Antecubital Fossa Research Articles

Compendium of Vascular Variations in the Anterior Cervical Region and Right Upper Limb – A Case Report

It is axiomatic that knowledge of variations of the major vessels is crucial, not only from anatomical standpoint, but also clinically. During the routine dissection for undergraduate study in Department of Anatomy, Faculty of Medicine, University of Jaffna, Sri Lanka, we came across compendium of vascular variations. Brachiocephalic trunk originated to the left of midline and its branches, the right common carotid and subclavian arteries, crossed the cervical trachea in front from left to right just above the left brachiocephalic vein. The right axillary artery divided into radial and ulnar arteries at the level of lower border of the teres major and these two branches travelled between the biceps brachial and median nerve. Radial artery took the course of the brachial artery in the arm and cubital fossa. Ulnar artery passed in a deeper plane in the arm medial to the biceps brachii and radial artery and passed deep to pronator teres and continued in the forearm lateral to the ulnar nerve as usual. The lateral root of median nerve crossed in front of axillary to unit with the medial root to form the median nerve, which coursed medial to the radial and ulnar arteries in the brachium The aim of this case reportis to compare with the variations reported and to discuss its clinical implications. In conclusion, we present a report of multiple arterial variations in the anterior cervical region and upper limb. Correct identification of variations is necessary for clinical practice, appropriate invasive techniques and to avoid complications.

Brachio-brachial arteriovenous fistula combined with superficialization of the brachial artery using a short skin incision for hemodialysis.

A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2-3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.

Dynamics of Skin Mycobiome in Infants.

Understanding the microbial community structure of the human skin is important for treating cutaneous diseases; however, little is known regarding skin fungal communities (mycobiomes). The aim of the present study was to investigate the features of and variations in skin fungal communities during infancy in 110 subjects less than 6 months of age. Skin samples were obtained from the back, antecubital fossa, and volar forearm, while physiological parameters including transepidermal water loss, pH, surface moisture, and deep layer hydration were evaluated. Skin fungal diversity decreased after the first three months of life. Differences in fungal community composition were greater among individual infants than among the three skin sites in the same individual. Inter- and intra-individual variation were similar and lower, respectively, than the variability between two samples obtained 12 weeks apart, from the same site in the same subject, suggesting low stability of fungal communities on infant skin. Skin physiological parameters showed little correlation with skin fungal community structure. Additionally, Malassezia was the most represented genus (36.43%) and M. globosa was the most abundant species in Malassezia with its abundance decreasing from 54.06% at 0–2 months to 34.54% at 5–6 months. These findings provide a basis for investigating the causative fungi-skin interactions associated with skin diseases.

Compression of the Lateral Antebrachial Cutaneous Nerve due to Leakage of Iron after an Intravenous Iron Infusion.

Skin staining due to iron leakage into the subcutaneous tissue can sometimes occur during intravenous iron infusion. We describe a case of lateral antebrachial cutaneous nerve (LACN) entrapment due to extravasated iron after an intravenous iron infusion. A 41-year-old woman received an intravenous ferric carboxymaltose infusion for iron deficiency anemia. However, during the infusion, extravasation of iron occurred and brown pigmentation developed on the lateral side of the cubital fossa. Sixteen months later, the patient still had some staining in her anterolateral elbow and proximal forearm. In addition, she complained of tingling pain over her left forearm. Ultrasonography (US) revealed a lateral antebrachial cutaneous nerve (LACN) under the stained area. When we swept the stained area with the US transducer, she reported a tingling pain on her left lateral forearm, the region innervated by the left LACN. Therefore, we considered that the pain resulted from the compression of the left LACN by the leaked iron during the intravenous infusion. Leaked iron can compress the cutaneous nerve and result in neuropathic pain and cosmetic problems. When patients with skin staining after iron infusion have neuropathic pain, clinicians should consider the possibility of entrapment of the cutaneous nerves.

