What's New | Decker

There remains controversy on the true origin and developmental stages of the external ear
Auricular reconstruction for microtia is complex and constantly evolving
Classification of auricular anomalies should focus on describing the anatomic subunits involved

Synthetic biodegradable dermal matrices are a recent innovation which regenerates a neodermis, with implications for wound coverage in burns and may confer benefits including decreased risk of infection and lower cost.
3-D printing of skin is a new frontier in tissue engineering, involving suspension and growth of keratinocytes and fibroblasts in a collagen matrix, with promising results in early animal studies.
Although face transplantation has been previously performed for debilitating burns of the head and neck, the number of face transplants has declined; reasons for this are multifactorial.

Increasing research on interventions to improve frailty with promising work on interventions that include an exercise component as well as nutritional measures
Recommendation against vitamin D to prevent falls in patients without osteoporosis or vitamin D deficiency
New and emerging therapies for pressure ulcers stress the importance of microclimate control, prophylactic dressings, and attention to reducing shear and friction in addition to pressure.

Prehospital control of bleeding with tourniquets, and permissive hypotension until operative bleeding control improve survival.
Damage control resuscitation and surgical principles improve outcomes in patients with abdominal trauma, impaired physiology.
Resuscitative Endovascular Balloon Occlusion of the Aorta, may aid the hemorrhaging abdominal trauma patient.

Prehospital control of bleeding with tourniquets, and permissive hypotension until operative bleeding control improve survival.
Damage control resuscitation and surgical principles improve outcomes in patients with abdominal trauma, impaired physiology.
Resuscitative Endovascular Balloon Occlusion of the Aorta, may aid the hemorrhaging abdominal trauma patient.

Compartment syndrome of the extremity is a clinical diagnosis in an awake and alert patient.
Measurement of intracompartmental pressures should be performed in the obtunded patient or if clinical assessment is inconclusive.
Once the diagnosis is made, emergent fasciotomy is the treatment of choice as time to fasciotomy is the most important factor determining outcome.
Any patient with risk factors for developing abdominal hypertension should have intra-abdominal pressure assessed, preferably via intermittent or continuous transbladder pressure.
Patients diagnosed with abdominal compartment syndrome require emergent decompressive laparotomy and the creation of a temporary abdominal closure.

The MSLT is essential in documenting pathologic sleepiness (e.g., sleep-onset latency of less than 8 minutes) and in diagnosing narcolepsy. The presence of two sleep-onset REMs on four or five nap studies and sleep-onset latency of less than 8 minutes strongly suggests a diagnosis of narcolepsy in the context of an appropriate history.
RLS is a lifelong sensorimotor neurologic disorder with a severe impact on sleep and quality of life that may begin at any age. RLS is most severe in middle-aged or elderly persons, in whom it has a chronic, progressive course. The overall prevalence of RLS for the adult population has been estimated to be about 7.2%, particularly in those of European descent, but the prevalence of the most severe cases (severe symptoms occurring at least two nights a week) is approximately 2.7%
For transient insomnia or insomnia of short duration, treatment with sedative-hypnotics (e.g., zolpidem, zolpidem extended release, zolpidem tartrate sublingual tablets, zaleplon, eszopiclone, or low-dose doxepin) or short- or intermediate-acting benzodiazepines (e.g., temazepam), as well as ramelteon, a melatonin receptor (MT₁ and MT₃) agonist, for a few nights to a few weeks is appropriate.

When massive bleeding exists and direct control of the site of bleeding is under way, the decision to transfuse should be based primarily on hemodynamic status rather than on the hemoglobin or hematocrit level. These laboratory values do not reflect acute hemorrhage because there is a time lag before these levels equilibrate from fluid shift between the extravascular and vascular compartments and from administration of IV fluids.
The concept of liberal, early use of plasma and platelets developed in large part from the recent US-led military campaigns in Iraq and Afghanistan. Initially in those conflicts, the lack of a reliable supply of blood products near the scene of injury—and platelets especially—led to the use of fresh whole blood transfusion. Although fresh whole blood would be impractical in the civilian setting because of logistical issues and the risk of transmitting transfusion-related infections, the perception of improved outcomes associated with its use prompted military surgeons to advocate 1:1:1 transfusion.
Beyond recognition and correction of the underlying problem causing DIC and the associated coagulopathy, the diagnosis of DIC represents something of an academic exercise because there is no specific treatment for the condition. Scoring systems that assess the severity of DIC are most useful for distinguishing DIC from other causes of coagulopathy (e.g., hypothermia, dilution, and drug effects).

Pediatrics