Nerve compression syndromes may cause postburn morbidity that can often be difficult to recognize and manage. This study reviewed patients in the authors' institution who needed nerve decompression secondary to thermal or electrical burns. The objective was to evaluate the timing of nerve decompression in the burn population. A 4-year review of the authors' institution's database found 22 patients who underwent peripheral neuroplasty. This patient population included both thermal and electrical burn patients. Two patients were excluded from the study because they underwent rapid forearm amputation, and a third patient who had his initial burn care done in Europe was also excluded. The authors reviewed the mechanism of burn: percentage of body surface area burned, which nerves underwent decompression, and time from burn to decompression. Nerve compression syndromes were diagnosed and treated in this group of patients from day 46 to 1530 post-burn. Carpal tunnel was the most common site of compression accounting for 46% of the nerve decompressions. Sixteen of the 19 (84%) patients required that synchronous nerves be decompressed. The average body surface area burn in the thermal group was 43 and 5% in the electrical burn group. Nerve compression syndromes secondary to burns can be a challenging problem to diagnose and treat. Multiple studies have shown the importance of treating nerve compressions in the acute setting; however, this study shows the importance of long-term surveillance, secondary to the late presentation of nerve compression syndromes. Late nerve compression neuropathies were present in both the electrical and thermal burn patients. The authors also found that presentation of a single nerve compression should raise the suspicion of a synchronous nerve compression. Patients with thermal burns greater than 20% body surface area and electrical burns should be routinely questioned and examined for the peripheral nerve compression syndromes during long-term follow-up.

Percutaneous vascular closure devices have become increasingly common in their use in both cardiac and peripheral vascular intervention. Our cases present the risk factors of repeat percutaneous vascular closure devices for subsequent infectious complications. A 43-year-old male underwent cardiac catheterization and closure with an Angio-Seal (St. Judes Medical, Inc., St. Paul, MN) device. He required a second cardiac catheterization with access gained on the same side as the previous intervention. He developed bacteremia and an infected hematoma with erosion of the femoral artery. The second case involves a 57-year-old male who underwent cardiac catheterization and closure with an Angio-Seal device. He developed a localized infection over the accessed groin site. The overall complication rate of closure devices is 2%, and 0.3% of patients have infectious complications. The high morbidity associated with these complications indicates the need to be able to identify patients who are at increased risk for these complications.

Rapid protocol distraction with rhBMP-2 allows distraction of the hypoplastic mandible to class III occlusion during the initial operation and avoids the latency and distraction phases of standard mandibular distraction. This case series demonstrates the safety and effectiveness of rapid distraction in neonates with Pierre Robin syndrome. Larger studies and long-term follow-up are necessary; however, this study suggests that rapid protocol distraction with rhBMP-2 is effective in neonates with Pierre Robin syndrome.

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BackgroundPeriareolar Augmentation Mastopexy is one of the most challenging operations in plastic surgery. Problems with scar quality, areolar widening, and distortion are frequent problems that interfere with a predictable result.MethodsA retrospective review was performed on fifty consecutive patients who underwent a periareolar augmentation mastopexy with the interlocking approach. Of the 50 patients, 30 had both preoperative and postoperative photographs and were the basis of the study.ResultsThe age of the patients ranged from 19 to 56 years with the average age being 39 years. The postoperative follow-up averaged 9.5 months and the implants averaged 316 mL. There were no deaths, pulmonary embolism, deep vein thrombosis, or infected implants. Four patients had complications following surgery for an overall complication rate of 13%. Two patients developed an infected Gore-Tex suture. Two of these complications were treated with revision surgery. Five patients required reoperation for an overall reoperative rate of 16% (one patient was converted to a full mastopexy).ConclusionsAs a result of this retrospective study, we have found the interlocking approach to periareolar augmentation/mastopexy to be a safe and reliable operation.