Staphylococcus saccharolyticus: An Overlooked Human Skin Colonizer.

Coagulase-negative staphylococcal species constitute an important part of the human skin microbiota. In particular, facultative anaerobic species such as Staphylococcus epidermidis and Staphylococcus capitis can be found on the skin of virtually every human being. Here, we applied a culture-independent amplicon sequencing approach to identify staphylococcal species on the skin of healthy human individuals. While S. epidermidis and S. capitis were found as primary residents of back skin, surprisingly, the third most abundant member was Staphylococcus saccharolyticus, a relatively unstudied species. A search of skin metagenomic datasets detected sequences identical to the genome of S. saccharolyticus in diverse skin sites, including the back, forehead, and elbow pit. Although described as a slow-growing anaerobic species, a re-evaluation of its growth behavior showed that S. saccharolyticus can grow under oxic conditions, and, in particular, in a CO2-rich atmosphere. We argue here that S. saccharolyticus was largely overlooked in previous culture-dependent and -independent studies, due to its requirement for fastidious growth conditions and the lack of reference genome sequences, respectively. Future studies are needed to unravel the microbiology and host-interacting properties of S. saccharolyticus and its role as a prevalent skin colonizer.

Legal Implication of Nerve Injuries Induced by Phlebotomy

Although venipuncture is ordinarily a routine, low-risk procedure, and injuries to the peripheral nerves that cross the cubital fossa have rarely been reported, they are sometimes the subject of compensation claims from patients who complain of having suffered this type of damage. There is no lack of judgements in civil law in which the resulting outcomes are contested, for example the positioning of a cannula needle, inter alia without informing the patient of potential risks (Court of Cassino, Judgement 09/08/2016). A dated Supreme Court judgement (No. 32553 of 25/08/2005) already observed that taking blood samples from the vein, albeit a routine practice, is nonetheless an invasive procedure which can cause the patient harm if not performed by professionally prepared practitioners and following precise techniques and methodologies.

Skin flora and bacterial contamination of diversion pouch and recovered platelet components in Moroccan blood donors.

The objective of this study was to evaluate bacterial reduction procedures used during whole-blood donations in Morocco. Bacterial contamination still poses serious challenges to blood safety, especially in countries with limited resources. In the first part of this study, we analysed 233 swab samples taken from blood donors' antecubital fossa. After donation, a second batch of samples was analysed from the diversion pouches of corresponding donors. In addition, we searched for the prevalence of bacterial contamination in 568 randomly chosen platelet components at their expiration date in order to control for the entire blood unit preparation process. The most frequently found bacterial species at the antecubital fossa of healthy blood donors were coagulase-negative Staphylococcus, aerophilic Corynebacterium, Staphylococcus aureus, Bacillus sp. and Micrococcus sp. After donation, 5.15% of the diversion pouches were contaminated with bacterial species, the most notable being Bacillus sp., aerophilic Corynebacterium, coagulase-negative Staphylococcus, Staphylococcus aureus and Pseudomonas aeruginosa. Of 568 platelet components, 18 were contaminated with three bacterial species: Bacillus sp., coagulase-negative Staphylococcus and Staphylococcus aureus. All three bacterial species found in platelet components were detected on the skin of blood donors. Serious measures need to be taken and enforced to ensure blood safety.

Radial motor nerve conduction studies in the upper arm.

The main goal of this study was to determine the contribution of the anterior forearm muscles to the compound muscle action potential (CMAP) recorded from the extensor digitorum (ED) after proximal stimulation. Twenty-one healthy volunteers and 114 patients with compressive and traumatic radial neuropathies were examined. Stimulation was carried out at six different points: distal third of the upper arm; Erb's point; axilla; medial upper arm; antecubital fossa; and ulnar groove. In the control group, Erb's CMAP area was significantly greater than the distal CMAP area. In compressive neuropathy, there was conduction block, but no change in conduction velocity. There were no differences in Erb's CMAP latencies between the control group and the neuropathies group. CMAPs recorded over the ED with stimulation at the brachial plexus represent the sum of the motor unit action potentials of the posterior and anterior forearm muscles.

