Reconstruction of the Upper Extremity High-Voltage Electrical Injury: A Pediatric Burn Hospital's 13-Year Experience

The Effect of Enhanced Rehabilitation Program on Upper Limb Function in Patients Undergoing Abdominal Pedicle Flap Surgery

To investigate the effect of an enhanced rehabilitation program on upper limb function in patients with abdominal pedicle flap surgery, we retrospectively analyzed 70 patients who received abdominal pedicled flap surgery between 2017 and 2022. Patients were categorized into the traditional rehabilitation group (rehabilitation initiated after the stage II pedicle dissection of the abdominal pedicle flap) and the enhanced rehabilitation group (rehabilitation initiated on the first day following the stage II abdominal pedicle flap surgery). All the patients received identical rehabilitation protocols. Passive Range of Motion (PROM), activities of daily living (ADL), Functional Independence Measure (FIM), and Manual Muscle Testing (MMT) were assessed at 5 days and 1 month following the stage II surgery. The main causes of injury were electrical burns in both groups. The hospital stay of patients in the enhanced group was significantly shorter than the traditional group. One month assessment indicated both groups showed significant improvements in the PROM of shoulder flexion, abduction, and elbow extension compared to the 5 days assessment. Notably, at 5 days assessment, the enhanced group had significantly higher PROM in shoulder abduction and elbow extension compared to the traditional group. Furthermore, the enhanced group continued to exhibit higher PROM in shoulder flexion and abduction than the traditional group at one month assessment. At one month assessment, a significant increase was observed in the ADL, FIM, and MMT of both groups compared to the 5 days. The study indicated the enhanced rehabilitation program immediately following the stage I surgery can effectively improve the PROM of the shoulder and elbow and reduce the length of hospital stay for patients.

The Roles of Fasciotomy and Peripheral Nerve Decompression in Electric Burn Patients: A Systematic Review and Meta-Analysis

INTRODUCTION

Peripheral nerves preferentially conduct electricity due to their low resistance as compared with other tissues, predisposing them to injury from electrical burns. The purpose of this study was to investigate the efficacy of fasciotomy and peripheral nerve decompression on peripheral nerves after electric injury.

METHODS

A systematic review of patients who had sustained electric burn injuries was performed according to PRISMA Guidelines. Incidence, demographic and injury characteristics, and patterns of symptoms were analyzed. Meta-analysis was performed to examine changes from baseline from nerve conduction studies. Outcomes for fasciotomy and various nerve decompressions were also analyzed.

RESULTS

Of the 119 articles included in for systematic review, 16,773 patients were included. Most available studies the case reports or case series that yielded moderate- to poor-quality evidence. The median follow-up of the included patients was 44 weeks (IQR 15-97 weeks). Patients who underwent fasciotomy had significantly lower rates of peripheral neuropathy than those who did not by the last recorded follow-up (45% vs. 92%, p < 0.0001). Patients who underwent peripheral nerve decompression after 30 days of injury had lower rates of peripheral neuropathy at the last follow-up compared with those who underwent decompression within 30 days (21% vs. 53%, p < 0.0001).

CONCLUSIONS

A paucity of high-quality evidence exists to standardize management recommendations for peripheral nerve injury; however, of what literature does exist, it seems that fasciotomy and nerve decompressions are associated with improved peripheral nerve function in the long-term, but nerve decompression likely provides more benefit when performed if symptoms persist one-year post-injury.

Exploring the underlying mechanism by transcriptome sequencing in rats with high-voltage electrical burns and the role of iron metabolism

BACKGROUND

Clinically, the condition of skeletal muscle injury is the key to the process of high voltage electrical burn (HVEB) wound repair. The aim of this study was to identify the potential mechanisms and intervention targets of skeletal muscle injury after HVEB.

METHODS

A skeletal muscle injury model in SD rats with HVEB was made. Pathological examination and transcriptome sequencing of injured skeletal muscles were performed, and the expression levels of key proteins and genes in related signaling pathways were verified.

RESULTS

Skeletal muscle injury was progressively aggravated within 48 h, then the injury was gradually repaired with scar formation occurring within 1 week. The mechanism of skeletal muscle injury is complex and varied, and ferroptosis is one of the mechanisms. The ferrous iron content in the injured skeletal muscle tissue of model rats increased significantly at 24 h after injury. After 24 h, damage to injured skeletal muscle tissue could be alleviated by increasing iron storage and blocking lysosomal phagocytosis of autophagy.

CONCLUSIONS

Skeletal muscle injury caused by HVEB is characterized by adjacent endangered tissue progression after injury. Ferroptosis is involved in the mechanism of HVEB, and iron metabolism-related proteins may be potential targets for preventing progressive skeletal muscle injury.

Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia

There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects. Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care. Muscle contractures are typically a consequence of the generated tension on the distracted muscle. It can be managed by physiotherapy initially and surgically in later severe stages. Furthermore, it is essential to avoid muscle contracture development, which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation. The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability. Joint stiffness is the other possible unfavorable effect of lengthening. It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening. Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness. Likewise, the effect of mental and physical rehabilitation programs should not be overlooked.