Physical Medicine Applications in Hand Burns: Treatment or Rehabilitation.

The aim of this study is to investigate the contribution of concurrent physical therapy to the preservation of hand function in patients with hand burns. This retrospective cohort study included the records of adult patients who presented with hand burns between July 1, 2020, and December 1, 2021. A total of 67 of 1578 burn patients who attended the clinic were included in this study. The patients' age, sex, total BSA with burns, causative agent, depth of burn on the hand, right or left hand, location of the burned area on the hand, treatment applied, healing time of the burn on the hand, limitation of movement, the joint restrictions, contractures, and compliance with physical therapy were assessed and recorded. Among the 67 patients included, 82.1% (n = 55) had no limitation in terms of their joint range of motion, whereas 17.9% (n = 12) had a limitation of movement in their finger joints. When the prevalence of movement limitation was examined by gender, such limitation was found to be more common in females (P = .041). Moreover, contractures were found to occur more frequently in patients with full-thickness burns (P = .032). It was also found that the limitation of movement was more severe in patients with skin grafts (P = .044). In addition, it was observed that the recovery time of the burn area was longer in those patients who had movement limitations (P = .004). In this study, we found that applying early physical therapy to patients after burn injuries facilitated the recovery of hand functions.

Prefabrication of a conjoint flap containing xenogenic tissues: a preliminary report on an experimental model.

Conjoint flaps are the compound flaps possessing multiple independent flaps, each with an independent vascular supply, but linked by a common indigenous source vessel. We have developed a new model of flap prefabrication using autogenic and xenogenic tissues in rats. Flaps were prepared at abdomino-inguinal regions of 20 male wistar albino rats. Autologous muscle, fascia, cartilage, bone grafts and acellular human dermal matrix (Alloderm, LifeCell Corp., Branchburg, NJ) were wrapped on the branches of external iliac, inferior epigastric and femoral arteries. The feasibility of prefabricating autogenic and xenogenic tissue containing flaps was investigated experimentally. Four weeks later, flaps were dissected and histopathological evaluation was undertaken. New blood vessel development was detected in all specimens with varying degrees. To our surprise, acellular dermal matrix (Alloderm), which was used as a xenogenic graft, exhibited a better revascularization potential than autogenic grafts in this prefabrication process, and a relatively dense network of new vessel formation was seen. As acellular dermal matrix is an allogenic tissue for human beings and has a superior revascularization potential, it can be prefabricated together with different autogenic tissues, and this flap can be used to reconstruct massive composite tissue defects, such as the defects occurring after tumor resection in head and neck region. With this method, donor site morbidity will be dramatically reduced. This is the first attempt of conjoint flap prefabrication using autogenic tissues combined with xenogenic tissues, which creates a new type of flap combining tissues from different species. We believe that new flap prefabrication models will be developed in the future, on the basis of this study.

Perforator artery based flap debulking: an alternative method.

The postoperative bulky appearance of a musculocutaneous flap constitutes aesthetic problems that could necessitate secondary operations. Three patients who were reconstructed with free musculocutaneous flaps were re-operated at the postoperative sixth month. The fasciocutaneous flaps were elevated based on perforator arteries, and the excess skin, dermal, and adipose tissues were excised. There were no complications in the follow-up. This one-staged, perforator artery based flap debulking is proposed as an efficient and alternative method.

Delayed assessment of the nasolacrimal system at naso-orbito-ethmoid fractures and a modified technique of dacryocystorhinostomy.

Nineteen patients between 8 and 65 years of age (mean age 32) who were treated for naso-orbito-ethmoid area traumas and suffering from epiphora were evaluated. The time after the trauma was at least 4 months. The patients were divided into two groups. The first group consisted of 10 (52.7%) patients who have undergone a surgical procedure for the fractures before. The second group has 9 (47.3%) members who have never been surgically treated after trauma. All of the patients were evaluated with dacryocystography. Obstruction was found to be in the bony nasolacrimal canal in 13 (68.4%) patients. The nasolacrimal canal was intact in six (31.6%) of the patients. Dacryocystorhinostomy (DCR) was essential for five (50%) of the patients in the first group and eight (88.8%) of the patients in the second group. No additional surgical intervention was carried out for nasal deformities of the patients resulting from naso-orbito-ethmoid fractures. Palpebral malposition was present in six (32%) patients. Relief in tear flow was supplied in all patients. Our aim is to compare the outcomes of a modified technique of DCR and incidence of nasolacrimal system injury in patients with naso-orbito-ethmoid fractures and epiphora on whom reduction was or was not carried out. In conclusion, early surgical reduction of naso-orbito-ethmoid fractures should be performed to prevent problems and deformities of the nasolacrimal system.