Traumatic Soft Tissue Injuries Research Articles

Exploring the success of fasciocutaneous flap techniques in treating distal leg injuries, a Sub-Saharan African experience from Sudan

BackgroundSoft tissue and bone injuries in the lower extremities associated with high-energy trauma remain a formidable challenge to treat. The timing of the operation, the most suitable type of tissue, and the decision between local or free flap coverage remain under discussion. MethodThis prospective, cohort, multi-center study was conducted in Khartoum, Sudan, from April 2021–September 2021. The study included 70 patients. Data was collected using a questionnaire filled with patients after getting informed consent. ResultsMales were 53(75.7 %) and females were 17(24.3 %). Male to female ratio was 3.1: 1. The mean age of the patients was 27.2 ± 3.4 years. The indications for the use of fascia-cutaneous flap in the management of traumatic soft tissue injuries of distal legs were distal substance loss areas of the leg 55(78.6 %), bone exposure 60(85.7 %), open fracture 29(41.4 %), and tendon exposure 31(44.3 %). The type of fasciocutaneous flap used for the patients in this study was perineal artery flap in 20(28.6 %), sural flap in 19(27.1 %), anterior tibial artery perforator flap in 18(25.7 %), and posterior tibial perforator flap in 13(18.6 %) of the patients in 42(60 %) of the patients, no complications were reported. The reported complications were infection 16(5.7 %), distal flap necrosis 8(11.4 %) and total loss 4(5.7 %). ConclusionDespite advances in microsurgery and free flap use, a fascia-cutaneous flap is still a valid option for distal leg soft tissue reconstruction in settings where this service is unavailable. fasciocutaneous flaps are an excellent option for distal leg defects to cover soft-tissue defects, exposed bones, and tendons.

Multi Targeted Non Invasive Photoceutical Therapeutic Approach for Combat and Traumatic Soft Tissue Injuries

Combat and soft tissue traumatic injuries pose unique challenges in terms of their severity, complexity, and thus need for the exploration of rapid, novel therapeutic interventions. Traditionally, combat injuries have been managed through invasive surgical procedures associated with potential complications and prolonged recovery times. However, advancements in non-invasive treatment modalities have opened up new possibilities for managing combat injuries more effectively and efficiently. The present article aims to provide a comprehensive overview of non-invasive, drug-free, biophysical therapeutic approaches for combat and external traumatic injuries, focusing on their benefits, efficacy, and potential applications. The non-invasive nature and favourable safety profile of photobiomodulation therapy (PBMT) make it an attractive option for combat injury management. The evidence on underlying mechanistic insights supports the efficacy of PBMT in promoting tissue repair, reducing pain, inflammation, oxidative stress, and facilitating functional recovery. In conclusion, the present review highlights the significant potential of non-invasive PBMT using dual/multi-wavelength light energy as a valuable therapeutic approach for traumatic soft tissue and combat injuries and extensively explores associated mechanistic insights. Further research on combination therapies using potential pharmacological agents in conjunction with PBMT, with optimal irradiation protocols and other energy-based healing modalities will favour the translation of potential non-invasive healing intervention for combat and traumatic injuries in clinical applications.

The Need To Address Skin Pathologies Amidst Flooding Crisis In Pakistan.

