications were simultaneous mucosal and cutaneous defects, divergent mucosal defects, and extensively wide and long cutaneous defects. Three additional vascular pedicles were anastomosed: the transverse branch of the lateral circumflex (n = 3), a perforator coming directly off the superficial femoral artery (n = 1), and a posterior perforator from the profundus femoral artery (n = 1). The anastomosis of a separate pedicle from the superior, medial, and/or posterior-lateral thigh may be a useful technique when confronted with an extensive defect that may not reliably be reconstructed with a routine anterolateral thigh flap based on a single perforator.

CASE REPORT Reconstruction and Characterization of Composite Mandibular Defects Requiring Double Skin Paddle Fibular Free Flaps.

OBJECTIVE: Fibular free flaps are the preferred method for reconstruction of composite lateral mandibular defects. This reconstructive technique is limited by the skin paddle's inability to freely rotate when attempting to fill 2 poorly aligned defects. Reconstructive surgeons have been exploring multiple methods of creating 2 independent skin paddles based on the same peroneal blood supply. We present a variation of these techniques. METHOD: Our patient with a history of squamous cell carcinoma presented with a left retromolar recurrence and osteoradionecrosis of the mandible with a draining anterior sinus tract. The combination of these defects warranted further composite resection with fibular free flap reconstruction. RESULTS: A subperiosteal dissection was performed to create 2 separate septocutaneous skin paddles based on the same peroneal blood supply. This dissection and discard of proximal fibula provided the rotational freedom needed for the 2 skin islands to fill both a lateral oral defect and anterior cutaneous defect. CONCLUSION: Although similar reconstructive methods have been reported in the literature, the characterization of defects benefiting from these techniques is scarce and unclear. We describe clear and concise characteristics of these defects, which should be meaningful to the reconstructive surgeon when considering operative technique.

Considerations for tissue expansion in the management of massive dermatofibrosarcoma protuberans of the head and neck.

OBJECTIVE: Dermatofibrosarcoma protuberans (DFSP) is a locally invasive soft tissue tumor with rare malignant potential, but a high tendency for local recurrence. We present 2 cases of DFSP involving the head and neck requiring tissue expansion for reconstruction. METHODS: A retrospective review of the medical records for 2 patients with DFSP was performed. Data concerning the operative approaches, reconstructive strategies, details of tissue expansion, and outcomes were collected. RESULTS: Case 1: A 4-year-old child with a large DFSP infiltrating her entire anterolateral neck and shoulder. Case 2: A 34-year old woman with a large DFSP involving the scalp overlaying the anterior-frontal scalp. Both patients underwent successful tumor resection and reconstruction; however, the timing of tissue expander placement and final reconstruction differed. CONCLUSIONS: These cases present the challenges of soft tissue reconstruction of the head and neck following tumor extirpation. In addition, we discuss the important considerations for tissue expansion prior to tumor resection versus after tumor resection and free flap reconstruction.