Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns:A Retrospective Case Series

Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Factors Which Influence Patient Choice When Choosing a Hand Therapist

Background: Orthopedic surgeons often refer patients to hand therapy following orthopedic injury or surgery to facilitate recovery and maximize outcomes. Patients should be a key part of the shared decision-making process when it comes to their rehabilitation. While there is existing literature investigating factors considered by patients when choosing other medical providers, there are currently no studies investigating factors considered by patients when choosing a hand therapist. Purpose: The purpose of the study is to investigate public perception of factors which are important when choosing a hand therapist. Methods: A convenience sample (N = 220) of adults over the age of 18 completed an anonymous online survey using an internet crowdsourcing platform. Respondents were asked to quantitatively rank the importance of 10 predetermined factors related to selecting a hand therapist. Results: Respondents ranked insurance coverage and credentialing as a certified hand therapist as highest in terms of importance. Conclusion: We found that the factors people consider important when selecting a hand therapist are similar to the factors described in the medical literature that are important when selecting a physician or other healthcare provider. The results have implications for physicians when ensuring continuity of care for their patients.

Distal Radius Fracture: What Does the Patient Want?

Distal radius fractures are common and while historically most have been treated nonoperatively the frequency with which distal radius fractures are treated surgically is increasing. Criteria for considering surgical treatment are often based on radiographic appearance of the fracture. Less often discussed is patient preference: what do patients want. We investigated responses of a general population when presented with various treatment options following a hypothetical distal radius fracture. Many respondents chose nonoperative treatment even when told that surgery might result in a better outcome. This information can help during the shared decision-making process when discussing treatment options with a patient who presents with a distal radius fracture.