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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
(EXAMINATION OF SERUM ZINC, COPPER, MAGNESIUM, AND IRON LEVELS IN PATIENTS WITH ELECTRIC AND FLAME/SCALD BURNS)
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 EXAMINATION OF SERUM ZINC, COPPER, MAGNESIUM, AND IRON LEVELS IN PATIENTS WITH ELECTRIC AND FLAME/SCALD BURNS
(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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