Search Results (172)

Background: Optical Coherence Tomography (OCT) is a high-resolution imaging technique capable of quantifying Blood Flow at Depth (BD) and the Attenuation Coefficient (AC). However, the clinical relevance of these parameters in burn assessment remains unclear. This study investigated whether OCT-derived metrics can differentiate between superficial and deep pediatric hand burns. Method: This prospective, single-center study analyzed 73 OCT scans from 37 children with thermal hand injuries. A structured algorithm was used to evaluate AC and BD. Results: The mean AC was 1.61 mm⁻¹ (SD ± 0.48), with significantly higher values in deep burns (2.11 mm⁻¹ ± 0.53) compared to superficial burns (1.49 mm⁻¹ ± 0.38; p < 0.001), reflecting increased optical density in more severe burns. BD did not differ significantly between burn depths, although superficial burns more often showed visible capillary networks. Conclusions: This is the first study to assess both AC and BD using OCT in pediatric hand burns. AC demonstrated potential as a diagnostic marker for burn depth, whereas BD had limited utility. Image quality limitations highlight the need for technical improvements to enhance OCT’s clinical application. Full article

Background: Reconstruction of distal forearm and hand soft tissue defects remains a complex surgical challenge due to the functional and aesthetic significance of the region. Several flap options have been established such as the posterior interosseous artery flap (PIA) or temporalis fascia flap (TFF), yet the anterolateral thigh flap (ALT) has gained increasing attention for its versatility and favorable risk profile. Methods: We retrospectively analyzed 12 patients (7 males, 5 females; mean age 51.8 years) who underwent free microvascular ALT reconstruction for distal forearm and hand defects between May 2020 and May 2025. Etiologies included infection, chemical burns, explosion injuries, and traffic accidents. The mean defect size was 75.4 cm², and the average operative time was 217 min. Secondary flap thinning was performed in eight cases. In one patient without available recipient veins, a pedicle vein was anastomosed using a coupler device anchored into a cortical window of the distal radius to establish venous outflow via the bone marrow. Results: All flaps demonstrated complete survival with successful integration. Minor complications included transient venous congestion in one case and superficial wound dehiscence in four cases. Functional outcomes were favorable, with postoperative hand function rated as very good in 10 of 12 patients at follow-up. The bone-anchored venous anastomosis provided effective venous drainage in the salvage case. Conclusions: The free microvascular ALT is a reliable and highly adaptable method for distal forearm and hand reconstruction. It provides excellent soft tissue coverage, allows for secondary contouring, and achieves both functional and aesthetic goals. Furthermore, intraosseous venous anastomosis using a coupler device might represent a novel adjunct that may expand reconstructive options in cases with absent or unusable recipient veins. Full article

Background: Seafarers are highly susceptible to work-related injuries, which can result in serious consequences or permanent disabilities. Understanding the frequency and characteristics of occupational injuries is crucial for developing effective prevention strategies and identifying their underlying patterns and causes. This study aimed to determine the frequency and characteristics of telemedicine-assisted work-related injuries among seafarers on board Italian-flagged vessels. Methods: A retrospective descriptive study was conducted to analyze occupational injuries using medical data recorded in the Centro Internazionale Radio Medico (C.I.R.M.) database from 1 January 2010 to 31 December 2022. Injuries in the database were coded according to the 10th revision of the International Classification of Diseases (ICD-10) by the World Health Organization (WHO). Variables extracted from the database included injury type, seafarers’ age, rank, nationality, worksite, gender, date of injury, affected body region, clinical outcomes, and other demographic and occupational characteristics. Injury frequency and characteristics (e.g., location, type, and cause) were analyzed and stratified by seafarers’ rank and worksite groups. Results: The analysis included 793 seafarers who sustained injuries. Their average age was 39.15 ± 10.49 years (range: 21 to 70 years). Deck ratings and engine officers accounted for 27.9% and 20% of those who claimed injuries, respectively. 39.2% of injured seafarers were aged between 30 and 40 years. In terms of affected body parts, the most reported injuries were to the hand/wrist (33.3%), followed by the knee/lower legs (21%), and the head/eye (19%). Open wounds (38%) and burns/abrasions (14%) were the most common types of injury. Slips/falls (32%), burns/explosions (16.6%), and overexertion while lifting or carrying (14.8%) were the leading causes of injury during the study period. Nearly 35% of injuries affected workers on the deck and were due mainly to slips/falls, 19% in the engine room were due to being caught in machinery or equipment, and 32.5% in the catering department were due to burns/explosions. Conclusions: One-third of seafarers who suffered work-related injuries sustained hand and/or wrist injuries, with slips/falls being a significant cause. The results of this study emphasize the need for preventative measures in the marine sector, particularly to reduce risks associated with slips and falls, overexertion, and other injury-causing factors. Campaigns for the larger use of protective equipment are desirable to reduce occupational accidents at sea and provide better health protection for seafarers. Full article

