Flap-Based Lower Extremity Reconstruction in the Elderly-Is It Safe and Does Age Impact Ambulation?

INTRODUCTION: Lower extremity (LE) reconstruction in the elderly population presents a multifaceted challenge, primarily due to age-related degenerative changes, comorbidities, and functional decline. Elderly individuals often encounter conditions such as osteoarthritis, osteoporosis, and cardiovascular and peripheral artery disease (PAD), which can severely compromise the structural integrity and function of the lower limbs. As such, we aim to assess postoperative complications and functional recovery following LE reconstruction in elderly patients. METHODS: Patients ≥ 18 years who underwent post-traumatic LE reconstruction with flap reconstruction at a Level 1 trauma center between 2007 and 2022 were included. Patient demographics, flap/wound characteristics, complications, and ambulation for the elderly (≥ 60 years old) and the control (< 60 years old) cohorts were recorded. The primary outcome was final ambulation status, modeled with logistic regression. Secondary outcomes included postoperative complications. RESULTS: The mean ages of the control (n = 374) and elderly (n = 49) groups were 37.4 ± 12.6 and 65.8 ± 5.1 years, respectively. Elderly patients more frequently required amputation after flap surgery (p = 0.002). There was no significant difference between the two cohorts in preoperative ambulation status (p = 0.053). Postoperatively, 22.4% of elderly patients were independently ambulatory at final follow-up, compared to 49.5% of patients < 60. Of the elderly, 14.3% could ambulate with an assistance device (cane, walker, etc.), compared to 26.5% in the control group. A wheelchair was required for 46.9% of elderly patients, significantly higher than the 22.7% of those < 60 years of age (p < 0.001). Multivariate regression confirmed an association between older age and nonambulatory final status (p = 0.033). CONCLUSION: LE reconstruction can likely be performed safely in patients 60 years of age or older. However, older age is independently associated with significantly worse postoperative ambulation. Preoperative assessment, including gait and muscle strength, and early initiation of postoperative rehabilitation can potentially improve ambulation in elderly individuals undergoing LE reconstruction.

Venous Thromboembolism Incidence, Risk Factors, and Prophylaxis in Burn Patients: a National Trauma Database Study.

Comprehensive studies on the incidence, risk factors, and prophylactic measures related to venous thromboembolism (VTE) are lacking in burn care. This study characterizes VTE risk and existing prevention measures to improve and inform overall patient care in the field of burn care on a national scale. The US National Trauma Data Bank (NTDB) was queried from 2007 to 2021 to identify burn-injured patients. Descriptive statistics and multivariate regression analyses were used to explore the association between demographic/clinical characteristics and VTE risk as well as compare various VTE chemoprophylaxis types. There were 326,614 burn-injured patients included for analysis; 5,642 (1.7%) experienced a VTE event during their hospitalization. Patients with VTE were significantly older, had greater BMIs and %TBSA, and were more likely to be male (p<0.001). History of smoking, hypertension or myocardial infarction, and/or substance use disorder were significant predictors of VTE (p<0.001). Patients who received low molecular weight heparin (LMWH) were less likely to have VTE compared to patients treated with heparin when controlling for other VTE risk factors (OR: .564 95% CI .523-.607, p<0.001). Longer time to VTE chemoprophylaxis (>6 hours) initiation was significantly associated with VTE (OR=1.04 95% CI 1.03=1.07, p<0.001). This study sheds light on risk factors and chemoprophylaxis in VTE to help guide clinical practice when implementing prevention strategies in burn patients. This knowledge can be leveraged to refine risk stratification models, inform evidence-based prevention strategies, and ultimately enhance the quality of care for burn patients at risk of VTE.

The Impact of Increased Body Mass Index on Patient Outcomes and Complications in Microsurgical Lower Extremity Reconstruction.

