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trans curly fan art question mark? (No pressure👽)

yeah

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I really should come back to this account and post more analysis stuff but I'm really bad at splitting focus 😭

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I never post on this account anymore omg... hi 🫡

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I crave nicotine like a bitch in heat. I'm ovulating.

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I am so sorry for these ridiculously long ass posts... I promise I'm done now LOL.....

unless....

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I am quickly becoming Grant Curly's medical examiner and I'm not even mad about it.

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I don't know much about 'skin things' but I do have a little bit of information on it for those who are interested! (I hope you don't mind me using your comment). I'll be supplementing my knowledge with some research under the read more.

Skin grafting is a dermatological procedure utilized to facilitate wound closure.

We'll talk about some commonly used techniques:

1. Split-Thickness Skin Grafts (STSG) are composed of the epidermic and a superficial part of the dermis. These grafts are commonly used to cover large wounds, burns, and areas of skin loss. They are thinner than full-thickness grafts, which allows them to cover larger areas.

2. Full-Thickness Skin Grafts (FTSG) contain both the full epidermis and the dermis. These grafts are typically used for smaller wounds in areas where aesthetics and durability are essential, such as the face, hands, or neck. Since FTSGs retain the full dermal layer, they offer better cosmetic outcomes, including improved texture, pigmentation, and reduced scarring compared to split-thickness grafts. They also tend to resist contracture better, making them ideal for regions requiring flexibility. - FTSGs are more complex because they require a well-vascularized wound bed to survive and heal. - FTSGs are the most commonly used graft.

3. Composite Skin Grafts are usually small and include a combination of skin and underlying tissues, such as fat, cartilage, or muscle. These grafts are used to reconstruct areas where multiple tissue types are needed to restore both form and function, such as the nose, ears, or fingertips. - Composite skin grafts which combine allogeneic dermis and an expanded autologous epidermis can effect rapid wound closure.

It is further broken down by the following:

Permanent Skin Grafts

1. Autografts (autologous graft): skin collected from the patient 2. Isograft (syngeneic graft): skin collected from a genetically identical donor (twin)

Temporary Skin Grafts

1. Allocrafts (heterologous graft): skin from a cadaver (living donors are possible) 2. Xenograft (heterograft): skin from another species

Can be Temporary OR Permanent

1. Synthetic skin substitutes: use of manufactured skin - The only technique that is permanent is cultured epithelial autograft (CEA), which is essentially a skin graft grown from a patient's own skin cells.

NO NON-SELF TISSUE IS GUARANTEED TO COMPLETELY AVOID DEATH OR REJECTION.

Transplant Rejection: a patients immune system identifies the graft as a foreign body, which triggers an immune response to get "rid" of the tissue.

Skin implant compatibility is based on three highly polymorphic MHC genes (HLA-A, HLA-B, and HLA-C) that encode proteins and are a part of the Human Leukocyte Antigen (HLA) system. This system identifies foreign bodies.

Knowing this, the use of modified donor animals, such as pigs, to provide transplantable organs, is gaining some renewed research. It involves excising the genes in the pig that are most responsible for the rejection reaction after transplantation. However, finding these genes and effectively removing them is a challenge.

The use of autologous skin grafts is the most common approach in the treatment of chronic wounds. However, in the case of deep and/or large wounds or with extensive severe burns, the use of autografts is limited, and either allogeneic (from cadaver) or xenogeneic skin grafts are used for transplantation.

The use of allogenic/xenogenic tissue carries a high risk of graft rejection, limiting their clinical applications.

Tissue Engineering

Advanced therapies for chronic wounds involve application of bioengineered artificial skin substitutes to overcome graft rejection as well as topical delivery of mesenchymal stem cells to reduce inflammation and accelerate the healing process.

Photo shows potentially ideal artificial skin graft:

Modern treatment includes skin tissue engineering aiming to produce bioengineered biomaterial-based artificial skin grafts. Therefore, the main roles of bioengineered skin grafts is to supply oxygen (by being oxygen permeable), keep the wound from dehydration, promote healing, and prevent infections. - Depending on the type of biomaterial used for the production of artificial skin grafts, they may function as skin equivalents providing temporary wound covers or permanent skin substitutes. - When the biomaterials are pre-seeded or have cells incorporated within their matrix, they are classified as cellular artificial skin grafts, whereas biomaterials without or deprived of cells are defined as acellular artificial skin grafts.

