Gracilis Free Muscle Transfer in the Treatment of Pediatric Facial Paralysis.

Facial paralysis in children is a disabling functional and aesthetic issue. In cases where recovery is not expected, there are numerous options for reconstruction of the midface "smile." At the Hospital for Sick Children in Toronto, Canada, we have been using a free functional gracilis muscle transfer. In this article, we review the technical details of the procedure, which we have refined over the past 30 years, and also briefly discuss secondary and adjunctive procedures.

Perspectives in the reconstruction of paediatric facial paralysis.

PURPOSE OF REVIEW: In this review article, aimed at those likely to encounter but relatively unfamiliar with paediatric facial paralysis, we summarize reconstructive options in its surgical management. RECENT FINDINGS: The article looks at static and dynamic reconstructions available to address the problems encountered in the different anatomical regions of paralyzed face. SUMMARY: Although multiple surgical options are available for each anatomical region, decision-making should be taken in a multidisciplinary environment, and take into account the individual requirements of the family and patients.

Non-surgical management of an avulsion fracture injury of extensor carpi radialis brevis.

Avulsion fractures at the base of the index finger or long finger metacarpals are rare. We found six cases in the English language of a similar injury involving the extensor carpi radialis brevis. All were treated surgically. We describe an isolated avulsion fracture injury of extensor carpi radialis brevis insertion treated satisfactorily without surgery. The patient healed uneventfully and returned to normal pain free activity.

Please close this skin wound.

Acute cutaneous wounds following trauma are commonly encountered in the emergency department. This article explains the principles of their closure and provides advice on optimal management. Wound healing occurs in four phases: haemostatic, inflammatory, proliferative and maturation (Janis et al, 2010). The guidance below is based on the authors' personal practice, designed to promote transition through these stages and result in optimized healing with minimal scarring. It is intended to guide the reader through what can be a daunting prospect for many doctors in training: the acute closure of simple wounds.

Bilateral trigger finger in a 7-year-old after a viral infection: case report.

Triggering in young children is rare. In this report, we describe spontaneous bilateral ring finger triggering in a 7-year-old boy after a viral infection. The pathology completely resolved without intervention. We propose that the triggering resulted from a viral synovitis. Such a case highlights the importance of eliciting evidence of recent infections in children presenting to hand clinics with finger triggering. It also implies that the transient synovitis often described in children may actually occur symptomatically in tenosynovium as well as articular synovium.

Spatiotemporal analysis of programmed cell death during mouse cardiac septation.

Cell death is thought to play an important role in mammalian cardiogenesis, although a precise map of its distribution during the crucial period of cardiac septation has so far been lacking. In this study, the spatiotemporal distribution of programmed cell death (PCD) during mouse cardiac septation is described between embryonic days 10.5 and 13.5. Two types of foci of cell death can be demonstrated in the developing heart. Those with high-intensity, with a PCD index greater than 1%, are clearly visible on individual TUNEL-assayed sections. Low-intensity foci, with a PCD index of less than 1%, become visible only following summation of data. High-intensity foci occur exclusively within the endocardial cushions of the outflow tract and atrioventricular region, appearing at the 52-54 somite stage (late E11.5), concomitant with the formation of the central mesenchymal mass. Low-intensity foci are present throughout the period of cardiac development from E10.5 to E13.5 and are frequently localized to regions of septation, such as the muscular ventricular septum and the mesenchymal cap of the primary atrial septum. Expression of Fas and FasL corresponds to these low-intensity foci, but not those with high-intensity, suggesting that activation of this death receptor may be specifically involved in molecular control of the low-intensity foci.