Extirpative Considerations of Melanoma of the Head and Neck.

The incidence of melanoma is continuing to rise in the United States, and head and neck melanomas account for 25% of all cutaneous melanomas. The National Comprehensive Cancer Network guideline recommendations for surgical margins and sentinel lymph node biopsy in head and neck melanomas are the same as cutaneous melanoma located in other regions, but require special considerations when performing wide local excision, sentinel lymph node biopsy, and completion lymph node dissection and reconstruction taking into account the location of the melanoma and structures involved in and around the suggested margins.

Clinician's Guide to Nutritional Therapy Following Major Burn Injury.

This article provides a clinician's guide to nutritional support of the burn patient. The authors review the assessment and management of the needs of the thermally injured patient and provide recommendations on replacement and supplementation with calories, protein, carbohydrates, lipids, fluids, and minerals. Furthermore, the authors compare and contrast enteral versus parenteral delivery of nutrition.

Adult survivors' lived experience of burns and post-burn health: A qualitative analysis.

INTRODUCTION: The individual implications of major burns are likely to affect the full spectrum of patients' physical, emotional, psychological, social, environmental, spiritual and vocational health. Yet, not all of the post-burn health implications are inevitably negative. Utilizing a qualitative approach, this heuristic phenomenological study explores the experiences and perceptions early (ages 18-35) and midlife (ages 36-64) adults providing insight for how participants perceived their burns in relationship to their post-burn health. METHODS: Participants were interviewed using semi-structured interview questions framed around seven domains of health. Interview recordings were transcribed verbatim then coded line by line, identifying dominant categories related to health. Categories were analyzed identifying shared themes among the study sample. RESULTS: Participants were Caucasian, seven males and one female. Mean age at time of interviews was 54.38 and 42.38 at time of burns. Mean time since burns occurred was 9.38 years with a minimum of (20%) total body surface area (TBSA) burns. Qualitative content analysis rendered three emergent health-related categories and associated themes that represented shared meanings within the participant sample. The category of "Physical Health" reflected the theme physical limitations, pain and sensitivity to temperature. Within the category of "Intellectual Health" were themes of insight, goal setting and self-efficacy, optimism and humor and within "Emotional Health" were the themes empathy and gratitude. CONCLUSIONS: By exploring subjective experiences and perceptions of health shared through dialog with experienced burned persons, there are opportunities to develop a more complete picture of how holistic health may be affected by major burns that in turn could support future long-term rehabilitative trajectories of early and midlife adult burn patients.

Stimulating angiogenesis by hyperbaric oxygen in an isolated tissue construct.

BACKGROUND: Hyperbaric oxygen (HBO2) treatment has been shown to stimulate angiogenesis in prefabricated myocutaneous flaps. We conducted the current study to determine optimal HBO2 treatment intervals for peak angiogenesis. METHODS: Lewis rats were implanted subcutaneously with silicone molds in the inguinal region. Molds contained inguinal fat, a vascular pedicle and Matrigel plug. Thirty-two animals were randomized into four groups: HBO2 Treatment (2.5 atm of 100% oxygen, 90 minutes, 2x/day)--Group 1 (seven days) or--Group 2 (14 days); and Control Treatment (room air at atmospheric pressure)--Group 1 (seven days) or--Group 2(14 days). Implants were harvested, processed for H&E staining, and imaged digitally; angiogenesis was assessed by grade of vascularization at the Matrigel/fat boundary. Intergroup grading differences were assessed statistically. RESULTS: Vascularization in seven-day HBO2-treated implants was significantly increased compared to seven-day controls (p = 0.008). Vascularization in 14-day HBO2-treated implants was significantly decreased compared to 14-day controls (p = 0.012). There was no significant difference between seven-day HBO-treated implants and 14-day controls (p > 0.05). CONCLUSIONS: Short-term HBO2 exposure appears to increase angiogenesis in isolated tissue constructs. Prolonged HBO2 exposure may lead to vascular pruning. Short-term HBO2 exposure appears to expedite the natural vascularization process, resulting in equivalent vascularization in a shorter time.