Information on ED visits to Winnipeg hospitals was obtained from the database of the Emergency Department Information System (EDIS) for the period from December 2008 to June 2010. EDIS is a real-time ED monitoring system implemented across Winnipeg hospitals that captures information on every ED visit, including patient demographics and 'chief complaints.' We obtained aggregated daily data on the number of ED visits attributed to ILI and the total number of visits (for any reason) to all EDs included in EDIS. A visit was attributed to ILI if the patient's chief complaint was listed as weakness, shortness of breath, cough, headache, fever, sore throat, upper respiratory tract infection, or respiratory arrest. This definition likely overestimates the actual number of ILI visits, as none of these complaints are specific to the ILI syndrome. However, this definition has been used consistently throughout the study period, so time trends may still reflect changes over time in ED use due to ILI. Using ED data, we defined two syndromic indicators: 1) weekly count of all ED visits triaged as ILI (ED ILI volume), and 2) percentage of all ED visits that were triaged as an ILI (ED ILI percent).

Background Lower limb reconstruction is a well-recognized challenge to the trauma or plastic surgeon. Although techniques and outcomes in the adult population are well documented, they are less so in the pediatric population. Here, we present our experience in the management of posttraumatic foot and ankle defects with free tissue transfer in children. Methods We performed a retrospective analysis of 40 pediatric patients between the ages of 3 and 16 from 2008 to 2016 who underwent foot and ankle soft tissue reconstruction. Any patient who underwent reconstruction for any reason other than trauma was excluded. Data were collected on operative time, free tissue transfer type, use of vein grafts, length of hospital stay, and postoperative morbidity. Also, a comprehensive systematic literature review was completed according to the PRISMA protocol for all previous reports of foot and ankle reconstruction in the young age group with free tissue transfer. Results Of our 40 patients, 23 were males and 12 females, free tissue transfer was used to reconstruct primarily the dorsum (71%), heel (11%), medial (9%), and lateral (3%) aspect of the foot. The anterior tibial artery was the predominant recipient vessel for anastomosis (77%). Mean inpatient stay was 9 days and our complication rate was 20%, primarily of superficial infection treated with antibiotic therapy. The review of the literature articles is completely analyzed in detail. Conclusion The need for durable coverage of exposed joints, tendons, fractures, or hardware makes the free flap particularly well suited to trauma reconstruction of the foot and ankle. The lack of underlying vascular disease in this patient group allows for low complication rates. Our study evidences the safety and positive long-term outcomes of free tissue transfer for the reconstruction of huge sized-soft tissue defects of the foot and ankle in children.

The aim of this article is to provide an overview on paediatric facial paralysis, looking into aetiology, epidemiology, assessment and investigation and subsequent treatment options available. Facial paralysis describes the inability to activate the muscles of fascial expression. Overall, it affects 2.7 per 100 000 children under 10 years old and 10.1 per 100 000 children over 10 years old each year. There are many causes of facial paralysis and the outcomes and necessary treatments vary depending on the cause. The mainstays of medical management are corticosteroids and facial therapy; however, when the facial palsy persists, facial deformity surgery is an option to improve the facial symmetry, protect vision and recreate dynamic movement.

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