Rehab Centers: Elbow Reconstruction Using Island Flap for Burn Patients.

Elbow reconstruction using island flap for burn patients.

Filed under: Rehab Centers

Arch Plast Surg. 2012 Nov; 39(6): 649-54
Hur GY, Song WJ, Lee JW, Lee HB, Jung SW, Koh JH, Seo DK, Choi JK, Jang YC

Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow.A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients’ data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated.Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 cm(2) (range, 28 to 670 cm(2)). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was 98° (range, 85° to 115°). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%).Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient’s functional outcome.
HubMed – rehab


Acute burn resuscitation and fluid creep: it is time for colloid rehabilitation.

Filed under: Rehab Centers

Ann Burns Fire Disasters. 2012 Jun 30; 25(2): 59-65
Atiyeh BS, Dibo SA, Ibrahim AE, Zgheib ER

Fluid overloading has become a global phenomenon in acute burn care. The consensus Parkland formula that has excluded colloid use, the impact of goal-directed resuscitation, and the overzealous on the scene crystalloid resuscitation combined with subsequent inefficient titration of fluid administration and lack of timely reduction of infusion rates, have all contributed to this phenomenon of fluid overloading, known as fluid creep and recognized only recently, constituting a landmine in modern burn care. Solid evidence is supportive to the fact that excessive administration of crystalloid and the abandonment of colloid replenishment at some point of resuscitation are the major contributors to fluid creep. With available evidence from the literature, the present is a comprehensive review of literature about fluid creep, trying to determine the etiology behind it as well as to propose strategies to control its magnitude and complications, namely through colloid administration amongst other options.
HubMed – rehab


Speech comprehension training and auditory and cognitive processing in older adults.

Filed under: Rehab Centers

Am J Audiol. 2012 Dec; 21(2): 351-7
Pichora-Fuller MK, Levitt H

To provide a brief history of speech comprehension training systems and an overview of research on auditory and cognitive aging as background to recommendations for future directions for rehabilitation.Two distinct domains were reviewed: one concerning technological and the other concerning psychological aspects of training. Historical trends and advances in these 2 domains were interrelated to highlight converging trends and directions for future practice.Over the last century, technological advances have influenced both the design of hearing aids and training systems. Initially, training focused on children and those with severe loss for whom amplification was insufficient. Now the focus has shifted to older adults with relatively little loss but difficulties listening in noise. Evidence of brain plasticity from auditory and cognitive neuroscience provides new insights into how to facilitate perceptual (re-)learning by older adults.There is a new imperative to complement training to increase bottom-up processing of the signal with more ecologically valid training to boost top-down information processing based on knowledge of language and the world. Advances in digital technologies enable the development of increasingly sophisticated training systems incorporating complex meaningful materials such as music, audiovisual interactive displays, and conversation.
HubMed – rehab



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