A Novel Rodent Orthotopic Forelimb Transplantation Model That Allows for Reliable Assessment of Functional Recovery Resulting From Nerve Regeneration.

Improved nerve regeneration and functional outcomes would greatly enhance the utility of vascularized composite allotransplantation (VCA) such as hand and upper extremity transplantation. However, research aimed at achieving this goal has been limited by the lack of a functional VCA animal model. We have developed a novel rat midhumeral forelimb transplant model that allows for the characterization of upper extremity functional recovery following transplantation. At the final end point of 12 weeks, we found that animals with forelimb transplantation including median, ulnar and radial nerve coaptation demonstrated significantly improved grip strength and forelimb function as compared to forelimb transplantation without nerve approximation (grip strength: 1.71N ± 0.57 vs. no appreciable recovery; IBB scale: 2.6 ± 0.7? vs. 0.8 ± 0.40; p = 0.0005), and similar recovery to nerve transection-and-repair only (grip strength: 1.71N ± 0.57 vs. 2.03 ± 0.42.6; IBB scale: 2.6 ± 0.7 vs. 2.8 ± 0.8; p = ns). Moreover, all forelimb transplant animals with nerve coaptation displayed robust axonal regeneration with myelination and reduced flexor muscle atrophy when compared to forelimb transplant animals without nerve coaptation. In conclusion, this is the first VCA small-animal model that allows for reliable and reproducible measurement of behavioral functional recovery in addition to histologic evaluation of nerve regeneration and graft reinnervation.

Microsurgery in the burn population - a review of the literature.

The management of patients suffering from burn injury poses unique challenges for the reconstructive surgeon, both in the acute and delayed settings. Once resuscitative measures are optimized and hemodynamic stability is achieved, early burn debridement and coverage is performed. Traditionally, this consists of excision of devitalized tissue and subsequent coverage using split thickness skin grafts. However, in certain instances, and depending on the extent and nature of the burn injury, skin grafting (or even local tissue rearrangement) may not be a reasonable option. in these cases, free tissue transfer may provide a viable reconstructive alternative. While free flap reconstruction is rare in burn surgery, particularly in the acute setting, burn injuries that expose vital structures, such as tendon, nerve, bone, or deep vessels, require robust flap coverage. in the delayed setting, unsightly scar formation and contracture often occurs secondary to skin graft coverage. These significant patient morbidities are often amenable to free tissue transfer as well. This review article discusses the indications, applications, and problems with free flap surgery for burn injuries in both the acute and delayed setting, and summarizes the available literature on microsurgical free tissue transfer for burn management.

La prise en charge des patients atteints de brûlures pose des défis uniques pour le chirurgien de reconstruction, à la fois dans les cadres aigus et retardés. Une fois les mesures de réanimation sont optimisés et la stabilité hémodynamique est obtenue, il faut faire le débridement précoce et la couverture de la brûlure. Traditionnellement, il s'agit de l'excision des tissus dévitalisés et la couverture par division ultérieure en utilisant des greffes de peau partielle épaisse. Cependant, dans certains cas, et en fonction des dimensions et la nature de la brûlure, une greffe de peau n'est pas toujours une option raisonnable. Dans ces cas, le transfert de tissu libre peut fournir une alternative viable. Alors que la reconstruction de lambeau libre est rare dans la chirurgie des brûlures, en particulier dans le cadre aiguë, les brûlures qui exposent les structures vitales, telles que les tendons, nerfs, os, ou les vaisseaux profonds, nécessitent une couverture robuste. Dans le cadre retardé, la formation de cicatrices inesthétiques et de contractures se produit fréquemment secondaire à une couverture de greffe de peau. Souvent ces morbidités importantes sont aussi prêtent au transfert de tissu libre. Cet article de revue discute les indications, les applications, et des problèmes avec la chirurgie de lambeau libre pour des brûlures dans les cadres aigus et retardés. Cet article résume aussi la littérature disponible sur la microchirurgie du transfert de tissu libre pour la prise en charge des brûlures.

