This prospective, randomized study assessed the clinical, microbiological, and patient comfort characteristics of two silver-based topical agents in the management of partial-thickness burn wounds. Pediatric patients were randomly assigned to treatment with either SilvaSorb Gel (Medline Industries, Munedelein, IL) or Silvadene silver sulfadiazine cream (King Pharmaceuticals, Bristol, TN) for up to 21 days or to the point of full reepithelialization of the wound. Inclusion criteria were patients ranging in age from 2 months to 18 years with TBSA ranging from 1 up to 40%. A total of 24 patients were enrolled and completed the study. Findings demonstrated that the use of SilvaSorb Gel was associated with less pain and greater patient satisfaction when compared with Silvadene. No statistically significant differences were found when assessing the rate of infection, time to reepithelialization, or the number of dressings changes required during treatment. The reduction of pain and improved overall patient satisfaction with the use of SilvaSorb Gel compared with Silvadene indicates an important role for SilvaSorb Gel in treatment of partial-thickness burns in a pediatric population.

Botulinum toxin A has been described in treatment protocols for several disease processes, from primary axillary hyperhydorosis to esophageal dysfunction. It is best known for its use in plastic and dermatological practices. Botulinum toxin has a straightforward mechanism of action. The toxin inhibits acetylcholine release at the neuromuscular junction causing a chemical denervation, which ceases contractions of the muscle. With its minimal side effect profile, botulinum toxin should be considered when muscle spasm is a detriment. This case involves an injury to the hand of a patient with a history of intermittent diffuse muscle spasms. Subsequently, due to the patient's previous upper extremity muscle spasms, repeated flexor tendon repair ruptures of the index finger occurred until botulinum toxin was administered to the offending muscle. The patient has not required any additional surgical interventions for the repaired tendon and is now actively flexing all digits. This case report demonstrates how botulinum toxin can be used in a clinical scenario when decreased muscle activity is desired to promote tendon healing.Keywords Flexor tendon rupture . Botulinum toxin A . Botox . Teno fix . Flexor tendon repair Case ReportA 44-year-old right-hand-dominant male presented to the emergency room with injuries sustained to his left hand owing to a table saw laceration across his palm. His exam and operative findings noted the following: fractures of the index and small finger proximal phalanges, zone III flexor digitorum superficialis and profundus tendon lacerations to the index, zone III flexor pollicis longus tendon laceration, and zone III flexor tendon injuries to the small finger. Concurrent injuries also included digital nerve lacerations to the thumb, index, and small finger. There were vascular lacerations of the digital artery to the small and index fingers.His past medical history is significant due to an ongoing neurological dysfunction from a prior traumatic injury. This prior injury has left the patient with intermittent diffuse muscle spasms. His medications for this condition include neurontin 600 mg four times a day, baclofen 20 mg three times a day, morphine 30 mg three times a day, and celebrex 200 mg twice a day. Despite this regiment of medications, he describes ongoing symptoms of muscle spasm including his injured extremity. His past surgical history is also significant for a prior left middle finger amputation through the level of the middle phalanx.Initial emergent operative management incorporated irrigation and debridement along with repairs of the tendon lacerations to the thumb, index, and small fingers. Tendon repairs were carried out using a four-strand core suture technique augmented with a 6-0 prolene epitendinous suture. The bony fractures were stabilized with 0.045 Kirshner wires. Repairs to the lacerated digital nerves and arteries were also performed. Finally, a protective dorsal block plaster splint was applied.The patient was examined postoperatively in a routine fashion....

Flexor tendon laceration repairs remain challenging despite numerous advances in hand surgery. Although progress on this vital subject matter has been achieved, there continues to be discussion over which surgical technique produces the optimal result. Currently there are several recommended surgical repair options for the lacerated flexor tendon. However, these repairs continue to have possible significant complications including adhesions, decreased range of motion, gapping, and post operative rupture. Stainless steel suture has long been known as an option for flexor tendon repair. Stainless steel suture demonstrates one of the highest tensile strength sutures. However until recently, stainless steel suture placement for flexor tendon repairs was technically problematic. This case study discusses an additional option for repairing lacerated flexor tendons using an advanced stainless steel tendon repair system.

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