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Kildal, Morten
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Publications (10 of 21) Show all publications
Audolfsson, T., Rodríguez-Lorenzo, A., Wong, C., Cheng, A., Kildal, M., Nowinski, D. & Rozen, S. (2013). Nerve Transfers for Facial Transplantation: a cadaveric study for motor and sensory restoration. Plastic and reconstructive surgery (1963), 131(6), 1231-1240
Open this publication in new window or tab >>Nerve Transfers for Facial Transplantation: a cadaveric study for motor and sensory restoration
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2013 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 131, no 6, p. 1231-1240Article in journal (Refereed) Published
Abstract [en]

BACKGROUND

Restoration of facial animation and sensation are highly important for the outcome after facial allotransplantation. The identification of healthy nerves for neurotization, through recipient to donor nerve coaptation, is of particular importance for successful nerve regeneration within the allograft. However, due to the severity of the initial injury and resultant scar formation, a lack of healthy nerve stumps in the recipient is a commonly encountered problem. In this study, we evaluate the technical feasibility of performing nerve transfers in facial transplantation for both sensory and motor neurotization.

METHODS

Fifteen fresh cadaver heads were used in this study. The study was divided in two parts. First, the technical feasibility of nerve transfer from the cervical plexus (CP) to the mental nerve (MN) and the masseter nerve (MaN) to the buccal branches of the facial nerve (BBFN) was assessed. Next, we performed nerve transfers in simulated face transplants to describe the surgical technique focusing on sensory restoration of the midface and upper lip by neurotization of the infraorbital nerve (ION), sensory restoration of the lower lip by neurotization of the MN, and smile reanimation by neurotization of the BBFN.

RESULTS

In all specimens coaptation of at least one of branches of the CP to the mental nerve was possible as well as between the masseter nerve to the buccal branch of the facial nerve. In simulated face transplant procedures nerve transfers of the supraorbital nerve (SON) to the infraorbital nerve (ION), cervical plexus branches to the mental nerve, and masseter nerve to facial nerve are all technically possible.

CONCLUSION

Nerve transfers are a technically feasible option that could theoretically be used in face transplantation either as a primary nerve reconstruction when there are no available healthy nerves, or as a secondary procedure for enhancement of functional outcomes. The supraorbital nerve, branches of the cervical plexus and the masseter nerve are nerves usually located out of the zone of injury and can be selected as neurotizers for the infraorbital nerve, mental nerve and buccal branch of the facial nerve respectively.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-199926 (URN)10.1097/PRS.0b013e31828bd394 (DOI)000319567500037 ()23416435 (PubMedID)
Available from: 2013-05-17 Created: 2013-05-17 Last updated: 2017-12-06Bibliographically approved
Nilsson, H., Jonson, C.-O., Vikström, T., Bengtsson, E., Thorfinn, J., Huss, F., . . . Sjöberg, F. (2013). Simulation-assisted burn disaster planning. Burns, 39(6), 1122-1130
Open this publication in new window or tab >>Simulation-assisted burn disaster planning
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2013 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 6, p. 1122-1130Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System® (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-199923 (URN)10.1016/j.burns.2013.01.018 (DOI)000324349700014 ()23462280 (PubMedID)
Available from: 2013-05-17 Created: 2013-05-17 Last updated: 2017-12-06
Rodriguez Lorenzo, A., Audolfsson, T., Rozen, S. M., Kildal, M. & Nowinski, D. (2012). Supraorbitary to infraorbitary nerve transfer for restoration of midface sensation in face transplantation: cadaver feasibility study. Microsurgery, 32(4), 309-313
Open this publication in new window or tab >>Supraorbitary to infraorbitary nerve transfer for restoration of midface sensation in face transplantation: cadaver feasibility study
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2012 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 32, no 4, p. 309-313Article in journal (Refereed) Published
Abstract [en]

Background:

The collected experience from facial allotransplantations has shown that the recovery of sensory function of the face graft is unpredictable. Unavailability of healthy donor nerves, especially in central face defects may contribute to this fact. Herein, the technical feasibility of transferring the supraorbitary nerve (SO) to the infraorbitary nerve (IO) in a model of central facial transplantation was investigated.

Methods:

Five heads from fresh cadavers were dissected with the aid of 3× loupe magnification. Measurements of the maximum length of dissection of the SO nerve through a supraciliary incision and the IO nerve from the skin of the facial flap to the infraorbital foramen were performed. The distance between supraorbital and infraorbital foramens and the calibers of both nerves were also measured. In all dissections, we simulated a central allotransplantation procedure and assessed the feasibility of directly transferring the SO to the IO nerve.