Madam, As the monsoon approached, Pakistan was ravaged by extreme rainfalls and deadly flooding which affected 33 million people, including 16 million children. (1) With this disaster came a horde of water- borne diseases. The officials recorded over 600,000 people reporting to the relief camps with illnesses, including gastroenteritis, skin infections, acute respiratory infection, cases of malaria, and bites ranging from insects to dogs. (2) Among these diseases, skin pathologies are the second most common complaint reported by the flood- affected population and even though they might be the second most common cause of morbidity; small wounds, lacerations, punctures and skin infections resulting from them are the first to appear in the impact phase after any hydrologic disaster, including floods, rendering it crucial to address skin related pathologies as a priority. (3) Skin diseases may not seem important, with malnutrition, gastroenteritis, malaria and dengue looming in the relief camps, Still the lack of attention can lead to disastrous effects ranging from atypical bacteria like vibrio vulnificus and mycobacterium marinum causing skin infections, infestations with scabies to necrotising soft tissue infection (NSTI) complicating traumatic soft tissue injuries (3.4). This significantly increases the burden of diseases and puts great stress on the already crippled healthcare system in the affected areas and also leads to increase suffering which could easily be avoided by timely precautions and preventative measures taken to decrease the burden.  Unfortunately, this isn’t the first time Pakistan has been dealing with the aftermath of a hydrologic disaster. In 2010, Pakistan faced a flood crisis resulting in 1600 deaths and 143,780 skin infections as the third most common cause of illness. (5) The numbers of infections aren’t different from the ones being reported in the recent monsoon floods. This warrants an imminent need to develop a flood response system to reduce the risk of dermatological diseases, tailored to the risk and population of the area. Health awareness programs to educate the masses about practicing good hygiene, making use of sunshine to deal with diseases like scabies which are rampant in the camps, and active involvement of community workers with basic first aid kit to treat minor cuts, lacerations could significantly reduce the morbidity and mortality associated with these conditions. ---Continue

The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region.

The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. Eight patients (mean age 55.8y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9cm 2 (range 17-85cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90d). Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.

EFFECTIVENESS OF SILICONE MATERIALS IN PREVENTING PATHOLOGICAL SCARS IN MAXILLO-FACIAL AREA

Pathological scars are not only an integral medical and aesthetic problem nowadays, but also serious functional and aesthetic consequences of traumatic and surgical wounds. The purpose of our study is to determine the effectiveness of silicone-based materials in wound healing and the prevention of scar tissue formation. The study was conducted at the Department of Maxillofacial Surgery, the Lviv Regional Clinical Hospital. Twenty patients (10 men and 10 women) with traumatic soft tissue injuries in the maxillofacial area participated in the study were divided into two groups of 10 patients each. The first experimental group received a silicone-based patch after suturing the wound, while the patients of the second clinical (control) group were operated on according to standard techniques without additional methods of scar prevention. The nature of the scars was assessed according to the modern scale for evaluating scarred tissues developed and implemented at the Poltava State Medical University. The analysis was carried out using seven indicators for different periods of the observation (on the 120th and 240th day of the clinical study).
 On the 240th day of the clinical study, the patients of the first group showed moderate hyperemia in 30% of cases, close to intact skin in 70%, moderate pigmentation in 20%, and isopigmentation in 80%. The scar raised above the skin surface in 20.0% (2 patients) of cases for 1-2 mm, while in the rest, 8 people, the scar raised less than 1 mm. Uniform raising of the scar was observed in 30.0% of cases (3 patients), while the surface was close to intact skin in 70.0% of cases (7 people). 20.0% of cases (2 patients) had a moderately compacted scar, while in 80.0% of cases (8 patients), the scares were assessed as mildly elastic, and only 1 patient complained of mild discomfort (itching). Other participants had no complaints. Non of patients in the first group complained of pain.
 On the 240th day of the clinical study, the second control group exhibited the following indicators: moderate hyperemia in 70.0% of cases (7 patients) and normal vascularization in 30.0% of cases (3 individuals). Hypopigmentation was observed in 60.0% (6 cases) and isopigmentation in 40.0% of cases (4 patients). The height of the scar above the skin surface was 1-2 mm in 60.0% of cases (6 patients) and less than 1 mm in the remaining 40.0% of cases (4 patients). A uniform increase in scar size was noted in 70.0% of cases (7 cases), while the surface was similar to that of intact skin in 30.0% of cases (3 individuals). Moderately thickened scars were observed in 50.0% of cases (5 patients) and pronounced induration of soft tissues in the other 50.0% of cases (5patients). Regarding subjective sensations, 70.0% (7 patients) had no complaints, 30.0% of cases (3 patients) experienced slight discomfort, and 10.0% (1 patient) reported mild pain, while the remaining 90.0% (9 individuals) had no complaints.
 Comparing the results of the clinical study on the 240th, the first study group's performance was better and 77.0% lower compared to the second control group. This allows us to suggest that the use of silicone gel after the wound closure, compared to the standard method, promotes the wound healing process and reduces the risk of pathological scarring.