The effects of wildfires and prescribed burnings on soil are highly variable. In order to evaluate the effects of different burning intensities on soil properties, a surface-controlled burn of undisturbed soil monoliths was carried out by combining temperatures (50 and 80 °C) and residence times (12 and 24 min). The effects of this burning gradient are evaluated at two soil depths (0–1 and 1–3 cm), with time (just after burning or immediate effects, T0, and five months later, T5), as well as the influence of ash (presence or absence). The results indicate that most soil properties were affected by the burning gradient applied only in the most superficial cm (0–1 cm), with few effects at greater depths. The most intense burn had the strongest immediate impact, reducing soil organic carbon, recalcitrant organic carbon, and microbial biomass carbon, as well as increasing the labile organic carbon and the microbial activity. On the other hand, this burning caused a strong decrease in soil water repellency at a 0–1 cm depth and increased it at 1–3 cm. In contrast, medium-intensity burning caused the opposite effect, increasing water repellency at the soil surface and reducing it at 1–3 cm. As a result of the mineralization of organic matter, the EC and pH increased significantly in all burning combinations and both soil depths studied. After five months (T5), several of these parameters tended to approach the values of unburned soil. Full article

Background/Objectives: The child and adolescent mental health service (CAMHS) hand-over to adult mental health service (AMHS) remains an ongoing shortfall in eating disorder (ED) treatment, typically in tandem with diagnostic drift, heightened suicide risk, and carer burn-out. We created one 14-to-25 Transition—ED track within our own unit, where a single multidisciplinary team continuously follows each patient and family across the CAMHS–AMHS boundary (via weekly joint paediatric and adult clinician meeting) without changing the individual psychotherapist, family therapist, or dietitian at the age 18 transition. We investigated the manner in which patients and parents perceive this model. Methods: A survey of two naturalistic parent cohorts—CAMHS (n = 16) and Transition—Adult arm (n = 15)—also joined, alongside the original group of young adults who had entered the programme during its set-up phase (n = 9). Here, the 14–25 pathway denotes one unified route of care across adolescence and young adulthood; the Transition—Adult arm is its ≥ 18-years component. All index patients had a primary DSM-5-TR diagnosis of restricting-type anorexia nervosa. Participants completed the Client Satisfaction Questionnaire-8 (CSQ-8; range 8–32) and four bespoke Continuity-of-Care items (1–4 Likert). Results: Overall, the caregivers in both cohorts were pleased (median CSQ-8 = 28.5 [CAMHS] vs. 27.0 [Transition]; p = 0.75). Continuity items were universally well rated across cohorts. Cohort parents reported a median of two unchanged core clinicians (i.e., the individual psychotherapist, the family therapist, or the dietitian), which was nonsignificantly positively correlated with CSQ-8 scores (ρ = 0.22). Early-group patients mirrored caregiver impressions (mean CSQ-8 = 27.0 ± 3.9). Conclusions: It is feasible and highly acceptable to both caregivers and anorexia nervosa young adults to have the same key staff and family-centred sessions over the 14-to-25 age span. Constrained by single-site study and small sample size, these preliminary data provide a rationale for wider implementation and controlled follow-up studies. Full article

This study assesses and maps the physical flood vulnerability within the Xerias, Krafsidonas, and Anavros ungauged catchments in Volos, Thessaly, Greece, using a Geographical Information Systems (GIS)-based Multi-Criteria Decision Analysis (MCDA) integrated with the Analytic Hierarchy Process (AHP). Six factors influencing flood dynamics were selected including slope, flow accumulation, geology, land use/cover, flood history and burned areas. The factors were weighted using the AHP based on their relative influence in flood occurrence. Physical flood vulnerability was assessed utilizing the Weighted Linear Combination (WLC) method and visualized through thematic flood-vulnerability maps. The analysis indicates that the southwestern and central-southern parts of the study area, which are highly urbanized and industrialized, exhibit the highest physical flood-vulnerability. Specifically, 32.76% of the Xerias catchment, 41.16% of the Krafsidonas catchment, and 34.71% of the Anavros catchment exhibit high to very high flood vulnerability. On the other hand, mountainous areas with steep slopes, permeable lithology, and dense forests exhibit low to very low physical flood vulnerability. The method’s accuracy was verified through sensitivity analysis and comparison with national flood-risk data for the study area. The results emphasize the physical vulnerability of Volos to flooding and the necessity for targeted flood mitigation measures, demonstrating the value of GIS in flood risk management. Full article

