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Hand Clinics

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https://www.readbyqxmd.com/read/28363305/optimizing-the-treatment-of-burn-injuries-of-the-upper-extremity
#1
EDITORIAL
Jason H Ko, Benjamin Levi
No abstract text is available yet for this article.
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363304/international-disease-burden-of-hand-burns-perspective-from-the-global-health-arena
#2
REVIEW
Daniel S Corlew, K A Kelly McQueen
Measuring the extent and impact of a health problem is key to being able to address it appropriately. This review uses available information within the framework of the Global Burden of Disease studies to estimate the disease burden due to burn injuries of the hands. The GBD indicates that since 1990 there has been an approximately 30% decrease in the disease burden related to burn injuries. The GBD methods have not been applied specifically to hand burns, but from available data, it is estimated that about 18 million people in the world suffer from sequelae of burns to the hands...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363303/outcomes-assessment-after-hand-burns
#3
REVIEW
Shepard P Johnson, Kevin C Chung
Accurately assessing function and disability after hand burns is imperative to improving the management of patients. The biological, social, and psychological impact of these injuries should be considered. The International Classification of Functioning Disability (ICF) and Health Core Sets for Hand Conditions provides a guide to what should be measured and reported. Although many outcomes measures instruments are available to assess patients with hand or burn injuries, few are validated in the subpopulation of hand burns...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363302/postburn-contractures-of-the-elbow-and-heterotopic-ossification
#4
REVIEW
Mary Claire Manske, Douglas P Hanel
Postburn contractures of the elbow are uncommon debilitating sequelae of severe burn injuries, which result from thermal injury to both deep and superficial tissues. When periarticular heterotopic bone forms in association with burn injuries, severe and rigid contractures may develop that prohibit basic functions of daily living and are often refractory to nonoperative intervention. Surgical intervention is aimed at releasing or excising all pathologic anatomy limiting elbow motion. In patients with proper indications, surgical intervention can result in substantial improvement in elbow motion, allowing patients to return to activities of daily living, employment, and recreational activities...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363301/heterotopic-ossification-following-upper-extremity-injury
#5
REVIEW
Shailesh Agarwal, Shawn Loder, Benjamin Levi
Heterotopic ossification (HO) presents a substantial barrier to rehabilitation for patients with severe burns or trauma. Although surgical excision is a mainstay of management for this condition, this is unable to address the chronic sequelae of HO, including chronic pain, joint contractures, nerve dysfunction, and open wounds. Current therapeutic modalities are aimed at excision and the prevention of recurrence using nonsteroidal antiinflammatory drugs (NSAIDs) or radiation therapy. Research is now focused on identifying alternative strategies to prevent the initial occurrence of HO through NSAIDs and novel inhibitors of the bone morphogenetic protein signaling pathway...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363300/microsurgical-reconstruction-of-the-burned-hand-and-upper-extremity
#6
REVIEW
Mauricio De la Garza, Michael Sauerbier, Germann Günter, Curtis L Cetrulo, Reuben A Bueno, Robert C Russell, Michael W Neumeister
Improvements in critical care and burn victim resuscitation have led to increased survival of burned patients. Initial resuscitation, early excision of burned tissues, prevention of burn wound sepsis, and wound coverage remain mainstays of care. Many burn wounds require complex reconstruction. This is particularly important in the hand. Coverage of tendons, ligaments, joints, vessels, nerves, and bones of the hand requires healthy vascularized tissue to maintain viability and function. Local flaps or regional flaps may be within the burn zone of injury...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363299/reconstruction-of-the-adult-and-pediatric-burned-hand
#7
REVIEW
Ryan P Cauley, Lydia A Helliwell, Matthias B Donelan, Kyle R Eberlin
Thermal injuries of the hand can have a great impact on function. Initial treatment should focus on the prevention of contracture through the use of tissue-sparing techniques and optimized occupational therapy. Surgical intervention should follow the standard reconstructive ladder and can involve several techniques from simple to complex including minimally invasive techniques, such as laser and steroid injection, contracture release and skin grafting, and local tissue rearrangement and regional flaps as well as distant pedicled and free flaps...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363298/postburn-contractures-of-the-hand
#8
REVIEW
Matthew Brown, Kevin C Chung
Postburn contractures are a common occurrence after severe burn injuries. It is important to understand the pathologic condition and anatomy of specific postburn deformities in order to provide comprehensive surgical care. Postburn contractures can result in a flexion contracture, boutonniere deformity, burn syndactyly, metacarpophalangeal extension contracture, wrist contracture, or claw hand. A patient evaluation is performed before proceeding to the operating room. Surgery sequences require proper incision design, release of the skin, and deeper contracted structures and coverage with an appropriate flap or graft...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363297/scar-management-of-the-burned-hand
#9
REVIEW
Michael Sorkin, David Cholok, Benjamin Levi
Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Although nonoperative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363296/postburn-upper-extremity-occupational-therapy
#10
REVIEW
Tiffany Williams, Tanya Berenz
Upper extremity burns can result in lifelong complications. A comprehensive occupational therapy program is imperative for restoration of arm function. Edema management, splinting, exercise, scar management, and activities of daily living are key treatment elements to achieve optimal postburn outcomes. Proper patient and family education are essential for therapeutic success. Burn recovery requires a commitment to therapeutic techniques that can progress a patient to their maximal independence.
