Long-term renal function after burn-related acute kidney injury with continuous renal replacement therapy.

Acute kidney injury (AKI) is a common complication of severe burn injury and is associated with significant morbidity and mortality. Continuous Renal Replacement Therapy (CRRT) is the preferred treatment for stage 3 AKI due to severe burn. This retrospective cohort study at a single institution aimed to examine the long-term renal outcomes after discharge of burn survivors who underwent CRRT during their ICU stay between 2012-2021 due to burn-related AKI, hypothesizing a return to baseline renal function in the long term. Among the 31 patients meeting inclusion criteria, 22 survived their burn injuries, resulting in a 29 % mortality rate. No significant disparities were observed in demographics, comorbidities, burn characteristics, or critical care interventions between survivors and non-survivors. Serum creatinine and eGFR values normalized for 91 % of patients at discharge. Impressively, 91 % of survivors demonstrated a return to baseline renal function during long-term (>3 years) follow-up. Furthermore, only 18 % underwent dialysis after discharge, primarily within the first year. Cumulative mortality rates were 18.2 %, 22.7 %, and 31.8 % at 1, 3, and > 3 years after discharge, respectively. Causes of death were primarily non-renal. These results suggest that burn-related AKI with CRRT results in lower rates of conversion to ongoing renal dysfunction compared to general ICU cohorts. Despite limitations, this study contributes vital insights into the underexplored issue of long-term outcomes after dicharge in this patient population.

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy.

BACKGROUND: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. METHODS: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. RESULTS: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. CONCLUSION: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.

The SAEORA Flap for Prosthetic Breast Reconstruction: A Novel Flap Design without the Use of Acellular Dermal Matrices.

Background: The gold standard for implant-based breast reconstruction uses acellular dermal matrices (ADMs). They provide improved inferolateral pole coverage, reduced capsular contracture rates, and increased primary expander fill volumes. However, ADMs are costly and have been associated with increased rates of postoperative infection, seroma, hematoma, implant malposition, and mastectomy flap necrosis (MFN). This study describes a novel autologous flap without the need of ADM, the serratus anterior external oblique rectus abdominis (SAEORA) flap, as an alternative in prosthetic-based breast reconstruction. Methods: A retrospective study was conducted on all patients who underwent SAEORA flap breast reconstruction by a single surgeon between January 1, 2013 and May 31, 2020 at a single institution. Patient demographics, diagnosis, treatment, tissue expander (TE) volume, implant size, complications, and results were assessed. Results: Forty-seven patients underwent 78 SAEORA flaps. Sixty-two had TEs placed, and 14 were direct-to-implant. Mean body mass index was 23.1 kg per m². Median primary TE fill volume was 150 mL, and final implant volume average was 450 mL. Mean follow-up was 14.5 months. Complications included infection/cellulitis (7.9%), seroma (6.6%), hematoma (5.2%), and MFN (7.9%). Conclusions: The SAEORA flap is a novel autologous flap and is a viable option for prosthetic-based breast reconstruction, with an acceptable complication profile relative to ADM-based reconstructions. Additionally, SAEORA is MFN-resistant and has been used effectively in salvage of exposed implants or ADM, and in double-bubble deformity correction.

Keystone Flap for Closure of Skin Cancer Defects on the Upper Extremity.

Background: We sought to examine the efficacy of the Keystone Design Perforator Island Flap (KDPIF) for the reconstruction of skin cancer excision defects isolated to the upper extremity. In particular, to examine the size of defects repaired and the complications associated with the keystone flap procedure isolated to the upper extremity. Methods: This is a retrospective chart review including all patients older than 18 years of age who received a KDPIF procedure between February 2013 and February 2019 for the oncologic reconstruction of skin cancer defects isolated to the upper extremities by a single surgeon. All procedures were done according to the original description by Behan. Results: A total of 32 patients, 18 (56%) male and 14 (44%) female, received 35 keystone flaps between February 2013 and February 2019. The mean age of the males and females was 70.5 and 79.7 years of age, respectively. Thirty-five lesions suspicious for cancer were excised and 14 (40%) basal cell carcinoma (BCC), 11 (31%) squamous cell carcinoma (SCC), 9 (26%) melanoma, and 1 (3%) actinic keratoses diagnoses were histopathologically determined. Skin defect excisions varied from 3.53 cm2 to 31.42 cm2. No intraoperative or postoperative complications occurred. Conclusions: The keystone flap is a successful versatile flap procedure with a low or absent complication rate for the reconstruction of skin cancer excision defects of various locations (eg arm, hand, elbow, forearm, shoulder, and wrist), cancer pathologies, and sizes on the upper extremity. When needed, a Doppler may successfully identify adequate perforating blood vessels for the relatively larger flaps.