The practical integration of a hybrid model of ultrasound-guided peripheral venous access in a large apheresis center.

Apheresis treatments require adequate venous access using peripheral intravenous (PIV) catheterization or central venous catheters (CVC). Ultrasound-guided PIV (USGPIV) can be used to decrease the need of CVC insertions for apheresis procedures. A hybrid model of USGPIV and standard of care (SOC) for PIV access was developed. Nurses performed USGPIV on all patients considered for PIV access if felt SOC PIV access was not possible. Information was collected regarding nurses' confidence with access, number of attempts required, site of access, complications, and need for CVC. In all, 226 PIV access attempts were made during a 2-month period. All apheresis procedure types were represented. A total 65% were accessed by SOC and 35% by USGPIV. USGPIV was successful on first try on 90% draw/inlet access and 87% successful on first try on return access. Access above the antecubital fossa was required in 31% of USGPIV for draw/inlet veins, and 22% of return veins. Nurses' confidence with accessing PIV was increased by USGPIV, based on 7-point Likert scale assessments. During the recording period, 2/226 (0.9%) apheresis procedures required a CVC. In a separate cohort of only hematopoietic progenitor cell collections, CVC insertion was required in 44/238 (18.5%) patients, in 7 months prior to adoption of USGPIV and 5/152 (3.3%) patients in 7 months following adoption of USGPIV. A hybrid model of using SOC and USGPIV for PIV access for apheresis procedures resulted in decreased need for CVC access, high levels of successful initial access attempts, and increased nursing confidence in PIV access.

Longitudinal Analysis of Serum Biochemical Changes following Anterior Cruciate Ligament Injury and Reconstruction: A Matched Comparison-Control Analysis

Objectives:Individuals with an anterior cruciate ligament (ACL) injury are at high risk of developing posttraumatic osteoarthritis (PTOA). A comprehensive study is needed to determine the time course of joint tissue metabolic changes occurring following ACL injury and reconstruction (ACLR). The purpose of this longitudinal nested comparison-control study was to simultaneously evaluate serum biomarkers of inflammation and cartilage matrix damage in ACL injured patients prior to ACLR and 6 and 12 months post-ACLR, as well as in matched uninjured controls.Methods:Serum was collected from 34 ACL injured individuals (53% female, 20.7±2.4 years old, 24.2±4.1 body mass index [BMI]) within 14 days of primary ACL injury (baseline), as well as at 6 and 12 months following bone-patellar-tendon-bone autograft ACLR. Serum was also collected from 34 uninjured matched controls (53% Female, 20.5±2.4 years old, 24.1±3.5 BMI) at a single timepoint. Blood was collected from the antecubital fossa, centrifuged and stored at -80°C prior to batch analysis. Commercial enzyme-linked immunosorbent assays were used to evaluate concentrations of: 1) a pro-inflammatory cytokine [Monocyte Chemoattractant Protein; MCP-1]; 2) a matrix degrading enzyme [matrix metalloproteinase-3; MMP-3]; 3) a cartilage breakdown biomarker [cartilage oligomeric matrix protein; COMP]; and type-II collagen turnover [type-II collagen cleavage: synthesis; C2C:CPII]. Separate Bonferroni-corrected independent t-tests were used to determine differences between the ACL injured group at each timepoint and uninjured controls for each biomarker (P ≤ 0.015). Similarly, separate Bonferroni-corrected dependent t-tests were used to determine differences in biomarker concentrations over time for the ACLR group.Results:Serum concentrations of MCP-1 and COMP were greater in the ACL injured individuals at all timepoints compared to the controls (P ≤ 0.015, Table 1), yet no differences were found over time in the ACL injured group. MMP-3 concentrations increased between baseline and 6 months post-ACLR (P ≤ 0.015, see Table), yet no differences were found between 6 and 12 months post-ACLR, between baseline and 12 months, or between ACLR and controls at any of the time points. C2C:CPII was not different between ACL injured individuals and controls at baseline or 6 months post-ACLR. C2C:CPII was significantly increased between 6 and 12 months-post ACLR, and was found to be greater than baseline and greater than controls at 12 months post-ACLR (P ≤ 0.015, see Table).Conclusion:Our study is critical in demonstrating the time course of multiple joint tissue metabolic changes following ACL injury and ACLR. Elevated serum MCP-1 and COMP concentrations, linked to early deleterious metabolic processes associated with PTOA development, are evident soon after ACL injury and persist at 12 months post-ACLR. Serum MMP-3 concentrations were elevated 6 months post-ACLR compared to the baseline measurements, suggesting factors occurring after ACLR initiate upregulation of matrix degrading enzymes. Furthermore, elevated C2C:CPII occurs within the first 12 months post ACLR but not until after the 6-month post-ACLR timepoint. Further studies are needed to determine how long these joint tissue metabolic changes persist after ACL injury and ACLR, as well as how joint tissue metabolism is affected by the type and timing of different surgical and nonsurgical treatments.