Effects of multiwavelength photobiomodulation for the treatment of traumatic soft tissue injuries associated with bone fractures: A double-blind, randomized controlled clinical trial.

This study evaluated the efficacy and safety of multiwavelength photobiomodulation (MPBM) in healing soft tissue injuries associated with tibial and/or ankle fractures. Participants were randomized into the MPBM or control group. Primary outcome was wound healing, measured by the Bates-Jensen scale. Assessments were performed daily. Twenty-seven hospitalized adults were included. MPBM showed an improvement in the daily mean Bates-Jensen scale (MPBM 32.1 vs. control 34.2; p=0.029), daily mean pain score change (MPBM 0.5 vs. control 0.2; p=0.04) and occurrence of infection at the site of the external fixator pins (MPBM 15.3% vs. control 57.1%; p=0.02). MPBM group also showed faster-wound resolution (MPBM 13.1 vs. control 23.1 days). Subgroup analysis showed improvement in the MPBM group among less severe patients on the Bates-Jensen scale (MPBM 27.4 vs. control 34.7; p=0.0081) and mean time for wound resolution (MPBM 7.0 vs. control 14.6 days; p=0.03). MPBM appears safe and effective in reducing wound resolution time, infection in the surgical pin sites, reported pain and time before definitive surgery.

Role of High Resolution Ultrasound and Magnetic Resonance Imaging in Traumatic Soft Tissue Injuries of the Wrist and Hand

Abstract Aim of the Work To assess the role of ultrasound in the diagnosis of traumatic soft tissue injuries of hand and wrist. Patients and Method This study includes 30 patients with a mean age of 42.17 years ±9, all with history of traumatic soft tissue injuries in hand and wrist, all patients underwent ultrasound and MRI. The U/S&MRI diagnostic criteria of each patient were analyzed, compared and correlated with clinical diagnosis/ or operative findings . Results A comparison of the sensitivity of US versus MRI was done by correlating the final diagnosis of each modality with clinical diagnosis and/or operative findings. In general as regard all types of soft tissue injuries we found that, in correlation with clinical diagnosis US gives (93.3% sensitivity), while MRI gives (73.3% sensitivity). US & MRI result shows agreement in detection of all types of post traumatic soft tissue injuries except in chronic tendinopathy, tendon fibrosis ,and chronic tendon tear heals by fibrosis we found no agreement between them (in which ultrasound can diagnose them, while MRI couldn’t detect them). Conclusion Ultrasound shows higher sensitivity in diagnosis of soft tissue injuries of hand and wrist than MRI, as compared to operative findings and /or clinical data.

Management of Traumatic Soft Tissue Injuries of the Face.

Facial soft tissue injuries encompass a broad spectrum of presentations and often present significant challenges to the craniofacial surgeon. A thorough and systematic approach to these patients is critical to ensure that the patient is stabilized, other injuries identified, and the full extent of the injuries are assessed. Initial management focuses on wound cleaning with irrigation, hemostasis, and debridement of nonviable tissue. Definitive management is dependent on the region of the face involved with special considerations for critical structures such as the globe, lacrimal apparatus, facial nerve, and parotid duct. Following sound surgical principles, these injuries can be managed to maximize both functional and aesthetic outcomes while minimizing complications.