Results:

The average maximum length of dissection for the IO and SO nerve was 1.4 ± 0.3 cm and 4.5 ± 1.0 cm, respectively. The average distance between the infraorbital and supraorbital foramina was 4.6 ± 0.3 cm. The average calibers of the nerves were of 1.1 ± 0.2 mm for the SO nerve and 2.9 ± 0.4 mm for the IO nerve. We were able to perform tension-free SO to IO nerve coaptations in all specimens.

Conclusion:

SO to IO nerve transfer is an anatomically feasible procedure in central facial allotransplantation. This technique could be used to improve the restoration of midfacial sensation by the use of a healthy recipient nerve in case of the recipient IO nerves are not available secondary to high-energy trauma.

National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-163050 (URN)10.1002/micr.21944 (DOI)000303746900009 ()
Available from: 2011-12-07 Created: 2011-12-07 Last updated: 2018-01-12Bibliographically approved
Blomstrand, L., Sand, L. P., Gullbrandsson, L., Eklund, B., Kildal, M. & Hirsch, J.-M. (2012). Telemedicine: a complement to traditional referrals in oral medicine. Telemedicine journal and e-health, 18(7), 549-553
Open this publication in new window or tab >>Telemedicine: a complement to traditional referrals in oral medicine
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2012 (English)In: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 18, no 7, p. 549-553Article in journal (Refereed) Published
Abstract [en]

Introduction:

Introducing telemedicine into clinical practice has not been without difficulties. Within the framework of the European Union project "Health Optimum," telemedicine consultations with specialists at the Department of Oral & Maxillofacial Surgery at Uppsala University Hospital (Uppsala, Sweden) have been offered to dentists in the public dental health service. The aim is to streamline the consultation process, improve/develop the skills of the participating dentists and dental hygienists, and save time and money for patients, healthcare authorities, and society.

Subjects and Methods:

Patient records are collected in a database for demonstration and discussion, and the system is also available for referrals. Both medical and dental photographs and x-rays are digitized in the same system. These can be viewed during telemedicine rounds and by the consultants at the hospital prior to a consultation. Secure, interactive conferencing software is used, which provides a quick, easy, and effective way to share video and data over the Internet. Both parties can demonstrate different parts of an image using a pointer or a drawing system. Conference phones are presently used for verbal communication.

Results:

Ten patients were discussed during telemedicine rounds (3 males and 7 females), all of whom would normally have been referred to a specialist. As a result of the telemedicine round, 2 were referred to a specialist, whereas diagnoses were made for the other 8, and treatment was suggested. The dental health clinic could thus provide treatment without the need for referral to a consultant.

Conclusions:

The telemedicine system described here allows patient care to be provided rapidly and more economically. Future plans include "live" rounds using a videocamera, providing the possibility to relay real-time information about the intraoral situation. A camera is being developed and should preferably be permanently installed chair side.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181729 (URN)10.1089/tmj.2011.0207 (DOI)000308703300011 ()22823077 (PubMedID)
Available from: 2012-09-27 Created: 2012-09-27 Last updated: 2017-12-07Bibliographically approved
Willebrand, M. & Kildal, M. (2011). Burn Specific Health up to 24 Months After the Burn: A Prospective Validation of the Simplified Model of the Burn Specific Health Scale-Brief. Journal of Trauma, 71(1), 78-84
Open this publication in new window or tab >>Burn Specific Health up to 24 Months After the Burn: A Prospective Validation of the Simplified Model of the Burn Specific Health Scale-Brief
2011 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 71, no 1, p. 78-84Article in journal (Refereed) Published
Abstract [en]

Background: Outcome after burn injury is a multidimensional concept, but few multidimensional, injury-specific outcome measures have been psychometrically evaluated. A recent cross-sectional study using the Burn Specific Health Scale-Brief (BSHS-B) found three psychometrically sound health domains: function, skin involvement, and affect and relations. The aim of this study was to reexamine the psychometric properties of the BSHS-B using a prospective study design. Methods: Ninety-four consecutive adult patients with burns were included and asked to fill in questionnaires, the BSHS-B, the Hospital Anxiety and Depression Scale, and the short-form 36 (SF-36), at 6 months, 12 months, and 24 months postburn. Results: The factor structure was replicated and the three domains, function, skin involvement, and affect and relations, had excellent internal consistency. Over time the scores of function and skin involvement increased, indicating health improvement, whereas the domain affect and relations did not change over time. At 6 months and 12 months postburn, all domains were associated with burn severity. The function domain was highly associated with the SF-36 subscales physical functioning and role-physical, the affect and relations domain was highly associated with the Hospital Anxiety and Depression Scale and the SF-36 subscales denoting psychological health, and the domain skin involvement was highly associated with subscales indicating role-concerns, social functioning, vitality, and mental health. Conclusion: The psychometric properties of the BSHS-B domains were excellent and they had intelligible concurrent associations with other measures. Thus, the simplified model of the BSHS-B is a reliable, valid, and useful tool in describing postburn health over time.