In 2020, a high-intensity wildfire burned over 35,000 ha in the Santa Cruz Mountains of California, including over 1700 ha of old-growth coast redwood forest. This event created a unique opportunity to evaluate post-fire succession. We compared vegetation recovery in high versus low/moderate severity burned areas using data collected one year and four years following the fire. Random plot sampling was conducted at Big Basin Redwoods State Park to assess the regeneration of trees, shrubs, and herbaceous species. Descriptive and inferential statistical analyses were used to assess recovery over time and across burn severities. Results indicate significant increases in shrub cover and richness over time, with a positive association between shrub recruitment and high-severity fire. Notably, the fire-adapted species blue blossom (Ceanothus thyrsiflorus Eschsch.), which was not recorded one year following the fire, dominated the shrub layer after four years, particularly in higher severity areas. Herbaceous species also exhibited an increase in cover and richness over time, though a substantial portion of that increase was based on non-native species recruitment. Analysis did not indicate a significant relationship between fire severity and herbaceous species recovery, however. The regeneration of tree species occurred both through seedling recruitment and basal sprouting. The recruitment of basal sprouts was prolific following the fire, particularly for coast redwood. The number of basal sprouts declined significantly during the time frame of this study, as the sprouts became larger and began to self-thin. Seedling abundance, on the other hand, exhibited an approximately 30-fold increase. Seedling recruitment was primarily driven by coast redwood (Sequoia sempervirens [Lamb. ex D.Don] Endl) and Douglas fir (Pseudotsuga menziesii [Mirb.] Franco) and was positively correlated with low/moderate fire severity. These findings underscore the complex interactions shaping post-fire forest dynamics and highlight the importance of understanding such patterns to inform management strategies that support the resiliency of coast redwood forests in an era of increasing wildfires. Full article

This study aims to assess the ecological and human health risks associated with four heavy metals (Cd, Cr, Cu, and Zn) in the soil of a dumpsite in Targuist city, Morocco. In total, 16 surface soil samples were collected from the dumpsite and its nearby areas following leaching drain flows. The pollution load index (PLI), geo-accumulation index (Igeo), and potential ecological risk index (RI) were subsequently determined. In addition, hazard quotient (HQ) and health index (HI) were used to assess the non-carcinogenic and carcinogenic risks associated with the soil heavy metal contents. The PLI indicated significant contamination by the studied heavy metals. On the other hand, the Igeo values suggested no Cr contamination, moderate contamination by Cu and Zn, and severe contamination by Cd. The RI indicated a dominant contribution from Cd, with minor contributions from Cu, Zn, and Cr accounting for 92.47, 5.44, 1.11, and 0.96%, respectively, to the potential ecological risk in the study area. The non-carcinogenic health risks associated with exposure of the nearby population to the soil heavy metals at the dumpsite and burned solid waste-derived air pollution were below the threshold value of 1 for both children and adults. Although carcinogenic risks were observed in the study area, they were acceptable for both children and adults according to the United States Environmental Protection Agency (USEPA). However, carcinogenic risks associated with Cr were unacceptable according to the Italian Legislation. Finally, strategies to mitigate the risks posed by the dumpsite were also discussed in this study. Full article

Background and Objectives: Older adults are a vulnerable population to unintentional injuries due to age-related physiological decline and the presence of various chronic conditions. Unintentional injuries occurring in the home, such as falls, burns, poisoning, cuts, and suffocation, have been reported at higher rates in this age group compared to younger populations. This study examines the prevalence and types of unintentional in-home injuries in older adults and identifies the risk factors associated with falls and cuts/collisions. Materials and Methods: A cross-sectional study was conducted on 309 older adults (aged ≥ 65 years) recruited from eight senior welfare centers in South Korea. Results: The most frequent cause of injury was falls (28.7%), followed by cuts/collisions (27.0%), burns/fire (11.4%), and other injuries (8.1%). In the model adjusted for age and sex, risk factors for falls included a history of outdoor falls or indoor cuts/collisions, dizziness, and the use of two or more medications. Risk factors for cut/collision injuries included a history of indoor burns or falls, numbness in hands and feet, and visual impairment. Conclusions: To effectively prevent home injuries among older adults, it is crucial to focus not only on falls but also on frequent minor injuries caused by cuts and collisions. Full article