Surgical outcome of tibial condyle fracture with MIPPO technique

Background: Tibial condylar fractures are very common in road traffic accidents; however, sports injury, fall and other trivial trauma can frequently produce these fractures. These are unstable fractures and quite challenging to manage. This study was undertaken to evaluate locking compression plate (LCP) fixation in proximal intra articular tibia fractures by MIPPO (minimally invasive percutaneous plate osteosynthesis) technique. Materials and Methods: The study was conducted from 0ctober 2016 to 2018. 20 cases who had sustained tibial plateau fractures (Schatzker type 1- VI) and operated with LCP fixation using MIPPO technique were included in this study after obtaining informed consent. Follow-up was done at 6 weeks, 12 weeks, 18 weeks and 24 weeks after the surgery and they were evaluated in accordance with modified Rasmussen knee scoring system. Results: Modified Rasmussen functional knee scoring system and modified Rasmussen criteria for radiological assessment was used to analyse the functional outcome among the cases. After evaluation it was observed that 90% of the patients had good to excellent performance. Conclusion: MIPPO technique enables soft tissue stripping via a small surgical incision and provides a rigid fracture reduction. There is also a reduced chance of post traumatic soft tissue injury. Proximal Tibial locking plate is a good device to stabilize the fractures of Tibial plateau (intra articular), especially when used in conjunction with meticulous intraoperative handling of the soft tissues and active participation of the patients in the rehabilitation programme is ensured. Keywords: Proximal tibia, MIPPO, Intra – articular, Tibia plateau, Locking compression plate.

Extracellular matrix grafts: From preparation to application (Review).

Recently, the increasing emergency of traffic accidents and the unsatisfactory outcome of surgical intervention are driving research to seek a novel technology to repair traumatic soft tissue injury. From this perspective, decellularized matrix grafts (ECM-G) including natural ECM materials, and their prepared hydrogels and bioscaffolds, have emerged as possible alternatives for tissue engineering and regenerative medicine. Over the past decades, several physical and chemical decellularization methods have been used extensively to deal with different tissues/organs in an attempt to carefully remove cellular antigens while maintaining the non-immunogenic ECM components. It is anticipated that when the decellularized biomaterials are seeded with cells in vitro or incorporated into irregularly shaped defects in vivo, they can provide the appropriate biomechanical and biochemical conditions for directing cell behavior and tissue remodeling. The aim of this review is to first summarize the characteristics of ECM-G and describe their major decellularization methods from different sources, followed by analysis of how the bioactive factors and undesired residual cellular compositions influence the biologic function and host tissue response following implantation. Lastly, we also provide an overview of the in vivoapplication of ECM-G in facilitating tissue repair and remodeling.

Morel-lavallee lesion – a Hidden degloving injury

Morel-Lavallee lesion is a rare post traumatic soft tissue injury. It results in separation of the skin and subcutaneous tissue from the underlying fascia. An underlying blood filled cystic cavity is created. It is commonly causedby a shearing force resulting in separation of the hypodermis from the deeper fascia. It is most commonly seen around the greater trochanter. These injuries also occur at the flanks, buttocks, lumbar spine, scapula and the knee. Separation of the tissue planes result in a complex serosanguinous fluid collection with areas of fat within it. These lesions are usually missed during initial examination and become evident after few weeks or months. They may be associated with fractures. Magnetic resonance imaging is the modality of choice for the evaluation of this lesion. It plays a significant role in its diagnosis. Keywords: Morel-Lavallee lesion; post traumatc injury; hidden injury

Review of Cross-Leg Flaps in Reconstruction of Posttraumatic Lower Extremity Wounds in a Microsurgical Unit.

