Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines.

Background: Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites. Methods: A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores. Results: A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings. Conclusion: The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.R01 EB021308 - NIBIB NIH HHSPublished versio

Concussion Rehabilitation and Second Impact Syndrome Prevention: A Literature Review

The brain is the most important organ in our bodies, yet it is the most misunderstood. In every contact sport and many non-contact sports, one of the most serious injuries an athlete can sustain is a minor/moderate traumatic brain injury, better known as a concussion. The amount of force the brain might undergo during play is often unacknowledged. While every concussion is unique to itself, the fact remains that proper concussion care is vital to the full recovery of our athletes. Proper rehabilitation and testing protocol is the key to preventing further complications from concussions. If a concussed athlete returns to play without being evaluated, or returns to play too soon after the initial injury, the risk of repeated concussion, or Second Impact Syndrome, vastly increases. Second Impact Syndrome occurs when a concussed athlete sustains a second blow to the head, causing severe swelling, cerebral edema, and often death. Proper rehabilitation can ultimately save an athlete from permanent brain damage, long-term complications, or loss of life. Although treatment plans may differ, a concussed player should be symptom-free and pass concussion testing before returning to play. This literature review will emphasize the proper rehabilitation of minors to prevent Second Impact Syndrome