BACKGROUND: Elevated body mass index (BMI) is a known perioperative risk factor for complications such as delayed wound healing and infection. However, there is a gap in understanding how elevated BMI impacts outcomes after posttraumatic lower extremity (LE) microvascular reconstruction. METHODS: A retrospective review was performed at a level 1 trauma center between 2007 and 2022 of patients who underwent posttraumatic microvascular LE reconstruction. Demographics, flap/wound details, complications, and outcomes were recorded. Patients were stratified into BMI Center for Disease Control categories. RESULTS: A total of 398 patients were included with an average BMI of 28.2 ± 5.8. Nearly half (45%) of LE defects were located in the distal third of the leg, 27.5% in the middle third, and 34.4% in the proximal third. Most reconstructions utilized muscle-containing flaps (74.4%) compared with fasciocutaneous flaps (16.8%). Surgical approaches included free flaps (47.6%) and local flaps (52.5%). Class III obese patients were significantly more likely to be nonambulatory than nonobese patients (OR: 4.10, 95% CI 1.10-15.2, p = 0.035). At final follow-up, 30.1% of patients with Class III obesity were ambulatory, requiring either wheelchairs (42.3%) or assistance devices (26.9%). There were no significant differences in complication rates based on obesity status (0.704). The average follow-up time for the entire cohort was 5.8 years. CONCLUSIONS: BMI is critical for patient care and surgical decision-making in LE reconstruction. Further research is warranted to optimize outcomes for higher BMI patients, thereby potentially reducing the burden of postoperative complications and enhancing overall patient recovery.

GLP-1 Agonists: A Practical Overview for Plastic and Reconstructive Surgeons.

BACKGROUND: Glucagon-like peptide-1 (GLP-1) agonists, such as exenatide, liraglutide, dulaglutide, semaglutide, and tirzepatide, effectively manage type 2 diabetes by promoting insulin release, suppressing glucagon secretion, and enhancing glucose metabolism. They also aid weight reduction and cardiovascular health, potentially broadening their therapeutic scope. In plastic surgery, they hold promise for perioperative weight management and glycemic control, potentially impacting surgical outcomes. METHODS: A comprehensive review was conducted to assess GLP-1 agonists' utilization in plastic surgery. We analyzed relevant studies, meta-analyses, and trials to evaluate their benefits and limitations across surgical contexts, focusing on weight reduction, glycemic control, cardiovascular risk factors, and potential complications. RESULTS: Studies demonstrate GLP-1 agonists' versatility, spanning weight management, cardiovascular health, neurological disorders, and metabolic dysfunction-associated liver diseases. Comparative analyses highlight variations in glycemic control, weight loss, and cardiometabolic risk. Meta-analyses reveal significant reductions in hemoglobin A1C levels, especially with high-dose semaglutide (2 mg) and tirzepatide (15 mg). However, increased dosing may lead to gastrointestinal side effects and serious complications like pancreatitis and bowel obstruction. Notably, GLP-1 agonists' efficacy in weight reduction and glycemic control may impact perioperative management in plastic surgery, potentially expanding surgical candidacy for procedures like autologous flap-based breast reconstruction and influencing outcomes related to lymphedema. Concerns persist regarding venous thromboembolism and delayed gastric emptying, necessitating further investigation into bleeding and aspiration risk with anesthesia. CONCLUSIONS: GLP-1 agonists offer advantages in perioperative weight management and glycemic control in plastic surgery patients. They may broaden surgical candidacy and mitigate lymphedema risk but require careful consideration of complications, particularly perioperative aspiration risk. Future research should focus on their specific impacts on surgical outcomes to optimize their integration into perioperative protocols effectively. Despite challenges, GLP-1 agonists promise to enhance surgical outcomes and patient care in plastic surgery.

Expanding Accessibility in Cleft Care: The Role of Artificial Intelligence in Improving Literacy of Alveolar Bone Grafting Information.

OBJECTIVE: The American Medical Association (AMA) recommends patient education materials (PEMs) be written at or below a sixth grade reading level. This study seeks to determine the quality, readability, and content of available alveolar bone grafting (ABG) PEMs and determine if artificial intelligence can improve PEM readability. DESIGN: Review of free online PEMs. SETTING: Online ABG PEMs were retrieved from different authoring body types (hospital/academic center, medical society, or private practice). PATIENTS, PARTICIPANTS: None. INTERVENTIONS: Content was assessed by screening PEMs for specific ABG-related topics. Quality was evaluated with the Patient Education Material Assessment Tool (PEMAT), which has measures of understandability and actionability. Open-access readability software (WebFX) determined readability with Flesch Reading Ease, Flesch-Kincaid Grade Level, and Gunning-Fog Index. PEMs were rewritten with ChatGPT, and readability metrics were reassessed. MAIN OUTCOME MEASURE(S): Quality, readability, and content of ABG PEMs. RESULTS: 34 PEMs were analyzed. Regarding quality, the average PEMAT-understandability score was 67.0 ± 16.2%, almost at the minimum acceptable score of 70.0% (p = 0.281). The average PEMAT-actionability score was low at 33.0 ± 24.1%. Regarding readability, the average Flesch Reading Ease score was 64.6 ± 12.8, categorized as "standard/plain English." The average Flesch-Kincaid Grade Level was 8.0 ± 2.3, significantly higher than AMA recommendations (p < 0.0001). PEM rewriting with ChatGPT improved Flesch-Kincaid Grade Level to 6.1 ± 1.3 (p < 0.0001). CONCLUSIONS: Available ABG PEMs are above the recommended reading level, yet ChatGPT can improve PEM readability. Future studies should improve areas of ABG PEMs that are most lacking, such as actionability.

