Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Molly C. Gaffney, OMS-I 2 ; Jessica T. Reid, MS-II 1 ; Laurel E. Adams, MS-I 3 ; Adam Shalek, DO 1 , Abigail E. Chaffin, MD, FACS, CWSP, MAPWCA 1 1 Tulane University School of Medicine, Department of Surgery, Division of Plastic Surgery, New Orleans, Louisiana; 2 VCOM-Louisiana; 3 Louisiana State University School of Medicine, New Orleans, Louisiana 53 NOVEL APPROACH IN THE REPAIR OF RECURRING ACHILLES TENDON RUPTURE: A CASE REPORT

Benjamin Bich, OMS-IV 1 ; Shannon Faulkinberry, MD 1 VCOM-Louisiana; 2 Willis Knighton, Department of Pediatric Critical Care 54 DEXMEDETOMIDINE-ASSOCIATED HYPERTHERMIA IN A TODDLER: A CASE REPORT

Context: This case report describes a complex reconstruction of a recurrent Achilles region wound after Achilles tendon rupture (ATR) using a bipedicled fasciocutaneous advancement flap based on lateral calcaneal artery perforating blood vessels. Report of Case: A 72-year-old male presented with a nonhealing posterior left ankle wound and a complex history of multiple ATRs, skin substitute grafts, and skin grafts. The wound was fibrotic with recurrent infections managed by infectious disease. Vascular evaluation showed a normal ankle-brachial index. The patient underwent excisional sharp debridement and bipedicled fasciocutaneous advancement flap reconstruction, based on lateral calcaneal artery perforators preserved to enhance flap viability. A skin graft was applied to the donor site, and medial undermining reduced closure tension. The wound was dressed with multilayer compression and immobilized in a CAM walker boot. Postoperative care included a three-day inpatient stay, culture-directed antibiotic therapy, and outpatient wound management. Due to venous congestion and partial necrosis of the skin medial to the flap, the patient underwent

a second procedure for debridement and flap readvancement with complex closure and skin graft. Compression and immobilization were reinitiated, and multidisciplinary postoperative care was continued. Following the second procedure, the patient healed well with full healing of his flap and skin grafts without further signs of infection, venous congestion, necrosis, or wound dehiscence. At follow-up, the wound demonstrated complete healing with stable soft tissue coverage and no recurrence of ATR. Conclusions: Achilles Tendon Rupture is a common, debilitating injury, often resulting in poor outcomes due to healing via scar tissue formation. While management remains debated, surgical repair generally yields favorable results by reducing complications and preserving function. Chronic posterior ankle wounds, especially in patients with prior surgeries and tendon injuries, pose significant reconstructive challenges due to minimal surrounding soft tissue and vascularity. Successful reconstruction requires tension-free closure, vascular preservation, and protection of critical structures. This case highlights the effectiveness of a bipedicled fasciocutaneous

advancement flap in managing complex Achilles tendon wounds in patients with compromised local tissue. Success was attributed to the preservation of perforators, meticulous technique, and prompt intervention for flap complications. Flap readvancement emphasized the need for close postoperative monitoring, especially in high-risk patients. Multidisciplinary care and limb immobilization further supported recovery. Tailored, vessel-preserving reconstructive approaches offer a reliable option for managing complex posterior ankle wounds in high-risk patients and optimizing long-term outcomes.

Context: Dexmedetomidine is widely used for pediatric ICU sedation due to its favorable respiratory profile, but hyperthermia is an underrecognized adverse effect. This case highlights severe, refractory hyperthermia in a toddler that resolved only after discontinuation of dexmedetomidine, emphasizing medication induced fever in pediatric hyperpyrexia. Report of Case: A 1-year-10-month-old female with umbilical hernia and Veau class II cleft palate was admitted to the PICU after elective palatoplasty and hernia repair. She was intubated and mechanically ventilated; sedation included continuous dexmedetomidine infusion. Hospital days 0–1 were uneventful. On day 2, she developed worsening hyperthermia despite acetaminophen, ibuprofen, and ketorolac. Blood, urine, respiratory cultures, viral testing, and chest imaging were negative. Broad spectrum antibiotics were empirically started. Labs showed normal lactate and modestly elevated creatine kinase, with mild metabolic acidosis. Malignant hyperthermia and propofol infusion syndrome were considered but deemed unlikely due to absence of muscle rigidity, hyperkalemia, severe metabolic derangement, or

cardiovascular instability. On day 3, temperature peaked at 104.9°F. Dexmedetomidine was discontinued, and the patient became afebrile overnight, normalizing to 96–97°F within 24 hours without further intervention. Conclusions: A literature review was conducted using PubMed and Google Scholar for “dexmedetomidine hyperthermia,” and “pediatric dexmedetomidine hyperthermia.” Case reports, series, and reviews were included to compare patient age, clinical course, labs, and response to drug discontinuation. Dexmedetomidine associated hyperthermia is increasingly reported in adults, but pediatric cases are rare. Similar to prior reports, our patient had escalating fever during infusion, refractory to antipyretics, with rapid defervescence after cessation. Unlike most reports, our patient’s hyperthermia didn’t escalate until 30 hours into the infusion. This case underscores the importance of considering medication-induced hyperthermia in critically ill pediatric patients; early recognition and dexmedetomidine discontinuation may prevent unnecessary testing, prolonged antibiotics, and escalation of care.

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2026 Research Recognition Day