Since the advent of microsurgery, and expanding expertise in the field, extensive traumatic wounds of leg have been managed successfully with free tissue transfer. Various patient-related factors may preclude the use of free flaps even in units with available expertise and infrastructure. It is in such situations that the “cross-leg flap” comes into play. In these cases, instead of attempting complicated anastomotic techniques or anastomosis in the zone of trauma, it is better to perform the simpler and more reliable cross-leg flap. In this study, we try to show the utility of a cross-leg flap based on a retrospective study of 198 patients who underwent cross-leg flap in our institute over a period of 15 years extending from November 2003 to March 2018. Materials and methods: Case sheets of all patients who underwent cross-leg flap from November 2003 to March 2018 were reviewed. The location of defect in the leg, the indication for cross-leg flap, the pattern of cross-leg flap, and perioperative complications were noted. Results: A total of 198 patients underwent cross-leg flap for traumatic soft tissue injury of leg during this period. The most common reason for performing cross-leg flap was poor pulsatility of the recipient artery as seen intraoperatively, followed by the economics of the procedure wherein the initial cost of free flap was found significantly higher compared with cross-leg flap. All flaps survived with partial necrosis occurring in 23 patients. All flaps settled well by 2 years’ time. Bony union/fracture healing evaluation was not a part of this study. Conclusion: Cross-leg flap is still a useful tool for leg wound coverage even in microsurgical unit in situations precluding free flap coverage.

Percutaneous direct current stimulation - a new electroceutical solution for severe neurological pain and soft tissue injuries.

There is a high medical need to improve the effectiveness of the treatment of pain and traumatic soft tissue injuries. In this context, electrostimulating devices have been used with only sporadic success. There is also much evidence of endogenous electrical signals that play key roles in regulating the development and regeneration of many tissues. Transepithelial potential gradients are one source of the direct current (DC) electrical signals that stimulate and guide the migration of inflammatory cells, epithelial cells, fibroblasts and mesenchymal stem cells to achieve effective wound healing. Up to now, this electrophysiological knowledge has not been adequately translated into a clinical treatment. Here, we present a mobile, handheld electroceutical smart device based on a microcontroller, an analog front end and a battery, which generates DC electric fields (EFs), mimicking and modulating the patient’s own physiological electrical signals. The electrical stimulation is applied to percutaneous metal probes, which are located close to the inflamed or injured tissue of the patient. The treatment can be used in an ambulatory or stationary environment. It shows unexpectedly, highly effective treatment for certain severe neurological pain conditions, as well as traumatic soft tissue injuries (muscle/ligament ruptures, joint sprains). Without EF intervention, these conditions, respectively, are either virtually incurable or take several months to heal. We present three cases – severe chronic cluster headache, acute massive muscle rupture of the rectus femoris and an acute ankle sprain with a ruptured anterior talofibular ligament – to demonstrate clinical effectiveness and discuss the fundamental differences between mimicking DC simulation and conventional transcutaneous electric nerve stimulation (TENS) or TENS-like implanted devices as used for peripheral nerve cord, spinal cord or dorsal root stimulation.

Hyperbaric Oxygen Therapy in Plastic Surgery

Objective: In this review the literature aims to familiarize the reader with several of the more common plastic surgery problems and to review the appropriate use of HBO for each condition. Plastic surgery is a broad specialty encompassing a variety of areas including the treatment of traumatic soft tissue injury, burn care, hand surgery, microsurgery and limb replantation, problem wound management, flap reconstruction, cosmetic surgery, and congenital deformity. In recent years an emphasis on less anecdotal and more scientific research has provided a better understanding of the role of hyperbaric oxygen therapy (HBO) for many plastic surgical conditions. Patient selection remains the key to successful outcome. The rationale for HBO treatment of a specific plastic surgery problem should be based on scientific research if possible. If supportive research is not available or applicable to a specific case, then the decision to treat should be based on sound physiological principles.