Orthognathic Surgery Rates in Furlow Double-Opposing Z-Plasty Versus Straight-Line Repair: A Review of Three Decades of Experience.

OBJECTIVE: The influence of different surgical techniques on maxillary growth remains unclear. This study investigates the long-term impact of Furlow double-opposing Z-plasty versus straight-line repair (SLR) techniques on midface growth and subsequent orthognathic surgery. DESIGN: Retrospective cohort study. SETTING: Tertiary children's hospital. PATIENTS/PARTICIPANTS: This study evaluated patients who underwent primary palatoplasty with Furlow or SLR techniques from 1994-2023. Patients were >14 years old at their most recent follow-up. INTERVENTIONS: No interventions were performed. MAIN OUTCOME MEASURE(S): Primary outcomes were orthognathic surgery and orthognathic surgery recommendation rates to correct midface hypoplasia (MFH). Cephalometrics at the time of orthognathic surgery recommendation were traced to validate MFH. RESULTS: In total, 1857 patients underwent palatoplasty, of which 335 met inclusion criteria (49 SLR, 286 Furlow). Average age at last follow-up was 18.5±2.6 years. Patients who underwent Furlow versus SLR showed no significant difference in orthognathic surgery rates (p=0.428) or recommendation for orthognathic surgery rates (p=0.900). Patients recommended to undergo orthognathic surgery had more negative ANB angles (p<0.001) and smaller SNA angles (p<0.001) than patients not recommended for orthognathic surgery, demonstrating maxillary hypoplasia. Upon multivariate regression, patients with Veau III and IV clefts had an increased need for orthognathic surgery, p=0.047 and p=0.008, respectively. CONCLUSIONS: Our findings suggest that higher cleft severity contributes to future orthognathic surgery. However, palatoplasty technique did not influence orthognathic surgery rates. Our results provide valuable data when surgeons are considering the impact of palatoplasty technique on sagittal growth restriction.

Resources on lymphedema surgery: How effective are they for patients?

Online patient education materials (PEMs) on lymphedema surgery were assessed for quality, readability, and content. A total of 37 PEMs were identified, primarily authored by academic/medical organizations. Readability scores indicated materials were difficult to read, with an average Flesch-Kincaid Grade Level of 10.4. PEM Assessment Tools showed acceptable understandability (72.3%) but poor actionability (28.5%). PEMs often lacked information on surgical risks, postoperative care, and long-term follow-up. Simplifying language and adding visual aids could improve PEM effectiveness.

Single and Unhoused Population at Risk for Self-Inflicted Burn Injury: A Retrospective Analysis of an Urban American Burn Center's Experience.

Despite the growing recognition of self-harm as a pressing public health issue, demographic risk factors of self-inflicted burn (SIB) injuries in the U.S. have not been extensively described. In this retrospective study, we seek to identify demographic risk factors and patterns associated with SIB injuries at an urban burn center. Charts were reviewed of patients admitted to a single American Burn Association (ABA)-verified burn unit between 2015 and 2023 with a history of SIB injury, identified with ICD10 code X76.XXXA. Descriptive statistics, Welch's t-test of unequal variances, and Chi-Squared-analysis were performed. A total of 3,212 patients were admitted to our institution for management of acute burn injury, with 94 (2.9%) patients who presented with SIB injury. SIB patients were more likely than the control cohort to be male (p = 0.035), single (p=0.008), unhoused (p < 0.001), live alone (p < 0.001), and have documented psychiatric diagnoses (72.3% vs. 2.1%, p < 0.001). They had larger %TBSA affected (p < 0.001) and higher rates of inhalation injury (p < 0.001). The SIB cohort also showed significantly higher rates of positive urine toxicology results, primarily for stimulants and opiates (p < 0.001). Patients with SIBs had longer hospital stays (21.7 ± 2.6 days vs. 12.0 ± 22.1 days, p = 0.006), higher rates of ICU admission (p < 0.001), and mechanical ventilation requirement (p < 0.001). Mental health support services, substance abuse rehabilitation programs, and community outreach need to be prioritized, especially targeting vulnerable populations such as the unhoused.