Contexte: Nous avons cherché à connaître l'efficacité du lambeau en clé de voûte/îlot appelé « keystone design perforator island flap ¼ (KDPIF) pour la reconstruction de la peau après excision de cancers isolés du membre supérieur. Nous avons plus particulièrement examiné la dimension des tissus manquants et réparés, ainsi que les complications associées à la procédure KDPIF isolée au niveau du membre supérieur. Méthodes: Il s'agit d'une étude rétrospective de dossiers incluant tous les patients âgés de plus de 18 ans ayant bénéficié d'une procédure KDPIF entre février 2013 et février 2019 pour reconstruction oncologique de manques de substance isolés après excision de cancers de la peau du membre supérieur par un seul chirurgien. Toutes les procédures ont été exécutées selon la description originale de Behan. Résultats: Un total de trente-deux patients (18 hommes [56%] et 14 femmes [44%]) ont bénéficié de trente-cinq volets en clé de voûte entre février 2013 et février 2019. L'âge moyen des patients masculins était de 70.5 ans et celui des patientes féminines était de 79.7 ans. Trente-cinq lésions suspectes de cancer ont été excisées et les diagnostics ont été confirmés par l'histopathologie : 14 (40%) carcinomes basocellulaires, 11 (31%) carcinomes spinocellulaires (à cellules squameuses), 9 (26%) mélanomes et 1 (3%) kératose actinique. La surface de peau manquante due à l'excision était comprise entre 3.53 cm2 et 31.42 cm2. Aucune complication peropératoire ou postopératoire n'est survenue. Conclusions: Le volet en clé de voûte KDPIF est une procédure versatile efficace ayant un taux de complication faible ou nul pour la reconstruction pour manque de peau après excision de cancer cutané à divers emplacements (bras, main, coude, avant-bras, épaule, poignet), des pathologies cancéreuses et des tailles variables sur le membre supérieur. Quand cela est nécessaire, un examen Doppler peut identifier avec succès les vaisseaux sanguins perforants pour les volets relativement plus grands.

Accuracy of Weight Estimation Using the Broselow Tape in a Peruvian Pediatric Population.

Introduction The Broselow tape (BT) is a useful pediatric tool for weight estimation and dosing reference during emergency care. Many accuracy studies have been performed for various countries and regions of the world but there is very little information for Latin American countries. The primary objective of the study was to assess the accuracy of the BT in a Peruvian pediatric population. Methods This was a retrospective cross-sectional study of 1,160 children aged two to 19 years from three outpatient clinics in La Libertad, Lima, and Iquitos, Peru. Patient height and weight were measured and compared with the weight and color zone generated by the 2017 edition of the BT. Accuracy was estimated by statistical comparison of mean absolute percent differences, error within 10% (EW10), and color zone agreement. Results Comparison of mean differences between measured weight (MW) and estimated BT weight shows that the BT underestimates actual weight for all color zones in this population. Likewise, the Bland-Altman plot of agreement between estimated and measured weights shows an overall underestimation, or bias, equal to 1.60 kg. The overall percent difference was -7.84% with differences gradually increasing for weights over 10 kg. In terms of accuracy, the overall error within 10% was 62.8%. Conclusion The BT underestimates the actual weight of Peruvian pediatric patients in all color categories, particularly in children with higher body mass indexes. Underestimation of weight may lead to the use of non-therapeutic medication doses or incorrect equipment sizes and, subsequently, ineffective resuscitation.