A Practical Measure Of Endothelial Function Applicable To The Routine Clinical Setting?

BACKGROUND: The VENDYS-II is an alternative, fully automated and noninvasive methodology to evaluate endothelial function using temperature change on finger as a surrogate measure of the magnitude of vascular reactivity index (VRI). Due to the simplicity, it could provide more feasible technique to assess vascular endothelial function in the clinical setting. A most recent modification to the technique includes the application of occlusion cuff at the base of a finger. PURPOSE: To assess the validity of the VENDYS-II device compared with the standard flow-mediated dilation (FMD) protocol. METHODS: Twelve participants (7 males; 37±16 years) varying widely in age, health, ethnic, and socioeconomic status were studied. Occlusion cuff was placed over the right antecubital fossa or at the base of the right index finger. Temperature monitors were placed on bilateral index fingers to assess change in temperature throughout 5-minute occlusion and recovery phases. FMD was obtained simultaneously using high-resolution ultrasound. RESULTS: Mean brachial artery FMD was 7.2±2.6%. Measures of VRI obtained with the upper arm occlusion were significantly associated with simultaneously obtained brachial artery FMD (r=0.73). VRI values obtained with the finger occlusion (1.6±0.4AU) were not significantly different from VRI measured with the brachial artery occlusion (1.7±0.3AU), and both VRI values were moderately correlated with each other (r=0.50). CONCLUSION: Finger-based VRI may be a valid and novel alternative measure of endothelial function that is more suitable than the standard FMD for the assessment of endothelial function in the routine clinical setting.

Elbow Pain - CrossFit

HISTORY: A 29-year-old male CrossFit and surfing instructor with a history of left ulnar shaft fracture treated nonoperatively presented with a 9 month duration of chronic, intermittent, left, sharp and burning elbow pain since injuring himself weight lifting. Bicep flexion and thumb rotation caused pain radiating to the elbow. He endorsed numbness of the left hand that led to an ER visit 9 months ago. His tingling resolved prior to our visit and he denied shoulder or neck pain. He has been seen previously by a Hand Specialist, was offered a steroid injection, and presented to us for further evaluation. PHYSICAL EXAMINATION: The patient exhibited no obvious atrophy of the forearm, but trace atrophy at the left medial triceps. He had full flexion and extension equal bilaterally, with slightly decreased supination on the left as compared to the right side. He was tender to palpation over the distal biceps, but nontender in the antecubital fossa. There was mild crepitus with resisted supination and pronation on the lateral epicondylar region. Radial head was minimally tender to palpation. He had elbow pain with resisted elbow flexion in neutral and supination more so than pronation. No skin changes were appreciated and no obvious elbow effusion. Distal neurovascular exam was grossly intact. DIFFERENTIAL DIAGNOSIS: 1. Distal biceps tear 2. Bicipitoradial bursitis 3. Ulnar shaft fracture 4. Radial head fracture 5. Osteochondritis dissecans of the capitulum TEST AND RESULTS: Elbow MR arthrogram (obtained 3 weeks ago) demonstrated a very small partial thickness tear of the ulnar collateral ligament, minimal radial cartilage loss, and a partial thickness tear of the distal biceps with prominent bicipitoradial bursitis. FINAL/WORKING DIAGNOSIS: Left partial thickness distal biceps tear AND associated bicipitoradial bursitis TREATMENT AND OUTCOMES: 1. Patient elected to avoid steroid injections and pursue conservative management involving physical therapy and topical NSAIDs 2. Pain continued intermittently. Further work up 1 year later included CT elbow showing mild left ulnohumeral joint osteoarthritis with small ossific joint loose bodies and healed proximal left ulna shaft and coronoid process fractures 3. Elbow pain may be subsequent to malalignment from an old Monteggia fracture