Flap-Based Reconstruction in Patients with Autoimmune Disease: An Institutional Experience with the Deep Inferior Epigastric Perforator Flap and Review of the Literature.

BACKGROUND: Autoimmune diseases are associated with characteristic chronic inflammation, aberrations in tissue perfusion, and hypercoagulability, and thus have considerable implications for local and free-flap reconstruction. We seek to summarize the current evidence on outcomes of flap-based reconstruction in patients with pre-existing autoimmune disease and present our experience with autologous breast reconstruction in this population. METHODS: PubMed, Embase, Scopus, Cochrane, and Web of Science were searched for relevant articles, and pertinent data were presented qualitatively. Institutional data were queried for patients who underwent autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flaps between 2015 and 2024. A retrospective review was conducted to identify DIEP patients with a history of autoimmune disease. Data on patient demographics, medication history, flap outcomes, and perioperative complications were collected. RESULTS: The majority of existing studies found no increased independent risk of flap complications. However, other complications, predominantly wound dehiscence, were independently associated with autoimmune disease. Regarding immunosuppressant therapy, the literature demonstrated that perioperative glucocorticoid use was consistently associated with all complications, including seroma, infection, wound disruption, and partial flap loss.Our 13-patient institutional experience identified no cases of total flap loss or microvascular thrombotic complications. There was one case of partial flap necrosis further complicated by abdominal site cellulitis, and one case of recipient-site dehiscence managed with local wound care. No patients required re-operation for flap or donor-site complications. CONCLUSION: The literature suggests that flap reconstruction can be performed safely in patients with autoimmune conditions, which was also supported by our institutional experience. While there is likely minimal risk of microsurgical complications in the context of free tissue transfer, donor-site morbidity and wound dehiscence remain major concerns for patients with a history of autoimmune disease. Limiting the use of immunosuppressive agents, especially corticosteroids, may potentially improve outcomes of flap reconstruction.

FireSync EMS: A Novel Mobile Application for Burn Surface Area Calculation.

The percent total body surface area burned is a critical determinant of the required level of care, initial management, and prognosis in burn patients. The current gold standard for estimating this measurement, the Lund-Browder chart, requires familiarity with its construction and may not be practical for use by first responders in the field. In this study, we present a novel burn surface area calculator mobile application developed for first responders and validate its accuracy. Infant, pediatric, and adult manikins were fabricated with eight simulated burns of varying sizes and distributions. 42 pre-clinical medical students and firefighters were tasked with estimating the total body surface area of each burn using both the FireSync-EMS app and Lund-Browder chart. Univariate analysis and mixed-effects linear regression modeling were performed to compare the accuracy of both methods in relation to user experience, manikin size, and burn size. FireSync-EMS significantly reduced overestimation bias (0.11%, SD 2.33 versus 0.91%, SD 4.12, p = 0.002), particularly for burns on child-size manikins (p < 0.001) and burns involving <10% (p = 0.005) and >20% (p = 0.030) total body surface area. Multivariable modeling revealed that the Lund-Browder chart was an independent determinant of the magnitude of estimation error, with a 1.19 times multiplicative effect relative to FireSyncEMS (p < 0.001). Participants overwhelmingly found FireSync-EMS easier, more intuitive, faster, and preferable (p < 0.001 for all). FireSync-EMS may be an easier, faster, and more accurate alternative to the Lund-Browder chart for estimation of the total body surface area burned.

A Nationwide Analysis of the Impact of Cardiopulmonary Anomalies on Cleft Palate Surgical Outcomes.

