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 |
Volume
XII |
Number
3 |
September
1999 |
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Summaries
| 131 |
BURNS: THE
IMPORTANCE OF THE DOMESTIC ENVIRONMENT
Santos Heredero Ex., Jimetnez Garcia R., Sanchez-Gabriel Lopez J.,
Marfinez Hernandez D., Arroyo Romo, Hamann C. - Spain
An analysis was
made of the 119 patients treated for burns between 1 January 1996 and 31 October 1997 in
our department. We considered the burned body surface area (BSA), depth of burn,
localization, mechanism of burn, place of accident, age, and sex. Children and the elderly
were the groups with the greatest risk of suffering burns. Lesions by liquids constituted
60% of the cases. The average BSA was 20%. Dermal burns were involved in 74.8% of the
cases, the most common localization being the upper extremity (44%). At all ages the
highest prevalence was that of burns in the home, especially among children and the
elderly. The different rates between men and women who suffered burns in the home were
statistically significant (p < 0.001). Burns due to scalding liquids were the commonest
form in the home, with significant differences as regards other types of burn (p <
0.01). These data confirm that the home is the place most at risk for burns, especially in
children and the elderly, and that the domestic environment is the commonest site for
lesions due to scalding liquids. |
| 139 |
SURVIVAL IN PAEDIATRIC
BURNS INVOLVING 1100% TOTAL BODY SURFACE AREA
Barrett J.P., DesaiI M.H., Herndon D.N. - USA
Background: Survival
following severe thermal injury has improved during the last two decades. The question of
when futility of treatment is reached has however not yet been resolved. We hypothesized
that even patients with the largest burn size (i.e. 100%) are candidates for survival. Methods:
To test our hypothesis, we reviewed all paediatric burn patients admitted to our
centre in the last 10 years suffering from full-thickness burns in over 98% TBSA. Survival
and favourable outcome were the primary endpoints, Findings: Six patients were
admitted in the last 10 years with full-thickness burns in over 98% TBSA. Three patients
survived and were successfully discharged home after a mean hospital stay of 126 ± 50
days. One patient was covered with cultured epidenual autografts, while the rest of
survivors received widely expanded meshed skin autografts. The patients required 13.3 ±
3.7 operations to achieve wound closure.
Interpretation: Survival following massive burn injuries of 100% body area
with a 99% full-thickness component is feasible. All paediatric burns, regardless of burn
size, are candidates for treatment and survival. |
| 142 |
EXAMINATION OF SERUM
ZINC, COPPER, MAGNESIUM, AND IRON LEVELS IN PATIENTS WITH ELECTRIC AND FLAME/SCALD BURNS
Gumus N., Safran Z.B., Acarturk S., Abdulrezzak A. - Turkey
In this study, 5
cc venous blood samples were taken on the Ist, 4th, 8th, 13th, and 20th days post-burn
from 17 patients with high-tension electric burns, 14 with flame burns, and one with scald
burns. Scrum zinc, copper, magnesium, and iron levels were determined using an atomic
absorption spectrophotometer. Venous blood samples were taken from 20 healthy volunteers
as control levels for these elements. The results were evaluated using the Mann-Whitney U
test. On each day the serum levels of the elements were found to be significantly lower
than those of the control group (p < 0.05). The element levels in the electric bum
patients were also markedly lower than those in the healthy group (p < 0.05). A
comparison of the element levels in the flame and scald burn patients with those of the
electric bum patients by means of the Mann-Whitney U test did not reveal any differences
(p > 0.05). |
| 146 |
ANTIBIOTIC SALICYLATE VASELINE: A TOPICAL TREATMENT OF CHOICE IN
BURNED DIABETIC PATIENTS?
Napoli B., D'Arpa N., Iaia A., Sferrazza G., Masellis M. - Italy
The healing of burns in
diabetic patients is delayed by the vascular obstruction due to the disease and by the
effects of diabetes (insufficient inflammatory response, insulin insufficiency and/or
resistance). Local treatment is thus of fundamental importance for the healing of the
wounds and for metabolic compensation, which is closely related to healing and which in
turn it affects. In their clinical practice, the authors of this paper use antibiotic
salicylate vaseline as their elected topical treatment of burns in diabetic patients in
the light of the fact that antibiotic salicylate vaseline has a keratolytic and
antimicrobial effect, improves local circulation, and increases the activity of insulin. |
| 150 |
SUBESCHAR INFILTRATION OF EPINEPHRINE PRIOR TO EARLY EXCISION OF
BURN WOUNDS - TECHNICAL REFINEMENTS
Janezic T. - Slovenia
The early excision of
burn wounds may lead to massive blood loss, which often becomes a major factor limiting
the excision area. In order to diminish intra-operative blood loss following early
excision of burn wounds, epinephrine solution may be injected under the burn eschar prior
to excision. At the Burns Unit in Ljubljana (Slovenia) the technique of subeschar
infiltration of epinephrine solution was started in 1988. Up to now the technique has been
used in more than 500 patients. During the last ten years of clinical experience with this
technique, several important technical details have been found to be important. The most
important points of this technique are anaesthesia, the concentration of epinephrine
hydrochloride, marking of the area to be inoltrated, the instruments used, the plane of
infiltration, the time interval between infiltration and excision, assessment of the
burned tissue to be excised, the volume of epinephrine solution injected, and haemostasis.