Here are some current commercially available synthetic skin grafts I found applicable to Curly's injuries:

Definitions for Clarity: 1. Epidermal: Pertaining to the outermost layer of the skin. 2. Cellular Content: the complex structures and biomolecules that make up cells, the smallest units of life. 3. Acellular: not consisting of, divided into, or containing cells. 4. Fibroblasts: a cell in connective tissue which produces collagen and other fibers. 5. Keratinocytes: an epidermal cell which produces keratin (a fibrous protein forming the main structural constituent of hair).

Articles to Reference

Organ Transplantation and Rejection by Libretexts biology. LINK

(CW: Images) Skin Grafting by Joseph Prohaska and Christopher Cook. LINK

A Concise Review on Tissue Engineered Artificial Skin Grafts for Chronic Wound Treatment: Can We Reconstruct Functional Skin Tissue In Vitro? by Agata Przekora LINK

Composite skin graft: frozen dermal allografts support the engraftment and expansion of autologous epidermis by E L Heck, P R Bergstresser, C R Baxter LINK

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My headcanon for Jimmy’s lip scar is that he ate the road while trying to learn how to ride a skateboard

These are my favorite. The thought of him doing something so mundane is hilarious to me. Don't get me wrong I love the "bar fight" stuff too but this.... this is delicious.

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I'm surprised people really enjoyed my post about Curly's injuries I should do stuff like that more often....

Anya post coming soon :3

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Considering your post about Curly's injuries, how would you make that work in an AU where Curly survives?

This is actually an interesting question thank you for asking!

Honestly, no matter what your interpretation of events is, you have to remember to make what you want to make. Mouthwashing is fictional and futuristic, so ANYTHING goes. Just because real-world medical knowledge says one thing doesn't mean that you need to stifle your creativity in order to "make things work".

But, since you asked, here is a short list of things I think people could consider when going about a Curly survives AU (in line with canon events)!

1. Futuristic adaption to the chicken egg membrane dressings for cutaneous wounds as an easily producible, emergency 'fake skin' for burn victims. Mass-produced medical supplies can be ordered at a significant discount by companies. It would be interesting to see if it would be able to NOT REPLACE autografts and allografts, but to act as some type of temporary care. Laid in sheets across the body after debriding (removal of dead, infected, or damaged tissue from a wound) with antibacterial properties.

2. Consider injectable medication. In my last post I talked about the likelihood of nutrition and IV fluids. If injectables and needles are present on the ship, add Ceftriaxone as an injectable antibiotic to the medical room supply closet.

3. Proper upkeep and storage of personal protective equipment. Things like eye flush kits/stations, eye drops, and gels for chemical burns to the eyes.

4. Downgrade burn severity to 2nd degree burns on 82% TBSA to raise survivability. This speaks for itself.

5. Include medical text or other informative media in the medical room. It's not much, but it's better to have something to refer to while caring for Curly.

6. Reconsider Anya's medical training as 'inadequate' and not 'nonexistent'. For her to board the Tulpar and not be a liability risk, she must have gone through some type of company training. A personal headcanon of mine is that it's a watered down curriculum that includes proper treatment and disposal of a corpse in case of death on board. I could make an entire additional post about this but I will spare you after my first one LOL.

7. Research the hypermetabolic response in victims of severe burns. The hypermetabolic response follows burns greater than 40% TBSA. There is a 10-fold surge of plasma catecholamine and corticosteroid levels. This means that Curly would have increased resting energy expenditures, increased cardiac activity, increased oxygen consumption, severe lipolysis, liver dysfunction, severe muscle catabolism, increased protein degradation and insulin resistance. Understanding what it is and how to treat it will give some great insight! (See link under Read More)

Additional Information and Referenced Articles

Assessment of Chicken-Egg Membrane as a Dressing for Wound Healing by Fernando Guarderas, Yaowaree Leavell, Trisha Sengupta, Mariya Zhukova, and Timothy L Megraw. LINK

The Hypermetabolic Response to Burn Injury and Interventions to Modify This Response by Felicia N Williams, David N Herndon, and Marc G Jeschke. LINK

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If I die plz know its because of my classes getting the best of me. 8AM is too early to be logging into zoom 🥲

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A Deep Dive into Curly's Injuries

CW: Medical discussion and graphic themes.

I see a lot of people discussing Curly's injuries in the fandom and I thought that I would take some time to absolutely word vomit information for consideration as someone training in the medical field.