035 Biogeographical differences in gene segment usage

Biogeography is known to shape the human skin metagenome, which in turn, helps to shape the adaptive immune system. Clearly, immune-mediated diseases (e.g. hidradenitis, lichen planus, atopic dermatitis, psoriasis, palmoplantar psoriasis/pustulosis) have predilections for specific anatomical sites (axillae, groin, and inguinal folds; dorsal hands, volar wrists, anterior lower legs and oral mucosa; antecubital fossa and popliteal fossa; elbows and knees; and palms and soles; respectively). A better understanding of how immune composition and function differs by anatomic location remains a major gap in our understanding of skin immunology.

Long peripheral catheters for intravenous access in adults and children: A systematic review of the literature.

Long peripheral catheters are peripheral intravenous catheters of 6-15 cm in length. They are commonly inserted into the forearm, antecubital fossa or upper arm using a direct Seldinger technique. They have proven to be valuable for peripheral intravenous catheters, particularly in patients with difficult intravenous access. We conducted a systematic review of studies reporting the use of long peripheral catheters. The following keywords were used: 'long', 'Seldinger', 'guidewire', 'peripheral', 'venous', 'intravenous', 'IV', 'vascular', 'cannula' and 'catheter'. Three hundred forty-one publications were identified; 16 were included in the systematic review. There were 11 adult studies and 5 paediatric studies documenting 1288 long peripheral catheters in 1271 patients. Majority of studies (12/16) were conducted in acute care settings, (emergency department, n = 6; intensive care unit, n = 3; high dependency unit, n = 1; surgical unit, n = 2). The most frequently studied long peripheral catheter was 8 cm in length and 20 G in size. Nine studies recruited patients with difficult intravenous access; 11 studies used ultrasound guidance. Insertion success rate and mean procedural time ranged between 86% and 100% and 8 and 16.8 minutes, respectively. Average catheter duration ranged between 4 and 14.7 days (mean) and 1.1 and 9 days (median). Catheter failure occurred in 4.3-52.5% of long peripheral catheters, with leakage, infiltration and dislodgement being the most frequent causes of failure. In 3 randomised controlled trials, long peripheral catheters outperformed peripheral intravenous catheters in terms of duration and failure rate. Long peripheral catheters are safe and reliable in both adults and children. In addition, long peripheral catheters may provide improved quality of care over peripheral intravenous catheters for multi-day intravenous therapy.

Estudio de cohortes prospectivo sobre el manejo y las complicaciones del catéter venoso periférico en pacientes ingresados en Medicina Interna

ObjectiveTo analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. Patients and methodsWe conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. ResultsWe monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (P<.001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (P<.001), and the rate for transparent dressing was 2.1 and 11.5 (P<.001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). ConclusionsCompliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.

