Static and Dynamic Stabilization of the Shoulder After Total Scapulectomy in an Electric Burn Patient.

ABSTRACT: An otherwise healthy 49-year-old man experienced a high-voltage electrical injury to the left shoulder resulting in total scapulectomy, partial calviculectomy, and a substantial soft tissue defect. The majority of the muscles around his shoulder were debrided because of necrosis, with only the pectoralis and latissimus dorsi muscles remaining attached to the humerus. Surprisingly, the patient's brachial plexus remained intact, and his left elbow, wrist, and hand function were preserved. A novel combination of 3 static and dynamic suspension techniques were used to stabilize his shoulder and prevent traction injury to the brachial plexus. Postoperative follow-up at 1 year demonstrated excellent stability of his reconstructed shoulder, which allowed him to ambulate independently and return to employment.

The Use of Biologic Wound Agents in Pediatric Reconstructions.

The indications for using biologic wound agents have expanded greatly since first being employed for acute burn management. The majority of the literature details the use of said agents in the adult population; however, there is little representation regarding their uses for reconstructing defects typically observed in the pediatric population. Ironically, children, and to a lesser extent adolescents, greatly benefit from their use given the reduced skin laxity and amount of surrounding tissue available for locoregional tissue transfer when compared with adults. Herein, we detail the use of acellular and cellular biologic wound agents in the pediatric population.

A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins.

BACKGROUND: Choosing the ideal face-lift technique for a patient presents an added challenge for the plastic surgeon. With the multitude of well-established variations of this procedure, it would be beneficial to define which facioplasty technique produces the optimal result. By comparing the postoperative results from two of the most popularized face-lift incision techniques in monozygotic twins, it is hypothesized that the "best" technique may be determined. METHODS: Four sets of identical twins and one set of identical triplets underwent face-lift surgery performed by the senior author (D.E.A.). Incision technique selection was randomized, with the first-born twin undergoing the full-incision operation. Short- and long-term postoperative photographs were taken at approximately 1 and 5 years and subsequently graded by eight board-certified plastic surgeons with over 100 years of combined experience. RESULTS: Data obtained from this study suggest that no difference between these incisions exists at the shorter term follow-up. However, analysis of the long-term follow-up revealed a significant difference between the average scores assigned to the neck region, with the full-incision technique receiving a higher score. CONCLUSIONS: These findings suggest that at the short-term follow-up, both the short-scar and full-incision techniques yield comparable results. However, at the longer term follow-up, a significant difference appears between the two procedures exclusively in the neck region. Although a shorter incision is appealing to the patient and surgeon, this study suggests that the full incision may offer a superior long-term result in the neck. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.