Biomechanical Property and Biocompatibility of a New Silicone Rubber Nasal Retainer (Nostriloo).

Nasal retainers have been utilized to maintain the position of the nose after primary rhinoplasty in cleft lip patients. However, commercial nasal retainers made from silicone are quite expensive. To address this issue, the authors designed an alternative nasal retainer that is affordable, safe, and has similar biomechanical and biocompatibility properties to other commercial nasal retainers. Three types of nasal retainers were tested: our own (Nostriloo), a commercial nasal retainer from Turkey, and another one from Taiwan. There were 3 samples on each group, with a total sample of 9 retainers. Each sample was tested for biomechanical property and biocompatibility. Elasticity modulus, tensile strength, and direct and indirect toxicity were analyzed. Nostriloo had the least durable tensile strength but showed similar elastic modulus (2.76 ± 0.41 MPa) compared with human lower lateral cartilage (2.09 ± 0.81 MPa). On the basis of direct and indirect toxicity tests, Nostriloo is considered nontoxic. Nostriloo can be utilized for small-scale production and use. Further experiment is needed to produce higher-quality nasal retainers.

Challenges in Managing Post-Radiation TMJ Pseudoankylosis.

This study demonstrates the outcomes of post-radiation temporomandibular joint (TMJ) pseudoankylosis management and its challenges. A rare maxillary squamous cell carcinoma was treated with subtotal maxillary resection. Subsequent radiation therapy, failure of free flap reconstruction, and 1 year of jaw hypomobility instigated TMJ pseudoankylosis with a maximal mouth opening (MMO) of less than 5 mm. Bilateral coronoidectomy was done simultaneously with maxillary reconstruction, followed up with buccal fibrosis release and extensive jaw exercises. At 16 months of follow-up, the patient's MMO was 20 mm. Although bilateral coronoidectomy released the attachment of the atrophic temporalis muscle, it did not correct the other causes of trismus, specifically the progressive fibrosis of masticatory muscles, loss of elasticity of the TMJ ligaments, and other soft tissue abnormalities. Radiotherapy-induced-trismus refractory to physical exercise may require further management to achieve satisfactory MMO.

Bilateral Cleft Lip and Palate in Ring Chromosome 7 Syndrome: A Case Report and Review of Clinical Characteristics.

This report presents a case of ring chromosome 7 syndrome with bilateral cleft lip and palate. A four-year-old boy presented with bilateral cleft lip and palate, microcephaly, clenched toes, cafe-au-lait spots, a history of epilepsy, and severe intellectual disability. Genetic karyotyping revealed 46 XY r(7) (p22q36). His cheiloplasty and delayed palatoplasty were successful. A review of 22 previous r(7) patients revealed that 22.7% had cleft lip and/or palate. This case demonstrates the importance of a multidisciplinary evaluation for cleft patients, particularly those with syndromic features and global developmental delay.

Review of Traditional First Aid for Burn Injuries in the 21st Century.

INTRODUCTION: This review aims to investigate data on traditional burn first aid materials used in different countries. METHODS: A systematic search was performed through 8 databases for studies on traditional burn first aid published in the 21st century. Data regarding study demographics, burn first aid, first aid materials, water irrigation, and source of knowledge were summarized, and the use of each material was discussed. RESULTS: A total of 28 studies including 20,150 subjects were identified. An average of 29% of the study population applied water irrigation, whereas 46% used various traditional materials, and 30% did not administer first aid. People with higher education and socioeconomy class tend to choose correct first aid actions. DISCUSSION: The single best treatment as burn first aid is cool-water irrigation. Despite that, various other materials have been used, most of which are not suitable for first aid. Some materials possess healing abilities and can be used as wound dressing, whereas others are harmful. Inappropriate materials are mostly used in underdeveloped regions lacking water access and hygiene. Mass media and community knowledge have a large influence in burn first aid practices. CONCLUSION: Raising public health awareness on burn first aid is crucial along with providing the people access to water, basic hygiene, and health care.

Preoperative Blood Loss Prediction Formulas in Burn Surgeries: A Review.

Extensive burn surgeries lead to a considerable amount of blood loss. Predicting preoperative blood loss is essential for blood ordering and cross-matching. Accurate amount of ordered blood units ensures patients' safety and minimizes cost. However, blood loss estimation is complicated due to a variety of factors influencing blood loss, including patient and operative-related variables. Currently, no standard method to predict blood loss exists prior to surgery. Our goal is to review factors influencing blood loss and formulas that can predict blood loss. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE databases for studies investigating blood loss in burn surgeries with a clear quantitative outcome. Fifteen studies were included, comprising 1613 subjects. All studies calculated blood loss and assessed possible related factors, and four studies proposed preoperative blood loss prediction formulas. Larger areas of tissue excised and grafted, younger age, and delayed surgery were correlated with increased blood loss. Varying decrease in blood loss was observed with tumescent usage and other bleeding control methods. Other variables produced inconsistent results. From four prediction formulas, only one formula, Dye's Formula, had been applied and proven effective in reducing unused blood units clinically by up to 40% of cross-matched blood. Various confounding factors and dissimilarities between studies make reliable prediction method construction challenging. With consideration of diverse patient characteristics, some study develops formulas to achieve optimal patient care and avoid unnecessary hospital expenditure. Further research with consistent variables should be done to construct a standardized blood loss estimation formula.

Cutaneous Perforators and Their Clinical Implications on Intrinsic Hand Flaps: A Systematic Review.

Background: Most hand flaps are local intrinsic flaps because hand perforators are small and fragile. The purpose of this review was to gather anatomical data on cutaneous perforators of the hand and their implications on intrinsic hand flaps. Methods: An electronic search was performed through PubMed, Scopus, ScienceDirect, ProQuest, and CINAHL in April 2021. The search terms included "hand," "palm," "manus," "cutaneous artery," "angiosome," and "perforasome." Studies were filtered according to the PRISMA flow chart, and critically appraised using the Quality Appraisal for Cadaveric Studies (QUAC) and Appraisal Tool for Cross-sectional Studies (AXIS). Results: A total of 33 studies were included, of which 20 were pure anatomical studies, 10 combined anatomical and clinical studies, and three imaging-based clinical studies. A total of 643 hands and 406 fingers were included. The dorsal aspect of the hand, the dorsal digits, hypothenar, midpalm, thenar, and dorsal wrist consistently have adequate, closely distributed perforators of small diameters and short pedicle lengths. A series of clinical studies proved the success of elevating local perforator flaps on each of these areas. Conclusions: The hand contained densely interlinked cutaneous perforators of varying sizes and pedicle lengths. Although some areas of the hand are still unexplored, knowledge on cutaneous perforators of the hand allows the creation of a variety of possibilities for intrinsic hand flap designs.