Keywords
Burns, Questionnaire, Rehabilitation, Trauma, Validity
National Category
Surgery Psychiatry
Identifiers
urn:nbn:se:uu:diva-156669 (URN)10.1097/TA.0b013e3181e97780 (DOI)000292607400022 ()
Note

Conference: 13th Congress of the European-Burns-Association Location: Lausanne, SWITZERLAND Date: SEP, 2009

Available from: 2011-08-09 Created: 2011-08-07 Last updated: 2017-12-08Bibliographically approved
Willebrand, M. & Kildal, M. (2008). A simplified domain structure of the Burn-Specific Health Scale-Brief (BSHS-B): A tool to improve its value in routine clinical work. Journal of Trauma, 64(6), 1581-1586
Open this publication in new window or tab >>A simplified domain structure of the Burn-Specific Health Scale-Brief (BSHS-B): A tool to improve its value in routine clinical work
2008 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 64, no 6, p. 1581-1586Article in journal (Refereed) Published
Abstract [en]

Background:

Injury-specific instruments with good psychometric properties are valuable in the assessment of health status after trauma. Previous studies of burn-specific health have attempted to create broad domains such as physical and psychological health, but these domains have not been validated. In this study, burn-specific health domains were explored and validated by a factor analytic approach.

Methods:

Participants were 334 former burn patients injured between 1980 and 2000. Data were collected from medical charts and by a postal questionnaire, the Burn Specific Health Scale-Brief (BSHS-B). The nine subscales of the BSHS-B were subjected to second-order factor analysis. The sample was split into two subsamples that were equal with respect to burn severity.

Results:

The factor structure was well replicated in each of the subsamples and in the total sample. Three internally consistent and well separated domains were derived: affect and relations (BSHS-B subscales interpersonal relationships, affect, sexuality), function (simple abilities, hand function), and skin involvement (heat sensitivity, treatment regimens, body image). The work subscale of the BSHS-B was excluded from the analysis because of consistent double loadings. The three domains had intelligible associations with injury-specific and sociodemographic variables.

Conclusion:

The underlying structure of the BSHS-B comprises three clinically meaningful health domains. The work subscale is not part of these domains and can be considered a separate outcome domain. The domain scores increase the understanding of outcome after burn injury and could prove useful in clinical use of the BSHS-B.

Keywords
burns, questionnaire, rehabilitation, outcome scale, trauma
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-149659 (URN)10.1097/TA.0b013e31803420d8 (DOI)000256744100029 ()
Note

Conference Information: 13th Congress of the International-Society-for-Burn-Injuries Fortaleza, BRAZIL, SEP 25, 2006

Available from: 2011-03-23 Created: 2011-03-22 Last updated: 2017-12-11Bibliographically approved
Wikehult, B., Kildal, M. & Willebrand, M. (2008). Patient satisfaction with burn care 1-6 years after injury. Burns, 34(6), 783-790
Open this publication in new window or tab >>Patient satisfaction with burn care 1-6 years after injury
2008 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 6, p. 783-790Article in journal (Refereed) Published
Abstract [en]

Patient satisfaction is an important outcome in health care but has not been studied in relation to burn care. The aim was to explore factors related to satisfaction with care 1-6 years after a burn. Participants were 86 adult burn patients, injured on average 3.6 years previously. The Patient Satisfaction-Results and Quality (PS-RESKVA) was used to assess satisfaction. It has four subscales: Quality of contact with the nursing staff (QCN), Quality of contact with the medical staff (QCM), Adequate treatment information (INF) and Global satisfaction with treatment (GS). Further, data were gathered regarding personality traits and health. Average scores for QCN were significantly higher than scores for the other subscales, and INF received the lowest mean score. In multiple regressions, the PS-RESKVA subscales were associated with better interpersonal relationships (all PS-RESKVA subscales), more sensation seeking (QCM, INF, and GS) and less aggressiveness (QCM and GS). Other variables contributed to a lesser degree. Total amount of explained variance ranged between 18% and 25% for the PS-RESKVA subscales. In summary, satisfaction with burn care was only moderately explained by health and personality characteristics. Further, former patients rated satisfaction with nursing staff higher than other aspects of care, especially information routines.