Ulnar artery: A case report of high origin and superficial course

Blood vessel variety of the upper appendage are normal and these can be of impressive enthusiasm to orthopedic surgeons, radiologists and anatomists. During routine dissection for college understudies of the right upper limb in a male cadaver, a variation starting point of ulnar artery from brachial artery was taken note. The brachial artery ending in the cubital fossa by partitioning into radial and ulnar or interosseous supply routes. The outspread artery had taken typical course and branches. Different divisions was the basic interosseous artery, anterior and posterior ulnar recurrent arteries demonstrated ordinary course.The irregular high source of ulnar artery route from the brachial artery was seen which was taking root from medial side of the brachial artery higher than the radial artery, running on the shallow muscles and going underneath the Palmaris longus tendon and intersection the tendon from lateral to medial side. At that point its running shallow to the muscles which were taking cause from the regular flexor source from the humerus and it was secured by the profound belt of the forearm arm, at that point it crosses the flexor retinaculum and partook in the formation of the superficial palmar arch. During its course, supply route didn't give any branch.

Comparing the Potential for Irritation of a Ceramide-Based Moisturizer with a Urea-Based Moisturizer for Pediatric Atopic Dermatitis.

IntroductionMoisturizers are one of the mainstays of the topical treatment of atopic dermatitis (AD). One of the adverse effects of moisturizers is skin irritation, especially on excoriated AD skin. We compared the potential for irritation of two commercially available moisturizer products for the treatment of AD: a ceramide-based moisturizer (Ceradan® Cream; Hyphens Pharma Pte Ltd, Singapore) and a urea 5% moisturizer (Aqurea Lite Cream; ICA Pharma Pte Ltd, Singapore).MethodsWe performed a prospective single-blind randomized controlled study recruiting AD patients aged between 8 and 16 years with symmetrical or near symmetrical scratch marks (excoriations) of at least grade 2 to 3 severity score, according to the Eczema Area and Severity Index (EASI), over bilateral antecubital fossae. Subjects were randomized to receive the ceramide-based moisturizer to either the left or right antecubital fossa or urea 5% cream to the other antecubital fossa. Subjects were asked to grade the immediate skin irritation of both creams on a standard visual analogue scale (VAS) and which cream they would prefer to use as a daily moisturizer. Primary outcome was the mean irritant score of each cream, and secondary outcome was the subjects’ preference of either cream as their daily moisturizer.ResultsA total of 42 participants were enrolled with a mean age of 11 years 5 months. The ceramide-based cream had a significantly lower mean VAS score (mean 0.69, SD = 1.63) for irritation compared with urea 5% cream (1.43, SD = 1.64) (p = 0.035). More participants also preferred the ceramide-based cream over urea 5% cream (62% versus 38%) as their daily moisturizer, but this did not reach statistical significance (p = 0.164).ConclusionsA ceramide-based moisturizer may be considered as a suitable choice for children to minimize irritation from moisturizer treatment for AD.

Comparison of the effectiveness of circumferential versus non-circumferential spread in median and ulnar nerve blocks. A double-blind randomized clinical trial

Background and objectivesCircumferential (C) spread of local anesthetic around the nerve is recommended for a successful nerve block. We tested the hypothesis that C spread produces a more complete block...

Clinical effectiveness of simultaneous reconstructions of multiple joint scar contracture deformity of limb

