Yoga and Cutaneous Functional Unit Recruitment for a Patient with Cervical and Upper Extremity Burn Scar Contracture: Case Report.

Burn scar contracture greatly limits function for burn survivors, particularly when the scarring crosses multiple joints. Previous research has identified fields of skin recruited during single joint motion, called cutaneous functional units (CFU), indicating that impairments may be seen distal to the injured tissue. This case report connects the principles of CFU and yoga-inspired therapy modalities in improving clinical outcomes for a burn survivor. The patient is a 38-year-old male who sustained deep partial-thickness electrical burns to his neck, chest, and bilateral upper extremities, presenting with significantly decreased range of motion. The patient attended physical therapy 4 days a week, where he performed a specific yoga asana program during each session. Outcomes including standard range of motion measures, the Vancouver Scar Scale (VSS), and the Neck Disability Index (NDI), which were recorded every 10 sessions. CFUs of cervical extension and shoulder flexion were analyzed via photographs comparing cutaneous position during specified yoga poses and resting anatomical position in standing. Over 30 visits, cervical and shoulder range of motion increased, although the VSS and NDI did not show significant improvement. Yoga poses showed overall cutaneous recruitment distal to the targeted joints, and burned skin was recruited similarly to nonburned skin in positions of stretch. Incorporating multijoint approaches for stretching, like yoga, appears to contribute to improved clinical range-of-motion outcomes when paired with traditional burn-rehabilitation interventions. Yoga poses involving multiple joints align with the principle of CFUs, warranting continued investigation.

Complication Profile of Total Submuscular Versus Prepectoral Tissue Expander Placement: A Retrospective Cohort Study.

BACKGROUND: We sought to compare the safety profile of prepectoral breast reconstruction with total submuscular tissue expander reconstruction, previously our standard. Primary outcomes of interest in this retrospective cohort study were incidence of infection, hematoma, seroma, mastectomy flap necrosis, and reconstruction loss. METHODS: Total submuscular and prepectoral with acellular dermal matrix reconstructions consecutively performed by a single surgeon (P.D.S.) between January 1, 2016, and December 31, 2019, were compared. Demographic and clinical characteristics, as well as complications and complication types, were extracted for all patients. A t test was used to assess differences in continuous variables. Multivariate logistics regression was used to assess the association between type of reconstruction and complication rate. The statistical significance was set at 0.05 for all comparisons. RESULTS: A total of 133 patients (234 breasts) were included. There was a significantly greater incidence of infection (16.5% vs 5.5%, P < 0.01) in the prepectoral/acellular dermal matrix cohort. However, reconstructive loss was low in both cohorts (2.5% and 3.0%, P = 0.83). Adjusted odds ratio for complications in the prepectoral cohort was 2.26, but this was not statistically significant (adjusted P = 0.24). CONCLUSIONS: Prepectoral breast reconstruction shares an overall complication profile that is not greater than that of total submuscular reconstruction. It is associated with a greater risk of infection; however, the ability to salvage the reconstruction with early, aggressive intervention results in low rates of reconstructive loss, comparable with those of total submuscular reconstruction.

The Added Benefit of Combining Laser Doppler Imaging With Clinical Evaluation in Determining the Need for Excision of Indeterminate-Depth Burn Wounds.

Background Managing indeterminate-depth burn wounds remains challenging. Laser Doppler Imaging (LDI) has been validated for burn wound depth and can influence the clinical assessment. Our study investigated the value of LDI as an adjunct in determining the need for excision. Methods Seventy American Burn Association (ABA)-verified burn centers were surveyed. A controlled pre-test assessment without LDI and post-test assessment with LDI of 100 indeterminate-depth burn wounds was conducted to evaluate the influence on the clinical judgment among different health professionals. Relative risk, analysis of variance (ANOVA), paired t-test, and intention-to-treat were used for analysis. A p-value [Formula: see text] 0.05 was considered significant.  Results Among 32 burn centers, three confirmed using LDI. Six thousand grader-image interactions were analyzed. There was a significant difference in the predictive accuracy for pre-LDI and post-LDI assessments when all graders were considered (51.9% ± 7.0 vs. 72.9% ± 7.9; p < 0.0001). Post-LDI assessment added 20.9% more accuracy than the pre-LDI assessment. The post-LDI assessment was 1.4 times more likely to correctly predict the need for excision and skin-grafting than the pre-LDI assessment. All groups had an improved performance post-LDI: Group 1 (physicians), 51.9 ± 7.5 versus 76.4±5; Group 2 (nurses), 52.1 ± 6.1 versus 72.7±7.7; and Group 3 (others), 51.7 ± 9.2 versus 68.6 ± 10.1. No statistical difference was observed between groups (p = 0.92).  Conclusion LDI makes the clinical examination of indeterminate-depth burn wounds more accurate. For every five LDI evaluations performed, one assessor changed their treatment plan as a result of this imaging technique. LDI is cost-effective and increases the accuracy of determining the severity of indeterminate-depth burn wounds.

Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax.

BACKGROUND: An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. METHODS: A retrospective review of an urban level I trauma center's trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. RESULTS: A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. CONCLUSIONS: Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.