Burns and Calculating Total Body Surface

Starting off simple, we’ll discuss the following burns:

First degree burns only affect the outer layer of the skin (epidermis). Second degree burns, or partial thickness burns, affect both the epidermis and part of the layer underneath (dermis). Third degree burns, or full thickness burns, affect all layers of the skin, fat, and muscle. Third degree burns DO NOT HURT as they destroy the nerves.

Typically you will not see significant 4th degree burns premortem- they are often postmortem and resemble more of a char. The body is basically cremated/incinerated. I'll touch more on this further down.

The rule of nines is the method for estimating the percentage of affected body surface (size of the burn). I used this to roughly estimate that Curly is burned anywhere from 82-91% of his total body surface. We don't see his backside, but assuming he walked into the cockpit before the crash it is POSSIBLE that his backside isn't as burnt.

Note the R-Baux score and prediction of burn-related mortality (TBSA – Age + [17 x R] TBSA: total body surface area R: 1 (Inhalation injury) or 0 (No inhalation injury)

Amputation Possibility and Weight of Risk

While there are a lot of factors to keep in mind when it comes to Curly’s condition and subsequent survival, in order to connect reality and canon the following needs to be considered.

We'll go over two of the most popular interpretations post-crash:

1. Anya performing amputation as a preventative measure.

We have to think about the veins and arteries in the human body when discussing rudimentary amputation.

Note: Arteries carry blood away from the heart to the body, while veins carry oxygen-poor blood back to the heart. Arteries and veins are connected by capillaries. Direction as follows:

Risk to major arteries and veins would potentially result in excessive blood loss (we will focus on arteries since they are larger in diameter and their ability to withstand high pressure from pumping blood). Repairing arteries typically requires surgical intervention.

Curly's right arm ends at the wrist, while his left ends midway up the forearm. This would sever the radial and ulnar arteries.

Curly's right leg ends just below the knee. The popliteal (back of the knee) artery is the continuation of the femoral artery- one of the largest arteries in the body.

Curly's left leg ends about midway down his calf. We can assume that severs the posterior and anterior tibial arteries.

The image below is a quick edit and isn't an accurate representation of location, only a rough diagram.

Note: The legs network of small arteries are available to SOMEWHAT compensate for blood flow if one of the major arteries is damaged, but it likely wouldn't be enough to prevent excessive blood loss.

We CAN consider cauterization in emergency situations; however it would require some ingenuity and a significant heat source. Small tools that could be repurposed to cauterize Curly’s wounds would do more harm than good, and it is likely that Pony Express has banned large, heat producing objects. They ARE on a space freighter with artificial gravity and set oxygen levels, after all.

Lack of proper equipment and medical knowledge would make amputation unsurvivable.

2. Curly's limbs were eviscerated by the crash.

This is where we talk more about the possibility of fourth degree burns and what that means.

Fourth degree burns are the most severe type of burn that affects muscles, tendons, and bone.

Where to position Curly in the cockpit during the crash is… tricky.

It’s difficult to imagine the angle he would need to be in order to sustain full body burns and loss of limbs. This is the part I pondered the most, and I think a good explanation would be electrical burns from the control panel on impact.

Electrical burns are carried by nerves because it is the path of least resistance. Extremities are more susceptible to damage when a current passes through them. (Yes, this means his genitals are gone too. Sorry, folks!) *See article on electric extremity injury under Read More

Facial Injury and Eye Trauma

Moving towards Curly’s face we come back to our discussion of third degree burns, which I’ve explained a bit above. I do want to note that the survival of his left eye interested me the most while compiling this post.

Your eyes don’t melt in extreme heat (goofy ahh Indiana Jones shit).

Your eyes are mostly composed of water, which makes them resistant to combustion. Since we never directly see the eye socket beneath the bandaging it’s reasonable to assume that his right eye is not entirely destroyed but instead severely damaged (flattened, scarred, cloudy). Without eyelids or even eye drops his remaining eye would dry, potentially blinding him if the heat on impact didn't.

Another point of interest is Jimmy manually manipulating Curly’s mouth several times throughout the game.

This rounds back to third degree burns and the damage to the superficial masseter muscle (moves the lower jaw upward – mastication, or ‘protrusion of the mandible’), the deep masseter muscle (retraction of the mandible – mastication, or ‘closing the jaw with force’), the temporalis muscle (mastication, enabling jaw movement for chewing, biting, and grinding), and surrounding tendons.

Knowing this, a ‘slack jaw’ position would cause visible oral damage like dry mouth and halted saliva production. I’ll touch more on this below.

