Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars
Robert Dabek, MD1; Harrison McUmber2; Branko Bojovic, MD1,3
1Massachusetts General Hospital
2Tufts University School of Medicine
3Shriners Hospitals for Children – Boston
Burn injuries are often devastating accidents that result in long-term physical and psychosocial consequences and the formation of hypertrophic scars. Laser treatment is a low risk minimally invasive approach to treating such burn scars.
This video discusses the pulsed dye laser (PDL) and fractional ablative CO2 laser, and demonstrates their use in treating the scars on a pediatric patient who suffered from burn injuries 7 years ago in Vietnam.
Open Reduction and Internal Fixation of Mandibular Body and Parasymphyseal Fractures with Maxillomandibular Fixation and Broken Tooth Extraction
Derek Sheen, MD1; Cheryl Yu, MD2; Sarah Debs, MD2; Peter Kwak, MD2; Nima Vahidi, MD3; Daniel Hawkins, DDS2; Thomas Lee, MD, FACS2
1University of Texas Southwestern Medical Center
2Virginia Commonwealth University Medical Center
3Upstate Medical Center
This is a case discussing a 21-year-old male who suffered from both non-comminuted mandibular parasymphyseal and body fractures as a result of a motor vehicle accident, requiring open reduction internal fixation (ORIF) without postoperative maxillomandibular fixation (MMF). The fracture was complicated by a broken tooth root, which required extraction.
After intraoperative MMF, ORIF was performed. The parasymphyseal fracture was plated using two locking four-hole 2-mm thick miniplates utilizing two locking screws on either side of the fracture with one plate along the alveolar surface (monocortical screw) and one along the basal surface (bicortical screw). For the right body fracture, a three-dimensional locking ladder plate was used via a transbuccal trocar approach for additional exposure needed for proper screw placement. Once the hardware was secured, the patient was taken out of MMF and restoration of premorbid occlusion was confirmed. Lastly, watertight mucosal closure was performed using absorbable sutures and Dermabond (cyanoacrylate adhesive).
Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic
C. Scott Brown, MD1; Paulo Dominaitis, CST2; Fred F. Telischi, MEE, MD, FACS1
1 University of Miami Miller School of Medicine
2 Bascom Palmer Eye Institute
Coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic, profoundly impacting healthcare systems. Despite the use of personal protective equipment, concerns remain over the potential transmission of SARS-CoV-2 for otolaryngologists. Transmission occurs via respiratory droplets and aerosolized virus particles, which are generated during specific interventions such suctioning, bone drilling, and the application of diathermy. The mastoid and middle ear mucosa are connected to the nasopharyngeal mucosa and can serve as a potential source of viral particles in an infected patient. This highlights the need for the development and implementation of strategies that minimize aerosol spread.
Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion
Ryan P. Boyle1; Jonah Poster2; Jonathan Friedstat, MD3
1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
2Icahn School of Medicine at Mount Sinai
3Shriners Hospitals for Children – Boston
The complications stemming from a poorly-healed burn wound can lead to functional deficits and overall aesthetically unfavorable results leading to psychological distress. Due to the inquisitive nature of infants and toddlers, and their nature to learn the world with their hands, their sensitive regions like the hands become likely targets for burns.
Superficial burns can be managed on an outpatient basis with spontaneous healing expected in 2 or 3 days with minimal scarring. Deep burns, particularly in pediatric populations, need considerable attention to avoid secondary contracture that leads to deformity.
Many treatment options exist, but in sensitive areas like the hands and face, full-thickness skin grafts are favored due to their superior healing and decreased likelihood of secondary contracture. This article aims to guide the surgeon in managing a pediatric burn wound with an arsenal of treatment options with the goal of achieving full mobility and functionality of the hand.
Flexible Bronchoscopy and Bronchoalveolar Lavage (BAL)
Marcus S. Alpert, MD; Yu Maw Htwe, MD
Penn State Health Milton S. Hershey Medical Center
Flexible bronchoscopy is a commonly utilized endoscopic procedure allowing for direct visualization of the airways, as well as a variety of therapeutic and diagnostic interventions. Common indications of flexible bronchoscopy include evaluation of pulmonary infiltrates, hemoptysis, airway obstruction, foreign body aspiration, tracheal stenosis, bronchopleural fistula, and post-lung transplant.
The procedure involves the insertion of a flexible bronchoscope through the vocal cords and into the lumen of the trachea and bronchi. Direct visualization is provided by fiberoptic video imaging. Bronchoalveolar lavage (BAL) further refers to instillation and subsequent recovery of sterile saline into the airways. In this article, we will detail the technique, considerations, and complications of flexible bronchoscopy and BAL.
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