Treatment of a paediatric patient with a distal lower extremity traumatic wound using a dermal regeneration template and NPWT.

Degloving injuries are common in trauma and represent a spectrum of complex wounds, the management of which may be highly challenging especially in the paediatric population. In severe injuries leading to wounds reaching tendon and bone, vascularity is compromised precluding traditional wound management, and sometimes necessitating amputation. This report highlights the use of a dermal regeneration template combined with vacuum-assisted closure (VAC) in the treatment of complex traumatic degloving wounds. Here, we present a case of a five-year-old boy who sustained a high-energy shear injury to his lower extremity that resulted in an extensive degloving wound involving the distal third of his leg and the dorsum of his foot. After debridement, the patient underwent VAC combined with a dermal skin substitute placement, followed by split-thickness skin grafting. The extremity healed with no complications and without the need for amputation or flap reconstruction, achieving satisfactory recovery of range of motion and favourable cosmetic results.

Sulfur mustard gas exposure: case report and review of the literature.

This report describes a case of burn injury following exposure to sulfur mustard, a chemical agent used in war. A review of the diagnostic characteristics, clinical manifestations, and therapeutic measures used to treat this uncommon, yet extremely toxic, entity is presented. The aim of this report is to highlight the importance of considering this diagnosis in any war victim, especially during these unfortunate times of rising terrorist activities.

Ce rapport décrit un cas de brûlure suite à une exposition au gaz moutarde, un agent chimique utilisé dans la guerre. On présente un examen des caractéristiques de diagnostic, les manifestations cliniques et les mesures thérapeutiques utilisés pour traiter ce phénomène rare, mais extrêmement toxique. L'objectif de ce rapport est de mettre en évidence l'importance de considérer ce diagnostic dans toute victime de la guerre, surtout en ces temps malheureux de la hausse des activités terroristes.

Salvage of shoulder joint through simplification of wound management.

Infection is a common sequela of open dislocation of the shoulder joint. This typically leads to joint surface and humeral head necrosis, resulting in severe limitation of motion. Few cases of open and infected glenohumeral joints have been reported, and none had a good functional outcome with pain-free, near-full range of motion. Here we report the case of a 24-year-old man, who sustained a severe degloving injury of his left shoulder with an open glenohumeral joint, in a road traffic accident. We describe a treatment plan that salvaged near-full range of shoulder motion and resulted in pain-free active and passive movements.

Renal dysfunction in burns: a review.

Acute kidney injury (AKI), although rare, is a major complication of burn injury that commonly leads to mortality. It results from a complex interplay of various cellular and neuro-humoral changes affecting burn patients. Guidelines for the treatment of this entity are still not well defined; therefore, prevention and early diagnosis are key to avoid the unfavorable prognosis of AKI. These entail a comprehensive understanding of the global physiologic changes underlying the condition of burn patients and a judicious interpretation of their continuous homeostatic alterations. The aim of this review is to present the salient features in burn patient physiology that contribute to AKI. Strategies for identifying early AKI are presented. Finally, the different treatment modalities are revisited.

Les lésions rénales aiguës (LRA) sont rares, mais elles constituent une complication majeure des brûlures qui mène souvent à la mortalité. Ces lésions sont provoquées par une interaction complexe de divers changements cellulaires et neurohumoraux qui affectent les patients brûlés. Les directives pour le traitement de ces patients ne sont pas encore bien définies et, par conséquent, la prévention et le diagnostic précoce sont essentiels pour éviter le pronostic défavorable des LRA. Cela nécessite une compréhension complète des changements physiologiques présents dans ces patients et une interprétation judicieuse de leurs continuelles altérations homéostatiques. Les Auteurs se sont proposé de présenter les principales caractéristiques de la physiologie du patient brûlé qui contribuent à ce type de lésion. Apres avoir discuté les stratégies pour identifier ces lésions en phase précoce, ils concluent avec une description des différentes modalités de traitement.

The role of a dedicated staff psychiatrist in modern burn centers.

