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PURPOSE: Neonatal limb compartment syndrome (NLCS) is a rare and potentially limb-threatening condition defined as an increased pressure within a confined limb compartment. Clinicians may fail to distinguish NLCS from other mimicking conditions. Misdiagnosis is possible due to a low index of suspicion for this condition, which may delay appropriate and urgent treatment. A comprehensive review of the available literature was performed to explore common themes in NLCS and identify gaps in the evidence to guide future studies. METHODS: A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French. Studies were selected by two independent reviewers who extracted descriptive data including the delivery history and complications, the timing of diagnosis, the location of the lesion, and the management strategy. RESULTS: A total of 43 reports describing 86 cases of neonatal compartment syndrome were published between 1980 and 2021. The male-to-female ratio was 6:7. Compartment syndrome was mainly located in the upper extremity (95.3%). Clinical features including swelling (41%), sentinel skin lesion (94.2%), extremity cyanosis (89.5%), and necrotic fingers (7%) were observed. The treatment strategy was either surgical decompression (32.6%) or nonsurgical management (68.6%). Sequelae occurred at a rate of 16.6%, 81.3%, and 75.9% after early fasciotomy (< 24 hours), late fasciotomy, and nonsurgical management, respectively. CONCLUSIONS: Sentinel skin lesions and flaccid paralysis are the most observed clinical features and represent key clues for diagnosis. Neither radiography, Doppler ultrasound, nor magnetic resonance imaging has demonstrated any advantage in guiding the appropriate management of NLCS and may delay appropriate treatment. Despite nonsurgical management and late fasciotomy (> 24 hours) being the most described treatments, the lowest rate of sequelae was observed when decompression was performed within the first 24 hours. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
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Wound healing in the pediatric population is known to be a challenge and poorly studied. Split-thickness skin grafts, full-thickness skin grafts, and flaps overlap their applications with the growing field of cellular and tissue-based therapies. However, their role in pediatric reconstruction has yet to be defined. The Kerecis® Omega-3 wound patch, derived from decellularized codfish skin, has garnered attention due to its preserved microscopic architecture resembling the human extracellular matrix. This acellular dermal matrix acts as a scaffold, fostering dermal cell and capillary adhesion while harnessing omega-3 polyunsaturated fatty acids for granulation acceleration and antimicrobial effects. This study presents a comprehensive review and surgical protocol for utilizing Kerecis® fish skin in pediatric wound care. The research embraces a case series involving five patients with diverse wound locations. The Kerecis® Omega-3 wound patch underwent meticulous application and careful monitoring. The results highlight an average time of 48.6 days for complete epithelialization, yielding favorable outcomes with no hypertrophic scarring and mild retraction. Kerecis® fish skin grafting stands as a tool that not only accelerates healing but also addresses the multifaceted challenges associated with wound management in the pediatric population: the avoidance of donor site morbidity and improved postoperative pain control.
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Introduction: Circumscribed or pseudomalignant myositis ossificans (MO) is a rare and benign condition characterized by heterotopic bone formation in soft tissues. The clinical presentation of MO, imaging investigations, histological findings, and treatment strategies are unclear, especially in the pediatric population. Materials and methods: A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French of traumatic and non-traumatic MO. Studies were selected by 2 independent reviewers following the PRISMA recommendation and descriptive data were extracted. We harvest in each case the sex, age at diagnosis, location, presence of initial trauma, pre-emptive diagnosis, modalities of imagery used, realized biopsy, treatment performed, and type of follow-up. Results: Sixty pediatric cases of MO were identified between 2002 and 2023. Twenty-three patients (38.3%) were diagnosed with idiopathic/pseudomalignant and 37 patients (61.7%) with circumscribed. The mean age at diagnosis was 9.5 years (range 0.2-17 years), with a male-to-female ratio of 1:1. The initial pre-emptive diagnosis was neoplasia in 13 patients (21.7%). The biopsy was percutaneous in 9 patients (15%) and incisional in 7 patients (11.7%). Histological analysis was achieved in 35 cases (57%). Surgical excision was the first line treatment in 46.7% of patients, and non-surgical in the remaining patients. The follow-up strategy was clinical in 16 patients (26.7%) or based on imaging investigation in 23 patients (38.3%). Discussion: Although MO in children is described as a rare pathology, identifying the benignity of the condition is essential to avoid unnecessary invasive treatment and to avoid delaying the treatment of a potentially life-threatening entity. It seems that there is no consensus established concerning the proper imaging for diagnosis. Clinicians should acknowledge that the absence of a triggering trauma tends to direct the investigation and the management toward a surgical attitude. Conservative management is key, however, surgical excision can be proposed on matured lesions on a case-by-case basis. The absence of recurrence is not excluded. Therefore, a close clinical follow-up is suggested for all cases. The true benefit of a radiological is questioned in a question known to be self-resolving.