Objective: To explore the clinical effects of simultaneous reconstruction of multiple joint scar contracture deformity of limb. Methods: From January 2010 to June 2018, 24 patients with multiple joint scar contracture deformity of the same limb were reconstructed in simultaneous operations in Xiangya Hospital of Central South University, including 16 males and 8 females, aged 3-42 years, with 15 patients having deformities in the upper limbs and 9 patients having deformities in the lower limbs. One operation was performed to repair contracture deformity of axillary fossa and elbow in 3 patients, cubital fossa and palmar of wrist in 4 patients, cubital fossa and hand in 5 patients, palmar of wrist, palm, and palmar of finger in 3 patients, groin and medial knee in 2 patients, popliteal fossa and posterior ankle in 1 patient, and anterior ankle and dorsum of foot in 6 patients. After the release of various joint scar contractures, the area of skin defect was 140 to 580 cm(2). Autologous full-thickness skin grafts were used in 7 patients, autologous medium-thickness skin grafts were used in 4 patients, autologous full-thickness skin grafts combined with local skin flaps were used in 9 patients, and allogeneic acellular dermal matrix and autologous thin skin grafts were used in 4 patients. Comprehensive measures for rehabilitation were taken and the survival of the skin graft was observed after operation. Six months to eight years after the operation, all the patients were followed up for the functions of the affected limbs, among which the functions of the upper limbs were evaluated according to the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. The joint mobility, walking, and squatting function of lower extremity were examined after operation. Recurrence of contractures in all the affected limbs and reoperation were recorded. Results: The grafts survived after operation in 22 patients. Two patients had necrosis in small full-thickness skin area, of which one was healed by skin grafting after debridement, and the other one was healed after dressing changes. The deformity of scar contracture at each repaired joint was completely or partially corrected. During a follow-up for 6 to 96 months, the upper limb functions of 15 patients were rated excellent in 12 patients and good in 3 patients. Among the 9 patients of lower limb scar contractures, except for one 3-year-old child who experienced recurrence of medial knee scar contracture and underwent surgical release and skin grafting 5 years later, the remaining 8 patients basically recovered normal joint functions with pretty good outcomes. Conclusions: For continuous scar contracture deformity of multiple joints of the same limb, simultaneous surgical release and skin grafting can reduce operation frequency and obtain better outcomes of surgical operation.

Skin Temperature Response to a 1 km Swim Performed in Normal and Cold‐Water

Cold‐water swimming is a recreational activity that may become a future Winter Olympic event. However, unintentional cold‐water exposure can lead to hypothermia or death. Changes in body temperature are known to diminish swimming performance in persons experiencing hypothermia, although thermal changes during recreational exposure are not well characterized. This study examined skin temperature responses to a one‐kilometer swim in normal and cold‐water. Competitive swimmers (2 male and 2 female; age 44±17 years; BMI 24±2) completed a one‐kilometer swim (22 laps × 75 foot lengths) under free‐living indoor (25.5°C water and 25.0°C air) and cold outdoor (10.9°C water and 6.5°C) conditions. Skin temperature was determined with a digital infrared camera on the center of right palm, cubital fossa of arm, lateral aspect of pectoral muscle, cheek, and average of the four locations at 8.7±1.7 minutes before the swim (pre), then 0.6±0.2 and 6.4±2.1 minutes after the swim. Data (mean±SD) was analyzed with repeated measures ANOVA with significance if P&lt;0.05. Swimmers completed the indoor and outdoor swim events in 20.7±1.7 and 21.8±1.1 minutes respectively. Average indoor skin temperature at −8.7, +0.6 and +6.4 minutes was 94.0±1.7, 85.3±1.9, and 88.1±2.2°C. Average outdoor skin temperature at −8.7, +0.6 and +6.4 minutes was 83.0±3.6, 53.5±2.3, and 67.7±2.0°C. At all times average outdoor skin temperature was lower than indoor, with the lowest temperature 0.6 minutes post‐swim. Palm indoor temperature at −8.7, +0.6 and +6.4 minutes was 91.6±3.9, 83.1±0.5, and 87.3±5.0°C. Palm outdoor temperature at −8.7, +0.6 and +6.4 minutes was 75.1±7.9, 47.4±2.7, and 58.1±2.7°C. At all times outdoor palm temperature was lower than indoor, with the lowest temperature 0.6 minutes post‐swim. Similar thermal responses were observed in the cheek, cubital fossa and pectoral locations. While time to complete the indoor and outdoor one km swims were similar, swimming in cold water was associated with delayed rewarming in the palm and cheek relative to cubital fossa and pectoral muscle.