Efficacy and safety assessment of acute sports-related traumatic soft tissue injuries using a new ibuprofen medicated plaster: results from a randomized controlled clinical trial

ABSTRACTObjective: To investigate the efficacy and safety of a recently developed ibuprofen medicated plaster in the treatment of acute sports impact injuries/contusions.Methods: In this double-blind, multi-center, placebo-controlled, parallel group, phase 3 study (EudraCT Number: 2012–003257-2) patients (n = 132; ages 18 to 60 years) diagnosed with acute sports-related traumatic blunt soft tissue injury/contusion to the upper or lower limbs were randomized to receive either ibuprofen 200 mg plaster (n = 64) or placebo plaster (n = 68). Plasters were administered once daily for five consecutive days. The primary assessment was the area under the curve (AUC) of the visual analogue scale (VAS) of pain on movement (POM) over 0 to 72 h (VAS0-72).Results: The ibuprofen medicated plaster was associated with a reduction in pain on movement (POM) based on lower VAS AUC0-72h (2399.4 mm*h) compared with placebo (4078.9 mm*h) (least squares mean difference: – 1679.5 mm*h; P < 0.0001). The reduction in AUC of POM was also significantly greater for the ibuprofen medicated plaster compared with placebo at 12, 48, 24, and 120 h (P < 0.0001). Algometry/tenderness measurements found that the ibuprofen medicated plaster was associated with greater reduction in tenderness/pain than placebo at each timepoint (P values <0.0001). Seven patients experienced drug-related adverse events (n = 1 [1.6%] for the ibuprofen plaster, and n = 6 [8.8%] for placebo). All drug-related AEs were administration site reactions and were mild in intensity.Conclusions: The results of this study indicate that ibuprofen medicated plaster results in rapid and clinically relevant reduction of pain in patients suffering from blunt musculoskeletal injuries or recurrent pain. The ibuprofen medicated plaster was well tolerated.

A novel facilitated negative-pressure wound therapy for thoracic incision infection after esophagectomy.

Negative-pressure wound therapy (NPWT) is the therapeutic management of traumatic soft-tissue wounds and infections. The efficacy of NPWT in the treatment of thoracic incision infection is unclear. We assess the effectiveness and safety of a novel facilitated NPWT for thoracic incision infection after esophagectomy. Between Jan. 2013 and Mar. 2016, 380 patients underwent open esophagectomy in our department. Forty-five patients with thoracic incision infection were retrospectively reviewed. Of these patients, 25 were treated with NPWT and 20 patients were treated with open wound dressing. The patients' clinical demographic data, postoperative outcomes and wound treatment cost are reviewed. The thoracic incision infection rate was 11.8%. All of the incision infections were cured in the hospital or on an outpatient basis. No allergic reactions or other side effects occurred with NPWT. Although the patients who were treated with NPWT did not have a significantly shorter postoperative hospital stay than those treated with open wound dressing (P=0.092), the use of NPWT therapy for thoracic incision infection led to a shorter wound healing times (13 vs. 20 days; P=0.004) and a lower wound treatment cost (P=0.020). Thoracic incision infection is a common complication of esophagectomy. NPWT is a safe and effective therapeutic management for thoracic incision infection that is associated with shortened wound healing times and reduced wound treatment costs than traditional open wound treatment.

Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study.

Acute traumatic wounds are contaminated with bacteria and therefore an infection risk. Antiseptic wound irrigation before surgical intervention is routinely performed for contaminated wounds. However, a broad variety of different irrigation solutions are in use. The aim of this retrospective, non-randomised, controlled longitudinal cohort study was to assess the preventive effect of four different irrigation solutions before surgical treatment, on wound infection in traumatic soft tissue wounds. Over a period of three decades, the prophylactic application of wound irrigation was studied in patients with contaminated traumatic wounds requiring surgical treatment, with or without primary wound closure. The main outcome measure was development of wound infection. From 1974-1983, either 0.04 % polihexanide (PHMB), 1 % povidone-iodine (PVP-I), 4 % hydrogen peroxide, or undiluted Ringer's solution were concurrently in use. From 1984-1996, only 0.04 % PHMB or 1 % PVP-I were applied. From 1997, 0.04 % PHMB was used until the end of the study period in 2005. The combined rate for superficial and deep wound infection was 1.7 % in the 0.04 % PHMB group (n=3264), 4.8 % in the 1 % PVP-I group (n=2552), 5.9 % in the Ringer's group (n=645), and 11.7 % in the 4 % hydrogen peroxide group (n=643). Compared with all other treatment arms, PHMB showed the highest efficacy in preventing infection in traumatic soft tissue wounds (p<0.001). However, compared with PVP-I, the difference was only significant for superficial infections. The large patient numbers in this study demonstrated a robust superiority of 0.04 % PHMB to prevent infection in traumatic soft tissue wounds. These retrospective results may further provide important information as the basis for power calculations for the urgently needed prospective clinical trials in the evolving field of wound antisepsis.