OBJECTIVE: To increase awareness and improve perioperative care of patients with cleft palate (CP) and coexisting cardiopulmonary anomalies. DESIGN: Retrospective cohort. SETTING: Multi-center. PATIENTS/PARTICIPANTS: Patients who underwent surgical repair of CP between 2012-2020 identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Chi-squared analysis and Student's t-test were implemented to make associations between congenital heart disease (CHD) and congenital pulmonary disease (CPD) and postoperative complications. Multiple logistic regression was performed to identify associations between CP and CHD/CPD while controlling for age, gender, and ASA class. C2 values were used to assess the logistic regressions, with a significance level of 0.05 indicating statistical significance. MAIN OUTCOMES MEASURES: Length of stay (LOS), perioperative complications (readmission, reoperation, reintubation, wound dehiscence, cerebrovascular accidents, and mortality). RESULTS: 9 96 181 patients were identified in the database, 17 786 of whom were determined to have CP, of whom 16.0% had congenital heart defects (CHD) and 13.2% had congenital pulmonary defects (CPD). Patients with CHD and CPD were at a significantly greater risk of increased LOS and all but one operative complication rate (wound dehiscence) relative to patients with CP without a history of CHD and CPD. CONCLUSION: This study suggests that congenital cardiopulmonary disease is associated with increased adverse outcomes in the setting of CP repair. Thus, heightened clinical suspicion for coexisting congenital anomalies in the presence of CP should prompt referring providers to perform a comprehensive and multidisciplinary evaluation to ensure cardiopulmonary optimization prior to surgical intervention.

A National Analysis of Craniosynostosis Demographic and Surgical Trends Over a 10-Year Period.

The pathogenesis of craniosynostosis, characterized by the premature fusion of calvarial sutures, is multifaceted and often the result of an amalgamation of contributing factors. The current study seeks examine the possible contributors to craniosynostosis development and its surgical trends over time. A multicenter/national retrospective cohort study was conducted of patients who underwent surgical repair of craniosynostosis (n=11,279) between 2012 and 2021 identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Main outcome measures included risk factors and trends relating to surgical repair of craniosynostosis. Nationwide reports of craniosynostosis in the NSQIP-P database have increased between 2012 and 2021 by 195%. The prevalence of craniosynostosis per overall cases has remained between 1.0% and 1.3%. There were predominantly more White male patients in the craniosynostosis cohort (P<0.001). Craniosynostosis patients had significantly greater birth weights, gestational ages, and were less likely to be premature (P<0.05). Linear regression demonstrated that operative time, anesthesia time, and length of stay significantly decreased over the study period (P<0.001). This national data analysis highlights trends in craniosynostosis repair indicating potential improvements in safety and patient outcomes over time. While these findings offer insights for health care professionals, caution is warranted in extrapolating beyond the data's scope. Future research should focus on diverse patient populations, compare outcomes across institutions, and employ prospective study designs to enhance the evidence base for craniosynostosis management. These efforts will help refine diagnostic and treatment strategies, potentially leading to better outcomes for patients.

The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction-A Systematic Review.

BACKGROUND: When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction. METHODS: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted. RESULTS: A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports (n = 11) and case series (n = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures (n = 46, 73.0%) and chronic wounds secondary to H&N masses (n = 9, 14.3%). Defects were most commonly located in the neck (n = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm2 and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous (n = 48, 71.6%) and based on the dorsal scapular artery (n = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% (n = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years. CONCLUSION: This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.

Endoscopic Tissue Expander Implantation in Postburn Reconstruction: A Review of the Literature.

BACKGROUND: Tissue expansion generates new tissue that can be used in postburn reconstruction. Expanders are placed through small incisions, requiring difficult and sometimes blind dissection to prepare an adequate pocket. Recently, the use of endoscopy to assist in expander placement has been described, which may improve intraoperative visualization and allow for a smaller incision. In this review, we summarize the existing literature on endoscopic tissue expander (TE) placement in postburn reconstruction and highlight areas for future research. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to conduct this review. The following databases were queried for the initial search of relevant articles: PubMed, Embase, Scopus, Cochrane, and Web of Science. The data were assessed qualitatively due to the heterogeneity in reporting between the studies. RESULTS: Our literature query yielded 1023 studies. Sixteen manuscripts underwent full-text review, and 7 met inclusion criteria. All studies demonstrated that the endoscopic approach led to successful tissue expansion. Four articles performed a comparative analysis between the open and endoscopic approach, all of which found a significant reduction in complications like seroma, hematoma formation, and device exposure with endoscopic TE implantation. Two studies demonstrated that the use of endoscopy significantly reduced operative time and length of stay. CONCLUSION: Endoscopy is a safe and effective tool in tissue expansion for postburn reconstruction. Further prospective research should include evaluating the cost-benefit of this approach and long-term outcomes for patients who have undergone endoscopic-assisted TE placement.

