Application and Management of Cultured Epidermal Autografts on Posterior Burns-A 5-Year, Multicenter, Retrospective Review of Outcomes.

Severe burns on the posterior trunk present a treatment challenge in that these surfaces bear the major portion of body weight, with shearing forces exerted when changing the patient from supine to prone position. In their high-volume center at Burn and Reconstructive Centers of America, the authors developed protocols for use of cultured epidermal autografts (CEAs) for coverage of large burns, including those specific to posterior burns. This paper describes techniques and approaches, including milestone timelines, to treat and manage these patients. Key factors for successful treatment begin with early development of a detailed surgical plan. Members of the trained team participate in the plan and understand standard procedures and any deviation. Patients are identified early for treatment with CEA so that a full thickness skin biopsy can be sent to the manufacturer for processing. Patients with >30% total body surface area (TBSA) burns are considered for CEA burn wound coverage due to the potential for conversion of superficial partial thickness to deep partial thickness or full thickness burns over hospitalization time. We also present the outcomes in patients with posterior trunk burns treated with CEA from 2016 to 2019 in three participating centers within our network. Data in 40 patients with mean TBSA of 56% demonstrated a high rate of successful CEA engraftment (83%), and overall survival rate (90%) following one or two applications with CEA and/or CEA + split thickness skin graft (STSG). Development of standard treatment protocols and surgical plans has enabled positive outcomes with CEA in severe burns including posterior burns.

Anomalous Radial Artery as an Incidental Finding During a Routine Carpal Tunnel Release.

BACKGROUND: Compression of the median nerve at the wrist, or carpal tunnel syndrome, is the most commonly recognized nerve entrapment syndrome. Carpal tunnel syndrome is usually caused by compression of the median nerve due to synovial swelling, tumor, or anomalous anatomical structure within the carpal tunnel. METHODS: During a routine carpal tunnel decompression, a large vessel was identified within the carpal tunnel. RESULTS: The large vessel was the radial artery. It ran along the radial aspect of the carpal tunnel just adjacent to the median nerve. CONCLUSIONS: The unusual presence of the radial artery within the carpal tunnel could be a contributing factor to the development of carpal tunnel syndrome. In this case, after surgical carpal tunnel release, all symptoms of carpal tunnel syndrome resolved.

Tissue Dynamics: Lessons Learned From Sutural Morphogenesis and Cancer Growth.

UNLABELLED: Why are cranial sutures the way they are? How do cancers grow? Merging physics and mathematics with biology, we develop equations describing these complex adaptive systems, to which all biological entities belong, calling them laws of tissue dynamics:Where t is time, E is energy, M is body mass, X is the biological characteristic of interest, C is a constant, a is an exponent.(1) is based on conservation of matter: for any given tissue, materials in must equal to materials out +/- assimilated or degraded. (2) is based on energy conservation. All living systems require energy, without which life becomes impossible. Equation (2) is a power spectrum. OBJECTIVES: This study aimed to introduce the laws of tissue dynamics and to illustrate them using observations from craniofacial and cancer growth. METHODS: We use cranial sutures as a model system to test Equation (1), we also measure the in vitro growth rate of normal murine liver and spleen cells, comparing them to B16F10 melanoma cells. We show the increase in compound growth rate and energetic requirement of malignant versus normal cells as partial proof of Equation (2). RESULTS: The constant width and wavy form of cranial sutures are the inevitable results of repeated iteration from coupling of growth and stress. The compound growth rate of B10F16 melanoma cells exceeds that of normal cells by 1.0 to 1.5%, whereas their glucose uptake is equal to 3.6 billion glucose molecules/cell per minute. SUMMARY: Living things are complex adaptive systems, thus a different way of thinking and investigating, going beyond the current reductive approach, is required.