All these factors are described and discussed in this report. |
| 154 |
ADIPOFASCIAL TURN-OVER FLAP COMBINED WITH NERVE
RECONSTRUCTION IN SEVERE INJURY OF THE ELBOW
Calcagni M., Liguori G.C., Bollero D., Clemente A., Risso D., Stella M. - Italy
Severe injury of
the elbow involving nerves is quite common. Several techniques have been proposed for
resurfacing this region: distant pedicled flaps, muscle and musculocutaneous flaps,
fasciocutancous flaps, and free flaps. The appropriate indications for all these
techniques are still controversial. In recent years adipofascial tum-over flaps have been
used. These can be raised without sacrificing the overlying skin and tailored in thickness
to fill different defects. The flap is outlined on the flexor aspect of the arm. The
subcutaneous layer is exposed through an H-shaped incision, The skin is dissected at
dermal level and the subcutaneous tissue with the deep fascia is then elevated in the
planned size. A two-centimetre pedicle is left intact proximal to the defect and the flap
is turned over to fill it. Two cases treated with this technique are presented. |
| 158 |
FREE ARTERIALIZED VENOUS FLAP
Ayad H.M. - Egypt
Free flap
transplantation is an important method for the surgical resurfacing of soft tissue defects
in all parts of the body. The arterialized venous flap technique depends on the use of two
veins in the skin flap that are used respectively for arterial flow and venous drainage.
The blood in the arterialized venous flap disperses faster and over a larger area than in
flow-through venous island flaps. Survival depends on the size of the flap, arterial
inflow, and venous outflow. For good results, an arterialized venous flap should be
designed to contain most of the venous network in the centre, the arterial inflow should
be anastomosed to one afferent vein, and two or more efferent veins should drain the
arterialized venous flap. Nine cases of skin defects were treated with a free arterialized
venous flap. The aetiology of the defects was secondary to release of scar contracture.
Five patients were suffering from post-bum contracting scars. Two cases were secondary to
post-traumatic scar and two cases presented a recent traumatic skin defect. The results
showed that the arterialized venous flap was useful as a free flap in small soft tissue
defects. It is an easily elevated, thin flap that can be harvested with little morbidity
from a wide variety of donor sites. |
| 164 |
SUPERIORLY BASED NIPPLE-AREOLA COMPLEX FLAP: A MILESTONE
FOR RECONSTRUCTION OF THE POST-BURN DEFORMED BREAST
Elsayed M. Abdel-Razek - Egypt
Post-burn
deformities of the female breast pose a problem for plastic and reconstructive surgeons as
well as psychological problem, for the patient. The female breast is roughly circular,
except at the upper outer quadrant where the axillary tail of Spence extends to the
axilla. To achieve good cosmetic results we should endeavour to regain the shape of the
breast and the nipple-arcola complex. In this study we reconstructed 35 breasts in 23
females suffering from post-burn deformed breasts, including malpositioned or destroyed
nipple-arcola complex, in patients aged 16 to 23 yr. In all patients we made a superiorly
based nipple-areola complex Hap with two kiteral flaps advanced below it to provide
protrusion, in addition to shifting whole breast tissues upwards into the correct
position. The post-operative results and follow-Lip have proved satisfactory to
both surgeon and patients. We recommend employing this technique in the reconstruction of
the burned female breast. |
| 168 |
LONG-TERM PSYCHOLOGICAL EFFECTS OF BURN UNIT ADMISSION
AMONG PAEDIATRIC PATIENTS WITH MINOR BURNS
Haddadin K.J., Kurdy K.A., Haddad A.I. - Jordan
This is a study
of the long-term psychological effects of burn unit admissions among paediatric patients
with minor burns treated at the Burn Unit in the Farah Royal Jordanian Rehabilitation
Centre/King Hussein Medical Centre. The psychological assessment was made by means of an
interview and a questionnaire conducted on 98 children with a minimum follow-up period of
30 months post-burn, during visits to the Burn Rehabilitation Out-patients Clinic. The
cohort of patients examined were children less than 12 years of age (average age on
admission, 4.2 yr) admitted to hospital for the treatment of minor burns over the 3-year
period 1 January 1993 to 31 December 1995. The patients were divided into two groups: 57
patients treated in the restricted Burn Unit, with parental separation, and a control
group of 41 patients treated in the open Paediatric Ward, without parental separation. The
effects on social integration, family and peer group acceptance, self-esteem, and
behaviour were studied. Relevant factors such as place of treatment, age, sex, cause and
site of burn, burn surface area, and hospital stay were analysed. There was no
statistically significant difference between the Burn Unit and the control groups with
respect to the Total Psychological Score for each patient. Patients with a hospital stay
longer than 14 days had significantly lower Total and Individual Psychological Scores.
There were more significant behavioural changes among patients treated in the restricted
Burn Unit, as also among patients with a larger total burn surface area. Recommendations
to minimize the long-term psychological effects of hospitalization include the reduction
of overall hospital stay, the reduction of burn unit stay to the minimum necessary for
critical care, and the reduction of the period of parental separation. |
| 174 |
POST-CIRCUMCISION KELOID - A CASE REPORT
Usama Saad Eldin - Egypt
Circumcision,
performed for religious reasons at or after birth, is a relatively simple operation to
perform with relatively few complications. However, any complication arising from this
operation should be viewed with dismay. A very rare complication is a post-circumcision
keloid, observed in 1994 in a boy from Aswan, Egypt. Circumcised one year before
presenting, the boy had a huge mass obscuring the entire penis except the glans penis,
extending proximally to the suprapubic region. Excision of the mass and histopathological
studies proved it was a keloid. Reconstruction of the penis and suprapubic region was
achieved with satisfactory results. |
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