Navigating Scar Care: An Evaluation of Scar Treatment Patient Education Materials.

While patient education materials (PEMs) across various specialties have been reported as being too difficult to read, the quality and understandability of PEMs related to scar management have not been assessed. In this study, we report the breadth of scar management interventions and readability of online PEMs authored by academic societies and university hospitals. Websites of academic medical societies and university hospitals with scar revision PEMs were assessed for relevance. PEM readability was assessed via Flesch Reading Ease, Flesch-Kincaid Grade Level, and Gunning-Fox Index scores. Understandability and actionability were evaluated using the Patient Education Material Assessment Tool (PEMAT). A total of 26 scar revision PEMs met the inclusion criteria. The most commonly mentioned scar management interventions were scar revision surgery (73%) and laser scar revision (70%), with minimal emphasis on noninvasive methods like scar massage or sun protection. Readability analysis yielded a mean Flesch reading level of 8.8. Overall, PEMAT understandability of online scar treatment PEMs was moderate, with a median of 76.0% (IQR 71.5%-80.5%). PEMs from all specialties and institution types were lacking in actionability, with median actionability of 40.8% (IQR 38.1%-60.0%). Online scar revision PEMs included a wide breadth of scar management interventions; however, the least costly interventions, such as sun protection and scar massage, were not commonly included. PEMs for scar management could be improved by simplifying language, including visual aids, and including checklists or specific steps, patients can take to take action on scar management interventions.

Analyzing Burn-Related Content on Social Media Platforms: A Study of Creator Types, Content Focus, and Engagement Metrics.

Social media offers a readily available, cost-effective way for medical experts to disseminate knowledge and shape public health outcomes but also allows for the spread of misinformation. This study aims to analyze burn-related material on social media by creator, content type, and engagement. Facebook, TikTok, and X (formerly Twitter) were queried with the following search terms: "burn," "burn injury," "burn recovery," and "burn treatment." Identified accounts were then manually screened for relevance. Year of creation and engagement metrics were collected. Accounts were categorized by content and creator type. Data was reported using descriptive statistics and visualized graphically to explore trends. Our search yielded 434 profiles, 234 of which met inclusion criteria. TikTok had the most engagement at a median of 43,500 followers per account, with 38.3% of accounts focusing on individual experiences of burn survivors primarily on personal accounts (48.3%). In contrast, content on Facebook was related to promotion of medical services (36.9%), where the most represented creator type was medical centers (33.6%). Nonprofits made up 40.4% of accounts on Twitter/X and more than a third of the content focused on patient advocacy, support, or burn prevention (36.5%). Important topics like burn education, prevention, and social support are lacking on major social media platforms. Engagement from burn care organizations and burn experts on social media is necessary. The findings of this study may guide advocates in the burn community on where and how to disseminate information in social media.

Neuropathic pain in burn patients - A common problem with little literature: A systematic review.

BACKGROUND: The prevalence of neuropathic pain (NP) in burn patients is reported in the literature to be as high as 80%1. Given the complexity of NP in burn patients and the wide range of treatments available, a systematic review of the literature is warranted to summarize our current understanding of management and treatment of NP in this population. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following databases were queried to identify relevant articles: PubMed, Cochrane, Embase, Scopus, Ovid, and Web of Science. The main outcome measures were incidence and management of NP. Secondary outcomes included risk factors for NP. RESULTS: Included articles presented findings from 11 different countries, capturing outcomes for 4366 patients. Risk factors for neuropathic pain in burn patients were identified, including older age, alcohol and substance abuse, current daily smoking, greater % total body surface area burns (TBSA), and longer hospitalizations. Pharmacologic treatments included gabapentin/pregabalin (n = 7), ascorbic acid (n = 1), and lidocaine (n = 1). Overall, the studies showed varied results regarding the efficacy of pharmacological treatments. While certain studies demonstrated gabapentanoids to be effective in reducing neuropathic symptoms, others found conflicting results. With regards to non-pharmacologic treatments, electroconvulsive therapy (n = 1), electropuncture (n = 1), nerve release/reconstruction (n = 2), and somatosensory feedback rehabilitation (n = 1) were used and demonstrated promise in reducing pain intensity and improving functionality. CONCLUSIONS: Despite NP afflicting the majority of burn patients long after their injury, this systematic review demonstrates insufficient evidence on the pathophysiology, outcomes, and risk factors in NP, as well as the efficacy of various therapies. Future prospective and randomized studies evaluating the etiology of these factors can substantially improve our treatment strategies. This can allow for the development of well-delineated and evidence-based protocols in NP management in hopes of improving quality of life and both psychological and physical function in burn patients.

