Complication Rates in Patients With Classic and Radiographic Variants of Seymour Fractures.

Background: At a tertiary-care, level 1 pediatric trauma center, we have observed fractures of the distal phalanx involving the physis, with associated nail bed injuries, that are distinct from the classic description of the Seymour fracture. We investigated the time to definitive management and the associated morbidity of these Seymour fracture variants compared with classically described Seymour fractures. We hypothesize that these Seymour variants are similarly problematic in terms of complications and delays to the definitive treatment and thus warrant increased awareness.

The Use of Biologic Wound Agents in Pediatric Reconstructions.

The indications for using biologic wound agents have expanded greatly since first being employed for acute burn management. The majority of the literature details the use of said agents in the adult population; however, there is little representation regarding their uses for reconstructing defects typically observed in the pediatric population. Ironically, children, and to a lesser extent adolescents, greatly benefit from their use given the reduced skin laxity and amount of surrounding tissue available for locoregional tissue transfer when compared with adults.

Reconstructing Severe Lower Extremity Skin Necrosis in a Pediatric Patient.

Purpura fulminans can result in significant full-thickness wounds, posing a challenge in the pediatric population, given the paucity of donor sites for reconstruction. The authors present the case of an 11-month-old patient for whom a split-thickness skin allograft (TheraSkin) was successfully implemented as a temporizing measure for a large leg wound.

Revision Peripheral Nerve Surgery of the Upper Extremity.

Peripheral nerve injuries of the upper extremity can result from a wide array of etiologies, with the two most common being compression neuropathy and traumatic injuries. These types of injuries are common and can be psychologically, functionally, and financially devastating to the patient. A detailed preoperative evaluation is imperative for appropriate management.

Operative Pediatric Hand Infections: A Retrospective Review.

Background: Infections in the pediatric population are a less well studied topic in hand surgery. Crucial aspects of the management of pediatric hand infections differ from adults, though much of current treatment is generalized from adult care. This study evaluates our clinical experience with regards to the epidemiology, management, and outcomes of pediatric hand infections requiring operative intervention.

The Epidemiology of Operative Pediatric Hand Trauma: A Retrospective Chart Review.

Hand injuries are common in the pediatric population with a wide spectrum of morbidity that can occur. Simple injuries are distinguished from complex injuries by the number of fingers/systems that are involved. The epidemiology of simple and complex operative hand trauma in the pediatric population has not yet been defined.

Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study.

Background: Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described.

Objectives: To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT.

Methods: We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center.

Nerve Transfer versus Interpositional Nerve Graft Reconstruction for Posttraumatic, Isolated Axillary Nerve Injuries: A Systematic Review.

Background: The purpose of this study was to compare functional outcomes between nerve grafting and nerve transfer procedures in the setting of isolated, posttraumatic axillary nerve injuries.

Methods: A systematic review was performed using the PubMed, Scopus, and Cochrane databases to identify all cases of isolated, posttraumatic axillary nerve injuries in patients aged 18 years or older. Patients who underwent axillary nerve reconstruction were included and categorized by technique: graft or transfer.

The Duplicated Thumb: A Review.

Preaxial polydactyly is a common, often sporadic, congenital anomaly that must be addressed surgically early in life. Ideally, the surgeon seeks to accomplish three goals: construction of a thumb that is adequate in size, preservation of pinch function, and reconstruction of all components in one procedure. Although each case is unique, several classification systems attempt to describe the various types.

Reconstructive algorithms in the pediatric population.

Reconstruction of oncologic defects in the pediatric population is a unique challenge. Differences in patient comorbidities, size of the reconstructive components, response of the skeletally immature body to surgery and radiation, compliance, and overall recovery potential make the pediatric patient cohort distinct from the adult population. Considering that patients are enjoying longer life spans, it behooves the surgeon to reconstruct oncologic defects with durable and long-lasting tissue.

Sildenafil for microcystic lymphatic malformations of the head and neck: A prospective study.

Background: Microcystic lymphatic malformations (LM) are congenital birth defects that can cause severe functional or esthetic deformity. At this time, several treatment interventions are possible, but there is no ideal therapy. A recently published article noted a coincidental improvement in microcystic LMs with the use of sildenafil for pulmonary hypertension, but conclusive and reproducible data is lacking regarding its efficacy.

Overview of nasal soft tissue reconstruction: keeping it simple.

The authors provide an overview of nasal soft tissue reconstruction and of the senior author's practice. Nasal soft tissue reconstruction is a challenging endeavor as the nose is one of the most prominent and complex facial features. A multitude of surgical repair options exist, which can make the decision-making process unnecessarily complicated.

Local foreign-body reaction to commercial biodegradable implants: an in vivo animal study.

Biodegradable plates have been used extensively in fracture fixation since the 1960s. They rarely cause stress-protection atrophy or problems requiring secondary plate removal, common complications seen with metallic plates. However, aseptic foreign-body reactions have been reported, sometimes years after the original implantation.

A Prospective Study of Strut versus Miniplate for Fractures of Mandibular Angle.

This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures.

Bilateral proximal delta phalanges: an unusual presentation of familial congenital clinodactyly.

We report a unique case of bilateral proximal delta phalanges with secondary distal accessory ossification centers of the long fingers in a 16-month-old boy. The bony anomalies presented as severe ulnar deviation at the proximal interphalangeal joints bilaterally. This is a unique occurrence of congenital clinodactyly which has not been previously reported.

Effect of dietary zinc and phytase supplementation on botulinum toxin treatments.

Purpose: To determine whether oral zinc supplementation might affect the efficacy and duration of botulinum toxin treatments.

Methods: In a double-blind, placebo-controlled, crossover pilot study, we examined the efficacy of three botulinum toxin preparations (onabotulinumtoxinA, abobotulinumtoxinA, and rimabotulinumtoxinB) following oral supplementation with zinc citrate 50 mg and phytase 3,000 PU, zinc gluconate 10 mg, or lactulose placebo in individuals treated for cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm.

Results: In seventy-seven patients, 92% of subjects supplemented with zinc 50 mg and phytase experienced an average increase in toxin effect duration of nearly 30%, and 84% of participants reported a subjective increase in toxin effect, whereas no significant increase in duration or effect was reported by patients following supplementation with lactulose placebo or 10 mg of zinc gluconate.

General management considerations in pediatric facial fractures.

The treatment of pediatric facial fractures, although similar to that of adults, requires a separate and thorough understanding of the unique developmental issues inherent to this age group. The contribution of several of these factors allows for a large portion of these injuries to be managed more conservatively; however, operative indications still exist. The optimal form of management in these situations must balance the risks of impacting dentition or future skeletal growth versus obtaining acceptable stability and reduction for healing.

The subtarsal incision: where should it be placed?

Purpose: The subtarsal incision is a frequently used approach to orbital floor fractures. Compared with the subciliary incision, there is a lower rate of lower lid retraction. Unlike the transconjunctival incision, there is no need to perform a lateral canthoplasty to restore canthal integrity.