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363295/biological-principles-of-scar-and-contracture
#11
REVIEW
Peter O Kwan, Edward E Tredget
Hypertrophic scar and contracture in burn patients is a complex process. Contributing factors include critical injury depth and activation of key cell subpopulations, including deep dermal fibroblasts, myofibroblasts, fibrocytes, and T-helper cells, which cause scarring rather than regeneration. These cells influence each other via cellular profibrotic and antifibrotic signals, which help to determine the outcome. These cells also both modify and interact with extracellular matrix of the wound, ultimately forming hypertrophic scar...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363294/the-use-of-dermal-skin-substitutes-for-the-treatment-of-the-burned-hand
#12
REVIEW
Ian C Sando, Kevin C Chung
The hand is commonly affected in burn injuries. Joints and extensor tendons are vulnerable given their superficial location. Durable coverage that permits relative frictionless tendon gliding and minimizes scar contracture is required to optimize functional outcomes. When soft tissue donor sites are limited, the use of dermal skin substitutes provides stable coverage with minimal scarring, good mobility, and acceptable appearance. A comprehensive review of dermal skin substitutes and their use with burn reconstruction of the hand is provided...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363293/cold-injuries
#13
REVIEW
Deana S Shenaq, Lawrence J Gottlieb
New treatments of frostbite have led to unprecedented salvage of extremities including fingers and toes. Success is predicated on prompt institution of time-sensitive protocols initiated soon after rewarming, particularly the use of thombolytics. Unfortunately, in the urban setting, most patients are not candidates for these treatment modalities. Triple-phase bone scans have allowed for early determination of devitalized parts that need amputation. Reconstructive surgical techniques are typically used to salvage limb length in these devastating injuries...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363292/a-3-phase-approach-for-the-management-of-upper-extremity-electrical-injuries
#14
REVIEW
Ketan Sharma, Miles Bichanich, Amy M Moore
Upper extremity electrical injuries present with unique pathophysiologic considerations due to the differing mechanisms of injury produced by the electromagnetic field. The initial phase of treatment consists of recognition of other life-threatening injuries, stabilization of patients, and multisystem resuscitation. The second phase of treatment consists of excising devitalized tissue, appropriate wound care to prevent delayed infection, providing temporary and definitive coverage over vital structures, and preventing contracture and joint stiffness via aggressive therapy...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363291/management-of-acute-pediatric-hand-burns
#15
REVIEW
William B Norbury, David N Herndon
Worldwide, approximately 500,000 children are admitted to the hospital with burn injuries every year. Referral to an accredited burn center is required for burns that involve the hand regardless of age. As with most burn injuries, a multidisciplinary approach is important; however, in the younger pediatric patient, extra resources such as child life services, pediatric psychotherapy, and music therapy all play major roles alongside the nurse, physical therapists, and psychiatrists so that together with the appropriate support for the family involved, a successful outcome can be achieved...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28363290/acute-management-of-hand-burns
#16
REVIEW
Ashwin Soni, Tam N Pham, Jason H Ko
The hand is extremely susceptible to burn injuries, and hand burns can occur in up to 90% of all major burns. A thorough neurovascular examination of the hand should be performed in the acute setting. Escharotomies are required in patients with full-thickness or circumferential burns, when perfusion of the upper extremity is compromised. The decision for excision and grafting is based on whether the wound will heal in the first 2 to 3 weeks after the burn injury. Acute care and resuscitation are always importance in this patient population; subsequent care leads to optimal hand functionality and cosmetic long-term outcomes...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/27886845/optimizing-the-treatment-of-upper-extremity-injuries-in-athletes
#17
EDITORIAL
Kevin C Chung
No abstract text is available yet for this article.
February 2017: Hand Clinics
https://www.readbyqxmd.com/read/27886844/hand-and-wrist-injuries-in-boxing-and-the-martial-arts
#18
REVIEW
Benjamin Todd Drury, Thomas P Lehman, Ghazi Rayan
Hand and wrist injuries in martial arts are typically a reflection of the combat nature of this discipline. In striking sports, the axial load mechanism of injury is common and causes fractures and dislocations; in grappling sports, sprain injuries and degenerative changes predominate. There is clear evidence to support that hand protection reduces the risk of hand injury. Traditional training in martial arts on proper technique and target selection in striking sports reduces the risk of hand injury, and is an important component of hand and wrist injury prevention...
February 2017: Hand Clinics
https://www.readbyqxmd.com/read/27886843/expediting-professional-athletes-return-to-competition
#19
REVIEW
Jeff M Coppage, Michelle G Carlson
Return-to-play (RTP) decisions often represent a challenge to physicians caring for athletes. The multifaceted and unique nature of each RTP decision makes standardization of the decision-making process impossible and demands of the physician thoughtful consideration of all competing interests and variables. Such difficult medical decisions are further complicated by unique ethical and legal considerations. Although no concrete RTP recommendations are available, the consensus of experienced team physicians and knowledge of the rules and regulations that apply to RTP are helpful guides to treating the various upper extremity injuries that occur in elite athletes...
February 2017: Hand Clinics
https://www.readbyqxmd.com/read/27886842/hand-and-wrist-injuries-in-golfers-and-their-treatment
#20
REVIEW
Sang-Hyun Woo, Young-Keun Lee, Jong-Min Kim, Ho-Jun Cheon, William H J Chung
A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended initial treatment starts with cessation of practice to rest the wrist, a splint or orthotic brace, and nonsteroidal antiinflammatory drug medication with corticosteroid injection and swing modification. Pisiform excision is the best treatment of the most severe chronic cases of pisiform ligament complex syndrome. Delayed diagnosis of hook of hamate fracture may lead to complications, including flexor tendon rupture...
February 2017: Hand Clinics
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