Preoperative hemoglobin less than 10 mg/dL and postoperative albumin less than 2.5 mg/dL seem to be useful as indicators of an increased likelihood of developing postoperative complications. Correction of these values preoperatively and postoperatively may lead to improved surgical outcomes.

No abstract

The introduction of skin substitutes in the last decade has dramatically changed how we think about the concept of "non-healing" wounds. Their use has improved prognosis and reduced morbidity in the treatment of open wounds. This article aims to summarize the development of tissue-engineered skin substitutes, discuss their use, and highlight some specific applications in different clinical settings.

Malunions are a well-recognized complication of pediatric supracondylar humeral fractures. Results of corrective osteotomies vary, and complication rates have been reported to be as high as 40%. Considering the high rate of complications for malunion correction, we investigated the feasibility of arthroscopy. We present a technique for arthroscopic supracondylar osteotomy and percutaneous pinning. There are many advantages of an arthroscopic approach to malunion correction, including extension-type deformity correction, safe access to the anterior humerus, and minimal dissection and scarring; any intracapsular contracture can be addressed as well. Elbow arthroscopy appears to be a viable option in the pediatric orthopaedic surgeon's armamentarium. S upracondylar humeral fractures are common in children aged younger than 10 years.1 Angular deformities of the distal humerus are common after supracondylar fractures. 2 The results of corrective osteotomies vary widely, and complication rates have been reported at 33%.2 Considering the high rate of complications for supracondylar humeral malunions, we investigated the feasibility of using arthroscopy. In addition, the complex bony anatomy of the elbow and close proximity of vital neurovascular structures make exposure challenging and, often, limited. Further complicating exposure is the need to avoid damaging the ligaments, which could potentially exacerbate the injury. We present a technique for arthroscopic supracondylar osteotomy and percutaneous pinning. IndicationsThe principal surgical indication for this technique is a supracondylar humeral malunion that results in loss of functional motion (Table 1). In addition to addressing bony malunion, this approach affords the surgeon the opportunity to address any intracapsular contracture concomitantly. ContraindicationsContraindications for this technique revolve around exposure. If arthroscopy does not improve exposure, the procedure should be abandoned in favor of a traditional open osteotomy. In addition, this approach demands an experienced elbow arthroscopist comfortable with pediatric elbow arthroscopy. Lastly, if there has been prior ulnar nerve transposition, we find that elbow arthroscopy is generally contraindicated. Preoperative PlanningPreoperative planning is necessary to determine the requisite dimensions of the osteotomy and degree of correction. Therefore it is important to obtain goodquality preoperative radiographs. The radiographs must comprise true lateral and true anteroposterior views. Then, using elementary trigonometry and compensating for the magnification factor of the radiographs, we select our osteotomy site and plan for the amount of correction necessary to provide the patient with a functional range of motion. We use the techniques detailed by Kim et al. 3 to determine the preoperative angles and degree of malrotation. The humerus-elbow-wrist angle is measured on the anteroposterior radiograph as described previously to assess the varus and valgus angles.