Surgical Management of Diabetic Foot Burns Is Associated With Poor Outcomes: A Systematic Review and Meta-Analysis.

There is no consensus on the optimal management of diabetic foot burn injuries. Here, we systematically identify studies reporting on diabetic foot burns and evaluate outcomes among patients managed operatively vs nonoperatively. PubMed, Embase, and Web of Science were searched. Screening was performed by independent reviewers. Primary research studies with English full texts published between 1980 and 2023 that discussed outcomes of foot burns in adults with diabetes were included and critically appraised using validated tools. Results are presented using descriptive statistics of aggregated data. The search yielded 2402 nonduplicate papers, of which 35 met the inclusion criteria. Nine papers were included for meta-analysis, including 7 retrospective comparative analyses, 1 cross-sectional study, and 1 retrospective chart review. There were 1798 diabetic foot burn patients. The mean age was 58.2 years (SD 4.12), and 73.1% (n = 1314) were male. A total of 15.7% (n = 283) of patients were surgically managed, including debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). The secondary amputation rate, defined as amputation following initial surgery, was 4.9% (n = 14). The overall amputation rate was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). One study reported functional status at the last visit. Diabetic foot burns are highly morbid. The surgical management of these complex injuries is high risk, as amputation results in poorer quality of life and functional outcomes.

Lessons Learned from a Single Institution's Eight Years of Experience with Early Cleft Lip Repair.

Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution's ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL/P deformity. Materials and Methods: Retrospective review was conducted at Children's Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015-2022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 ± 0.5 months. Mean operative and anesthetic times were 120.3 ± 33.0 min and 189.4 ± 35.4, respectively. Only 2.1% (4/188) of patients had postoperative complications. Lip revision rates were 11.4% (20/175) and 15.4% (2/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p < 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.

Scanning ion conductance microscopy reveals differential effect of PM2.5 exposure on A549 lung epithelial and SH-SY5Y neuroblastoma cell membranes.

Numerous studies have linked a wide range of diseases including respiratory illnesses to harmful particulate matter (PM) emissions indoors and outdoors, such as incense PM and industrial PM. Because of their ability to penetrate the lower respiratory tract and the circulatory system, fine particles with diameters of 2.5 µm or less (PM2.5) are believed to be more hazardous than larger PMs. Despite the enormous number of studies focusing on the intracellular processes associated with PM2.5 exposure, there have been limited reports studying the biophysical properties of cell membranes, such as nanoscale morphological changes induced by PM2.5. Our study assesses the membrane topographical and structural effects of PM2.5 from incense PM2.5 exposure in real time on A549 lung carcinoma epithelial cells and SH-SY5Y neuroblastoma cells that had been fixed to preclude adaptive cell responses. The size distribution and mechanical properties of the PM2.5 sample were characterized with atomic force microscopy (AFM). Nanoscale morphological monitoring of the cell membranes utilizing scanning ion conductance microscopy (SICM) indicated statistically significant increasing membrane roughness at A549 cells at half an hour of exposure and visible damage at 4 h of exposure. In contrast, no significant increase in roughness was observed on SH-SY5Y cells after half an hour of PM2.5 exposure, although continued exposure to PM2.5 for up to 4 h affected an expansion of lesions already present before exposure commenced. These findings suggest that A549 cell membranes are more susceptible to structural damage by PM2.5 compared to SH-SY5Y cell membranes, corroborating more enhanced susceptibility of airway epithelial cells to exposure to PM2.5 than neuronal cells.