In many clinical trials on cutaneous healing, wound closure is the primary endpoint and single most important outcome parameter, making precise assessment of this time point one of utmost importance. The assessment of wound closure can be performed either by subjective clinical inspection or with a variety of methodologies anticipated to provide more objective data. The aim of this study was to examine intra- and interrater variability of blinded photographic analysis of wound closure of human partial thickness wounds, as well as the reliability of remote photographic analysis of wounds with that of direct clinical assessment. Two plastic surgeons, a dermatologist, and a maxillofacial surgeon constituted our rater panel. High-resolution images of patient wounds derived from two randomized controlled clinical trials (EU Clinical Trials Register numbers EudraCT 2009-017418-56 (registered 12 January 2010) and EudraCT 2010-019945-24 (registered 13 July 2010)) were individually assessed by the blinded, experienced study raters. The reliability of photographic image analysis was tested using intraclass and interclass correlation. The validity of photographic image analysis was correlated with clinical assessments of documented time to heal from the study centers’ files. The results demonstrated that the mean intraclass correlation coefficient of all four examiners was excellent (r = 0.79; 95 % confidence interval (CI), 0.61, 1.00)). The interrater correlation coefficient was good (r = 0.67; 95 % CI, 0.57, 1.00)) and therefore acceptable. The agreement between remote visual assessment and clinical assessment at the time of healing was good (r = 0.64; 95 % CI, 0.52, 0.76)) with an overall difference of about 1 day. Remote photographic analysis of cutaneous wounds is a feasible instrument in clinical open-label studies to evaluate time to wound closure. We found that it was a reliable method of measuring wound closure that correlated satisfactorily with clinical judgment, bolstering the potential relevance in the current era of evolving application and dependency in the field of telemedicine. EU Clinical Trials Register EudraCT numbers 2009-017418-56 (date of registration: 12 January 2010) and 2010-019945-24 (date of registration: 13 July 2010).

Submandibular and intraoral approaches are the 2 most commonly used methods to access mandibular fractures. Although they provide excellent access to repair fractures of body and ramus, we have found it difficult to manage subcondylar fractures using either of these approaches. An extended preauricular approach is also described for condylar and subcondylar fractures of the mandible, but it results in inappropriately extensive dissection and a larger scar, especially for an isolated subcondylar fracture. We describe a novel approach for subcondylar fractures that provides direct access to the fracture site. The incision line is located just above the lower border of the mandible and lies accurately and safely between the marginal mandibular and the buccal branches of the facial nerve. We also performed cadaver head dissection to follow and locate facial nerve branches in relation to the proposed incision. To date, we have operated on 38 patients and have found excellent functional results and acceptable aesthetic outcome.

The ability to heal one’s wounds is perhaps one of the most fundamental and critical of physiologic processes. This coordinated and closely regulated sequential biological process involves a variety of migratory and resident cells. The activation, modulation, balance, and control of these functions depend upon soluble mediators that activate cells and modulate their diverse functions. Recent advances have identified mechanotransduction as functionally integral in many different cell types and physiologic processes. The mechanically sensitive ion channel Pieoz1 is expressed on platelets, neutrophils, macrophages, endothelial cells, keratinocytes, and fibroblasts, all of which are principally involved in wound healing. On a cellular level, there have been great advances in our understanding of the functional role of Piezo1 mechanotransduction in cutaneous wounding. The blocking of Piezo1 has recently been shown to reduce scarring in vivo and yet, thus far, a comprehensive understanding of the roles that Piezo1 plays in in vivo wound healing remains lacking. Recognizing the ever-present and critical importance of optimal and reparative wound healing, and with the availability of new physical mechanomodulating devices, the time is ripe for gaining deeper insights into optimizing wound healing. In this review, we describe the current knowledge of Piezo1 related to wound healing.

Burn injuries with cutaneous loss result in a severe systemic response when profound injuries exceed 20% of the total body surface area. The management of severely burned patients is a complex and dynamic process. Timely and safe operative interventions are critical components of multidisciplinary care. Effective management of severely burned patients, their cutaneous injuries, and the associated systemic disease requires a comprehensive understanding of the pathophysiologic response to trauma, objective indicators of patient status, and an appreciation for the dynamic nature of these parameters. Progress in both clinical and basic science research has advanced our understanding of these concepts and our approach to the management of burn patients. Incorporating concepts such as early total care, damage control surgery (DCS), and safe definitive surgery (SDS) in the polytraumatized patient may further aid in optimizing outcomes and quality of care for burn patients. This article connects current knowledge of the lethal triad, inflammation, immunosuppression, and eschar-derived toxins, with surgical burn care, especially burn wound debridement. The concepts of DCS and SDS for the care and management of burn patients are strongly advocated. Experimental and clinical studies are encouraged to validate these concepts in an effort to optimize patient outcomes.