Bromelain-based enzymatic burn debridement: Spanish multidisciplinary consensus.

Background: Bromelain-based enzymatic debridement is gaining increased interest from burn specialists in the last few years. The objective of this manuscript is to update the previous, first Spanish consensus document from 2017 (Martínez-Méndez et al. 43:193-202, 2017), on the use of enzymatic debridement with NexoBrid in burn injuries, adding the clinical experience of a larger panel of experts, integrating plastic surgeons, intensivists, and anesthesiologists.

Arterialized Posterior Interosseous Nerve Graft for Digital Neuroma.

Painful neuromas are not uncommon following nerve injury, and are especially bothersome in the hand, with severe cases resulting in significant disability. Outcomes of neuroma surgery are unpredictable regardless of technique. It is recognized that optimal soft tissue environment influences nerve healing more than the specific nerve graft technique, and it is in this context, we present a novel technique of transferring a posterior interosseous nerve graft along with vascularized synovial and fat tissue based on a branch of the posterior interosseous artery to provide healthy soft tissue for nerve healing of neuroma in continuity about the hand and digits.

Approach to Fingertip Injuries.

The fingertip is mankind's tactile interface with the physical world, from reading braille, to using touchscreens, to wielding power tools. Its special tissue architecture demands astute evaluation and meticulous surgical or nonsurgical care after injury to return patients to their preinjury level of function. Attentive deliberation of physiologic, vocational, and psychosocial factors could improve the odds of achieving satisfactory results.

The use of pedicled abdominal flaps for coverage of acute bilateral circumferential degloving injuries of the hand.

Reconstruction of bilateral soft tissue defects in hand and distal third of the forearm, is a challenge for any reconstructive surgeon. When there is circumferential skin loss affecting the whole hand and fingers as in major degloving injuries, the extent of tissue required for reconstruction narrows down the choice of flaps. When the injury affects both hands the magnitude of the problem becomes compounded.