Pontine Tegmental Cap Dysplasia and Challenges in Facial Reconstructive Surgery.

Pontine tegmental cap dysplasia (PTCD) is a rare condition that affects the brain stem and multiple cranial nerves, which can result in bilateral facial palsies, hearing loss, bilateral trigeminal nerve dysfunction, oculomotor apraxia, feeding difficulties, seizures, hypotonia, and undeveloped speech. We document a case in which a patient with PTCD presents with a challenging lip deformity and requires multidisciplinary treatment to improve reconstructive surgical success and treatment outcomes. An extensive literature review was conducted.

Angiographic delay: a viable alternative to surgical delay.

Background: Selective embolization of the inferior epigastric arteries can serve as a method for transverse rectus abdominis musculocutaneous (TRAM) flap delay. The purpose of this study was to determine whether delay by selective arterial embolization is comparable to traditionally surgically delayed TRAM flaps as reported in the literature, in terms of skin and fat necrosis, and to examine whether certain risk factors play a role in TRAM flap fat necrosis despite angiographic delay.

Methods: Retrospective chart review was performed for 88 consecutive patients who underwent unilateral TRAM flap breast reconstruction after selective embolization of bilateral inferior epigastric arteries.

Significance of motor vehicle crashes and pelvic injury on fetal mortality: a five-year institutional review.

Background: Motor vehicle crashes (MVC) are the leading cause of maternal injury during pregnancy. It is estimated that 1,300 to 13,000 fetal deaths/yr result from maternal MVC.

Methods: Pregnant women with injuries were identified by ICD-9 codes containing pregnancy and injury from hospital medical records and Trauma/ED registries.

Diagnosis and treatment of uncommon wounds.

Uncommon wounds present unique challenges to plastic surgeons and other wound care providers in regard to their presentation, recognition, and ultimate treatment. This article presents an overview of diagnosis and actual case treatment of unusual wounds, a review of the literature, and case studies of interest. A systematic approach to diagnosis; careful review of history; and full understanding of topical, systemic, and surgical therapies is paramount to proper treatment recommendations, appropriate patient management, and successful wound-healing outcomes.

Predictors of fetal outcome in pregnant trauma patients: a five-year institutional review.

Injury Severity Score (ISS) and lactate are controversial in predicting fetal outcome. A retrospective review was conducted to determine whether ISS and lactate are valuable in predicting fetal survival in injured pregnant patients. Injured pregnant women were identified by ICD-9 codes from our Trauma Registry, Emergency Department Registry, and hospital medical records.

Trauma education and care in the jungle of Ecuador, where there is no advanced trauma life support.

Background: The advanced trauma life support course is not available or affordable to rural areas in low-income countries. A trauma continuing education course was created to educate physicians of rural hospitals in the jungles of Ecuador.

Methods: A basic trauma care course was designed based on local resources and location of injury, including rudimentary health posts in the jungle, rural hospitals, and definitive referral centers.

Prospective evaluation of an extubation protocol in a trauma intensive care unit population.

Little data exists regarding extubation protocols in critically injured trauma patients. The objective of the current study was to prospectively examine the impact of implementing an extubation protocol on the outcomes of ventilated trauma patients in a surgical intensive care unit (STICU). Trauma patients admitted to the STICU over a 15-month period at a Level 1 trauma center were prospectively evaluated.