ABSTRACT
Recent evidence has demonstrated that silver has anti-inflammatory properties that are independent from the known antimicrobial ones. In our current model of care, non-adherent, non-silver dressings are applied for acute presentations of pediatric partial thickness burn injuries. The wounds are re-assessed after the progression phase (48-72 hours after injury) and silver dressings are applied. However, when logistical obstacles prevent re-assessment within the 48-72-hour window, nanocrystalline silver-based dressings are applied on presentation. The objective of this study was to test our model of care. We hypothesized that immediate application (< 24 hours after injury) of nanocrystalline silver-based dressings would reduce surgical interventions. This was a retrospective single-center cohort study. All patients <18 years old treated at a pediatric burn center for acute partial thickness burn injuries, between January 1, 2020, and December 31, 2021 were included. Multivariable logistic regression was used to compare surgical treatment rates between patients with different timing of nanocrystalline silver-based dressing application. Four hundred seventy-six patients were included for analysis. One hundred four (21.8%) had nanocrystalline silver-based dressings and 372 (78.2%) had non-silver non-adherent dressings applied within 24 hours of injury. Multivariable logistic regression identified three statistically significant variables as predictors for surgical treatment: age (OR = 1.14, 95% CI [1.06-1.23]), total body surface area (OR = 1.15, 95% CI [1.06-1.25]), and burns to buttocks/lower extremity (OR = 2.39, 95% CI [1.26-4.53]). Immediate (< 24 hours after injury) application of nanocrystalline silver-based dressings does not affect surgical treatment rate in pediatric patients with partial thickness burns.
ABSTRACT
Background: Single index finger replantation is often listed as a contraindication due to its hindrance of hand function when replanted. Recent studies demonstrate comparable subjective and global functional outcomes for index flexor zone II finger replants versus revision amputations. We therefore sought to identify current opinions of plastic surgery trainees and staff treating single index finger zone II amputations including influential patient and injury characteristics. Methods: With the approval of the Canadian Society of Plastic Surgery, a 17-question survey was sent via email to all listed members on 3 separate occasions. Participation was voluntary and survey responses were compiled and analyzed using SPSS statistical software. Results: Survey response rate was 38.5%. When asked whether the surgeon would replant a single index digit, flexor zone II, sharp amputation, 55.3% of respondents chose "yes," while 44.7% responded "no." Staff (51.5%) were less likely to replant a single index digit amputation. Likelihood of replant dropped substantially in crush (12.4%) and avulsion (17.1%) injury. Smoking was the most likely patient characteristic to change a surgeon's decision (61.9%). Poor range of motion (77.5%) and patient satisfaction (72.5%) were the most frequently listed reasons not to replant. Conclusion: Among Canadian plastic surgeons, there exists disagreement in how single index flexor zone II amputations should be managed. In review of the literature, these notions and previous teaching around replants highlight many inherent surgeon biases with regard to the merit and value of single digit replantation.
Contexte: La réimplantation isolée de l'index est souvent considérée comme une contre-indication compte tenu de la gêne causée au fonctionnement de la main une fois réimplanté. Des études récentes démontrent des résultats fonctionnels, subjectifs et globaux, comparables pour les réimplantations digitales du fléchisseur de l'index en zone II comparativement aux amputations de révision. Nous avons donc cherché à identifier l'avis actuel des stagiaires et du personnel de chirurgie plastique traitant des amputations isolées en zone II, incluant les caractéristiques de la blessure et l'influence des patients. Méthodes: Une enquête comportant dix-sept questions a été envoyée à trois reprises avec l'approbation de la Société canadienne de chirurgie plastique aux adresses de courriel de tous les membres listés. La participation était volontaire et les réponses à l'enquête ont été compilées et analysées au moyen du logiciel statistique SPSS. Résultats: Le taux de réponse à l'enquête a été de 38,5 %. À la question de savoir si le chirurgien réimplanterait un index isolé, fléchisseur zone II, après amputation nette, 55,3 % des répondants ont choisi « oui ¼ et 44,7 % ont répondu « non ¼. Le personnel (51,5 %) était moins susceptible de réimplanter un index après amputation isolée. La probabilité de réimplantation diminuait nettement en cas de lésion par écrasement (12,4 %) et arrachement (17,1 %). Le tabagisme était la caractéristique du patient le plus susceptible de modifier la décision d'un chirurgien (61,9 %). Une mauvaise amplitude de mouvement (77,5 %) et satisfaction du patient (72,5 %) ont été les raisons citées le plus souvent pour ne pas réimplanter. Conclusion: Il existe, parmi les chirurgiens plasticiens canadiens, un désaccord sur la manière dont les amputations isolées d'un index (fléchisseur zone II) doivent être gérées. La revue des publications montre que ces notions et l'enseignement antérieur concernant les réimplantations soulignent les multiples biais inhérents aux chirurgiens pour ce qui concerne l'intérêt et la valeur de la réimplantation d'un seul doigt.