Background: Coagulopathy in severe burn injury is associated with complications and mortality. Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis. Results: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p < 0.05). These changes were underlined through abnormal measurements of coagulation factors. Conclusions:CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality. Full article

Short- and long-term hand function was evaluated in adult patients with deep dermal and full-thickness hand burns after treatment with enzymatic debridement (NexoBrid^® MediWound Ltd., Yavne, Israel), assessing the results at discharge and 3, 6, and 12 months post-burn. This prospective cohort study was performed in the Burn Center in Beverwijk between March 2017 and December 2019. Hand function was assessed using Modified Kapandji Index scores, the Jebsen-Taylor Hand Function Test, and range of motion; scar quality using the Patient and Observer Scar Assessment Scale version 2.0; and quality of life using the Quick Disability Arm Shoulder Hand Questionnaire and the Canadian Occupational Performance Measure. Ten patients (14 hand burns) were included. The need for a skin graft after NexoBrid^® was 86%, and 50% needed additional surgical excision before skin grafting. Digits 3 and 4 achieved near-to-normal total active motion, and at least 50% of the hands achieved a normal range within the Jebsen-Taylor Hand Function Test in four items at 12 months post-burn. Scar quality and quality of life improved significantly over time. The present study can be considered as a proof-of-concept study for future clinical trials on enzymatic debridement for hand burns. Full article

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis^® fish skin and Epicite^® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts. Full article

Considered one of the most severe types of trauma with a high impact upon patient survival, burns are the leading cause of disability-adjusted life-years (DALYs), and are responsible for high morbidity, prolonged hospitalization, disfigurement and social stigma. Of particular interest are injuries that affect the functional areas: face, neck, hand and fingers, joints, feet and soles and perineum. Burns to these regions highly influence the day-to-day activities of patients due to the formation of vicious scars and contractures, which may affect both quality of life and functional capacity. One of the primary challenges in the management of burn patients is the effective coverage of tissue defects resulting from such injuries. Cases that have a large area of burned surface also have a limited amount of total available skin. As such, the importance of skin substitutes increases, particularly in the treatment of these areas. Skin substitutes are widely utilized in plastic surgery due to their ability to promote wound healing by providing an extracellular matrix. Consequently, ongoing research has focused on developing skin substitutes that can serve as alternatives to autografts, addressing the challenges associated with large-scale tissue loss. This article aims to present and compare the most used skin substitutes, highlighting their respective advantages and limitations. This topic continues to be a subject of significant debate, as an ideal substitute has yet to be created. The cost–efficiency ratio is a practical consideration that must be tailored to each specific medical system. The available data in the literature usually present general guidelines, not rules, and as such, they need to be adapted to each patient’s necessities. Full article

The first web space of the hand plays a fundamental role in daily hand function, facilitating crucial movements, such as pinching, grasping, and opposition. The structural anomalies of acquired defects of this anatomical region, whether secondary to trauma, burns, or post-oncological surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced microsurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limitations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplantation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques. Full article

Background/Objectives: Integra Dermal Regeneration Template (IDRT) has emerged as a viable reconstructive option in exposed avascular structures, such as exposed bone devoid of periosteum. This systematic review aimed at examining success rates by comparing different wound types and their characteristics, as well as the surgical methods involved. Methods: A systematic review was conducted to identify studies using IDRT in the reconstruction of defects with exposed bone devoid of periosteum. Primary outcomes of interest were IDRT and skin graft success rates, followed by patient and wound characteristics, and different surgical methods used. The results were accompanied by an illustrative case report of IDRT-based hand reconstruction after a deep burn injury. Results: The review included 40 studies, with a total of 202 individual defects. The primary indication for IDRT-based reconstruction was post-oncologic defects in the elderly population. Although surgeons mostly used burring/fenestration as a bone preparation method prior to IDRT placement, decorticated bones showed faster grafting time (23.8 vs. 27.9 days). The average success rate of IDRT was 87.54% (±25.9), with an excellent IDRT take rate (100%) observed in more than 50% of cases. In the majority of cases (95.5%), the skin graft acceptance rate was deemed to be higher than 95%, with an average graft take of 98.8%. Conclusions: The results of this review support the use of IDRT in managing complex defects involving exposed bone, offering fast coverage with good functional restoration, without any donor site morbidity. Additionally, bone preparation methods also play an important role in IDRT-based reconstruction by shortening the grafting time. Full article