Keywords
Burns, Information, Nursing, Outcome, Patient satisfaction, Quality
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97496 (URN)10.1016/j.burns.2007.11.001 (DOI)000259017200005 ()18378086 (PubMedID)
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2017-12-14Bibliographically approved
Dyster-Aas, J., Kildal, M. & Willebrand, M. (2007). Return to work and health-related quality of life after burn injury. Journal of Rehabilitation Medicine, 39(1), 49-55
Open this publication in new window or tab >>Return to work and health-related quality of life after burn injury
2007 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 1, p. 49-55Article in journal (Refereed) Published
Abstract [en]

Objective: Although severe burn injury is associated with long-term rehabilitation and disability, research on returning to work in burn patients is limited. The aims of this study were: (i) to explore injury- and personality-related predictors of returning to work, and (ii) to compare health-related quality of life and health outcome in working versus non-working individuals.Design: Cross-sectional study.Subjects: Forty-eight former patients with pre-burn employment were evaluated on average 3.8 years after the burn.Methods: Data were collected from medical records and by a questionnaire in which the patients were asked about their main activity status described in the terms: work, studies, pension, disability pension, sick leave or unemployment. It also contained the Swedish universities Scales of Personality, SF-36, Burn Specific Health Scale-Brief, items assessing fear-avoidance, Impact of Event Scale-Revised and Hospital Anxiety and Depression Scale.Results: Thirty-one percent had not returned to work. In logistic regression, returning to work was associated with time since injury, the extent of full-thickness injuries, and the personality trait embitterment. Those who did not work had lower health-related quality of life, poorer burn-specific health, more fear-avoidance and more symptoms of post-traumatic stress disorder, but they did not differ from those who were working regarding general mood.Conclusion: Returning to work was explained by both injury severity and personality characteristics. Those who did not work were characterized by low health-related quality of life and poorer trauma-related physical and psychological health.

Keywords
Adjustment, BSHS-B, Burns, Personality, SF-36, Trauma
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-95103 (URN)10.2340/16501977-0005 (DOI)000244355400009 ()17225038 (PubMedID)
Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2017-12-14Bibliographically approved
Arvidson, J., Kildal, M., Linde, T. & Gedeborg, R. (2007). Toxic epidermal necrolysis and hemolytic uremic syndrome after allogeneic stem-cell transplantation. Pediatric Transplantation, 11(6), 689-693
Open this publication in new window or tab >>Toxic epidermal necrolysis and hemolytic uremic syndrome after allogeneic stem-cell transplantation
2007 (English)In: Pediatric Transplantation, ISSN 1397-3142, E-ISSN 1399-3046, Vol. 11, no 6, p. 689-693Article in journal (Refereed) Published
Abstract [en]

TEN and HUS are challenging complications with excessive mortality after HSCT. We report the development of these two conditions in combination in a nine-yr-old boy after HSCT from an unrelated donor. TEN with skin detachment of more than 90% of body surface area developed after initial treatment for GvHD. Within a few days of admission to the burns unit, the patient developed severe hemolysis, hypertension, thrombocytopenia, and acute renal failure consistent with HUS, apparently caused by CSA. The management included intensive care in a burns unit, accelerated drug removal using plasmapheresis, and a dedicated multi-disciplinary team approach to balance immunosuppression and infections management in a situation with extensive skin detachment. The patient survived and recovered renal function but requires continued treatment for severe GvHD. Suspecting and identifying causative drugs together with meticulous supportive care in the burns unit is essential in the management of these patients and long-term survival is possible.

Keywords
children, allogeneic stem cell transplantation, hemolytic uremic syndrome, toxic epidermal necrolysis, cyclosporine A, plasmapheresis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-85160 (URN)10.1111/j.1399-3046.2007.00743.x (DOI)000249004000021 ()17663696 (PubMedID)
Available from: 2007-08-14 Created: 2007-08-14 Last updated: 2017-12-14Bibliographically approved
Willebrand, M., Andersson, G., Kildal, M., Gerdin, B. & Ekselius, L. (2006). Injury-related fear-avoidance, neuroticism and burn-specific health.. Burns, 32(4), 408-15
Open this publication in new window or tab >>Injury-related fear-avoidance, neuroticism and burn-specific health.
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2006 (English)In: Burns, ISSN 0305-4179, Vol. 32, no 4, p. 408-15Article in journal (Refereed) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-80233 (URN)16621317 (PubMedID)
Available from: 2006-12-20 Created: 2006-12-20 Last updated: 2017-01-24
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