Injectable Pore-Forming Hydrogel Scaffolds for Complex Wound Tissue Engineering: Designing and Controlling Their Porosity and Mechanical Properties.

Traumatic soft tissue wounds present a significant reconstructive challenge. The adoption of closed-circuit negative pressure wound therapy (NPWT) has enabled surgeons to temporize these wounds before reconstruction. Such systems use porous synthetic foam scaffolds as wound fillers at the interface between the negative pressure system and the wound bed. The idea of using a bespoke porous biomaterial that enhances wound healing, as filler for an NPWT system, is attractive as it circumvents concerns regarding reconstructive delay and the need for dressing changes that are features of the current systems. Porous foam biomaterials are mechanically robust and able to synthesize in situ. Hence, they exhibit potential to fulfill the niche for such a functionalized injectable material. Injectable scaffolds are currently in use for minimally invasive surgery, but the design parameters for large-volume expansive foams remain unclear. Potential platforms include hydrogel systems, (particularly superabsorbent, superporous, and nanocomposite systems), polyurethane-based moisture-cured foams, and high internal phase emulsion polymer systems. The aim of this review is to discuss the design parameters for such future biomaterials and review potential candidate materials for further research into this up and coming field.

Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children

Significance: The costs and morbidity of pediatric traumatic wounds are not well known. The literature lacks a comprehensive review of the volume, management, and outcomes of children sustaining soft tissue injury. We briefly review the existing literature for traumatic wounds such as open fractures and burns. Such injuries require dedicated wound care and we propose a novel approach for more efficient and more effective delivery of dedicated pediatric wound care. Recent Advances: New pediatric literature is emerging regarding the long-term effects of wound care pain in traumatic injuries-especially burns. A variety of wound dressings and alternative management techniques exist and are geared toward reducing wound care pain. Our institution utilizes a unique model to provide adequate sedation and pain control through a dedicated pediatric wound care unit. We believe that this model reduces the cost of wound care by decreasing emergency department and operating room visits as well as hospital length of stay. Critical Issues: First, medical costs related to pediatric traumatic wound care are not insignificant. The need for adequate pain control and sedation in children with complex wounds is traditionally managed with operating room intervention. Afterward, added costs can be from a hospital stay for ongoing acute wound management. Second, morbidities of complex traumatic wounds are shown to be related to the acute wound care received. Future Directions: Further guidelines are needed to determine the most effective and efficient care of complex traumatic soft tissue injuries in the pediatric population.

Paired maxillary and smaller mandibular mouthguard for rugby player with malalignment

A rugby player who had frequently experienced soft tissue injuries while playing rugby and wearing a conventional custom-made mouthguard came to the hospital clinic. The patient had suffered traumatic soft tissue injuries such as lip lacerations and bite trauma. Severe crowding due to ectopic maxillary and mandibular canines was observed. In response to the patient's request for better protection, a set of maxillary and mandibular mouthguards was designed: one covering the entire maxillary dentition and the other the mandibular front teeth only. The mouthguards were to be worn simultaneously. In this paper, we describe how these mouthguards were fabricated and discuss the results. The patient has experienced no injury to the stomatognathic system, including the lips, for five seasons since he began wearing this set of mouthguards. This new pairing of mouthguards appears to offer sufficient protection against injury, despite severe malalignment. We believe that this new type of paired maxillary and mandibular mouthguards has the potential to reduce sports-related dental injuries.