Psychiatric disorders may be more common in burn-injured subjects than in the general population, and oftentimes contribute to the injury itself. Even in the absence of underlying psychiatric illnesses, burn patients may still benefit from a psychiatric evaluation during and after their hospitalization. In this regard, we included a dedicated psychiatry service in our multidisciplinary burn team. We review herein the course of burn patients that were offered psychiatric evaluation and highlight the benefits of such a program. We conducted an IRB-approved retrospective chart review of burn subjects admitted to our institution between June 15, 2009 and April 30, 2010 and identified 83 patients that were examined by our psychiatrist. Indications for consultation, history of psychiatric illness and substance abuse, as well as administered drugs, were recorded. Among the 83 evaluated patients, 48 (57.8%) had a preexisting psychiatric disorder and 36 (43.4%) suffered from substance abuse. The most common indications for consultation were pain (28.1%), alcohol dependence (25.8%), anxiety (24.7%), illicit drug abuse (16.8%), depression (15.7%), post-traumatic stress disorder (8.9%), and sleep disturbances (8.9%). Pharmacotherapy was initiated in 75 patients (90.3%). 31 (37.3%) had neither a psychiatric disorder nor a history of substance abuse, although 26 of them (83.9%) still received drugs for psychiatric conditions. The inclusion of a dedicated psychiatrist as part of our burn team has improved our comprehensive burn care. In the overwhelming majority of cases, even in the absence of preexisting psychiatric illnesses, consultation resulted in pharmacologic intervention and enhanced patient care.

Les troubles psychiatriques peuvent être plus fréquents chez les patients brûlés que dans la population générale, et contribuent souvent à la blessure elle-même. Même en l'absence de maladies psychiatriques sous-jacents, les patients brûlés peuvent encore bénéficier d'une évaluation psychiatrique pendant et après leur hospitalisation. À cet égard, nous avons inclus un service de psychiatrie dédié à notre équipe multidisciplinaire pour la gestion des brûlures. Nous examinons ici les cours de patients brûlés à qui une évaluation psychiatrique a été proposée et nous mettons en évidence les avantages d'un tel programme. Nous avons effectué un examen rétrospectif - approuvé par les CPP - des patients brûlés admis dans notre institution entre le 15 Juin 2009 et le 30 Avril, 2010, à partir de lequel nous avons identifié 83 patients qui ont été examinés par notre psychiatre. Nous avons enregistré les indications pour la consultation, les antécédents de maladie psychiatrique et la toxicomanie, ainsi que les médicaments administrés. Parmi les 83 patients évalués, 48 (57,8 %) avaient un trouble psychiatrique préexistante et 36 (43,4%) a souffert de l'abus de substances. Les indications les plus fréquentes de consultation étaient la douleur (28,1%), la dépendance à l'alcool (25,8%), l'anxiété (24,7%), l'abus de drogues illicites (16,8%), la dépression (15,7%), les troubles de stress post-traumatique (8,9%), et troubles du sommeil (8,9%). La pharmacothérapie a été instaurée dans 75 patients (90,3%). 31 (37,3%) ne présentaient pas de troubles psychiatriques ni une histoire d'abus de substance mais quand même 26 d'entre eux (83,9 %) ont reçu des médicaments pour des troubles psychiatriques. L'inclusion d'un psychiatre spécialisé dans le cadre de notre équipe a amélioré notre système complet de soins aux brulés. Dans l'écrasante majorité des cas, même en l'absence des maladies psychiatriques préexistantes, la consultation a donné lieu à une intervention pharmacologique et a amélioré les soins aux patients.

Cardiovascular dysfunction in burns: review of the literature.

Major burn injury produces substantial hemodynamic and cardiodynamic derangements, which contribute to the development of sepsis, multiple organ failure, and death. Cardiac stress is the hallmark of the acute phase response and its severity determines postburn outcomes, with poorer outcomes associated with cardiac dysfunction. With available evidence from the literature, the present is a comprehensive review of cardiac dysfunction in burns as well as the different monitoring modalities.