Loss of Skin and Infection

The skin is the largest organ in the human body with a variety of life sustaining functions like protection and excretory function.

In Curly’s condition, the loss of his skin leaves him open to systematic infection. Skin protects against infection by producing antibacterial substances (defensins and cathelicidins), which greatly increase when injury or inflammation are present. Without skin your body's natural defenses no longer protect against bacteria.

Pathological vulnerability is the key factor in this section. A severe and sometimes fatal response to infection (sepsis) would likely occur under these conditions without proper medical care and antibiotics.

Administering Water, Food, and Medication

This section is where some interpretation comes into play.

The average healthy person can survive approximately three weeks without food and 3 days without water (both vary greatly). According to the games timeline he was kept alive in this state for four months, which means that somehow, in some way, they were able to get him enough nutrients for basic human survival.

This was likely in the form of paranutrition bags and IV fluids since Curly does not seem to have the ability to move his mouth or swallow on his own. When your mouth is kept open for extended periods of time you stop salivating as frequently because the act of swallowing, triggered by the build-up of saliva, is no longer happening.

When having medication administered, Jimmy can be seen (or more so heard) shoving the pills down Curly’s throat with his fingers.

I can’t help but speculate that additional damage was done to his esophagus and vocal cords since there isn’t a way to push the pills far enough down to avoid the steady breakdown of the medication in his throat.

Without properly swallowing pills Curly most likely developed pill esophagitis (irritation of the esophageal lining), which causes painful acid reflux.

Speculation of Internal Injury

This is more presumptive than other sections.

Due to previous notes regarding the source and nature of Curly’s wounds, it is reasonable to assume that not only is smoke inhalation a contributing factor, but ash, technological equipment, and shrapnel also run the possibility of entering his lungs on impact.

However, when I was looking into photos of the cockpit post-crash it brought another potential inhalation/consumption risk to mind; the expanding foam.

It is known that it expands to cover potential weak spots in the ship, so the strength of the substance needs to withstand the pressure of space and maintain the artificial gravity. The cockpit is covered in it, so it is possible that in some way Curly was physically in contact with it when the crash occurred.

Whether he ingested or inhaled it something to consider, but externally there must have been some effort removing the foam from his already burnt skin.

So, what does this mean, Leo? What’s your point?

Well, there is no real point to be made. Everyone is going to interpret things differently! I just thought it would be cool to put forth some real world medical knowledge and compare it to canon! I AM STILL IN TRAINING and I have a lot to learn, but I wanted to put something together for you guys! You can take something from it, or nothing at all!

Final Notes:

Realistic Prognosis (prediction of outcome):

Without medical treatment total body third degree burns are NOT SURVIVABLE.

Extended periods of festering and infection would make skin grafting impossible (There is some wiggle room with this depending on how you perceive medical care to have changed- but I do think it's important to consider the limits of the human body).

🖤 If you made it to the end, thank you for reading! 🖤

Thank you so dearly to my love, my life, @13nn0x for the help compiling information and just generally being the sexiest person alive.

Some extra articles to refer to:

Note: Some articles include images but I put a warning on the ones that do.

(CW: Includes Photos) Clinical spectrum of electrical burns - A prospective study from the developing world by Ashok Kumar Sokhal, Krishna Lodha, and Rajkumar Paliwal. LINK

(CW: Includes Photos) Electro-Amputation of Lower Limbs Due to a High-Voltage Shock: Report of an Unusual Case by Suraj Sundaragiri, Senthil Kumaran M, Venkatesh Janarthanan, Chaitanya Mittal, Gerard Pradeep Devnath S. LINK

Ocular Burns by Gregory C. Patek, Amanda Bates, and Allison Zanaboni. LINK

Drug-Induced Esophagitis by Fatima Saleem and Ashish Sharma. LINK

Better among the two for Burn Mortality Prediction in Developing Nations: Revised Baux or Modified Abbreviated Burn Severity Index? by Sheerin Shah, Renu Verma, Rajinder K Mittal, Ramneesh Garg. LINK

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Ima be so fucking fr my stomach hurts soooo bad nevermind on tonights post 😭😭😭😭

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GUYS LET ME COOK A MINUTE I GOT A LONG ASS POST COMING

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Mod Post: I wasn't going to show my young Jimmy and Curly edits (I made them mostly for silly joke asks) but a few people were interested so I figured I'd post them here.

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Hanging out