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Volume XXIII |
Number 1 |
March 2010 |
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Summaries
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ELECTRICAL BURN INJURIES. AN EIGHT-YEAR REVIEW
(BUJA Z., ARIFI H., HOXHA E. - KOSOVO)
Electrical injuries are very aggressive pathological lesions with heavy functional and aesthetic consequences. The primary cause of their gravity is the progressive tissue necrosis that occurs with the continuous extension of wound necrosis, even leading to loss of the entire injured extremity. The goal of this study is to analyse the role of the inefficiency of the electric energy system in the incidence of electrical injuries in Kosovo during the period December 2000 to 2007 suffered by a total number of 182 patients treated in the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo. Electrical injuries accounted overall for 17.25% of all patients admitted with burns; 35.72% of the burns were due to high voltage and 64.28% to low voltage; among the patients with contact burns the amputation rate was 28.58%, and four patients (7.14%) died. These results suggest that the aggravation of the electric energy system led to an increase in the number of patients with electrical injuries.
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PROFILE OF CHILDREN ABUSED BY BURNING
(MATHANGI RAMAKRISHNAN K., MATHIVANAN T., SANKAR J. - INDIA)
In an analysis of paediatric burn admissions to a hospital in India during the years 1992-2007, 9.3% of burn injuries were found to be secondary to abuse. These had valid documented evidence and child neglect was excluded. This incidence of child abuse has been on the rise in the last seven years and was more evident due to careful investigation by a team comprising a plastic surgeon, a paediatrician, a legal expert, a psychologist, and a social worker. As with the incidence reported by many other researchers, most of the injuries were caused by scalding.
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OPTIMIZING BURN TREATMENT IN DEVELOPING LOW- AND MIDDLE-INCOME COUNTRIES WITH LIMITED HEALTH CARE RESOURCES (PART 3)
(ATIYEH B., MASELLIS A., CONTE F. - LEBANON, ITALY)
The present review of the literature aims at analysing the challenges facing burn management in low- and middleincome countries and exploring probable modalities to optimize burn management in these countries. In Part I, epidemiology of burns injuries and the formidable challenges for proper management due to limited resources and inaccessibility to sophisticated skills and technologies in low- and middle income countries (LMICs) were presented. Part II discussed the actual state of burn injuries management in LMICs. In Part III of this review strategies for proper prevention and burn care in LMICs will be presented.
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BURN WOUND CLEANSING - A MYTH OR A SCIENTIFIC PRACTICE
(HAYEK S., EL KHATIB A., ATIYEH B. - LEBANON)
Burn wound cleansing is an integral step in every wound management protocol. Yet a lot of this practice is based on myth rather than real scientific basis. The literature is poor in scientific papers comparing the outcome of patients who underwent wound cleansing to those who did not. A survey form was designed by the Mediterranean Council for Burns and Fire Disasters - MBC and sent by e-mail to its members as well as members of the European Burn Association and other burn specialists, and 76 replies were received. Responses showed wide inconsistencies in the methods of burn wound cleansing, the solutions used for cleansing, the added antiseptics or detergents used, and the frequency of cleansing. Wound cleansing and dressing is a process that should be based on evidence and not on a ritualistic behaviour or a personal preference. In order to optimize burn wound care and promote optimal healing, more clinical evidence-based studies are needed to confirm or negate the positive or negative effects of any topical solution currently in use for burn wound cleansing.
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PAKISTANI EXPERIENCE OF CHILDHOOD BURNS IN A PRIVATE SETUP
(AHMAD M. - PAKISTAN)
Burns are the second leading cause of death in children. This study investigates the distribution and pattern of childhood burn injuries in a private setup. The study was conducted in Rawalpindi, Pakistan from January 2006 to December 2008. Only paediatric patients ² 12 years of age were included in the study. All paediatric burn patients (in- as well as out-patients) were included. A total of 44 patients were included (male-to-female ratio, 1.3 to 1) with 2.3% patients aged 1-3 years, 13.6% aged 4 6, 38.6% aged 7-9, and 45.5% aged 10-12. The mean age was 9.16 yr in males and 8.37 yr in females. Scald burns were the commonest kind of burn (43.2%), followed by flame burns (18.2%). In 6.8% of the patients, the burns were superficial, in 20.5% they were deep, and in 72.7% they were mixed. The majority of the patients had involvement of the hand with or without the forearm (47.7%). The mean hospital stay was 17.5 days. There was one mortality during the study period.
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PRE-EXPANDED EXTENDED ISLAND PARASCAPULAR FLAP FOR RECONSTRUCTION OF POST-BURN NECK CONTRACTURE
(ALBARAH A., KISHK T., MEGAHED M., ELSAKKA D., GHAREEB F. - EGYPT)
Background. Since it was described by Nassif et al. in 1982, the parascapular flap has been used as a pedicled or island flap for axillary contractures and as a free flap for neck reconstruction. To the best of our knowledge, there are no reports in English describing its use as an island flap for neck reconstruction. Methods. Nine patients with severe post-burn neck contracture scars were reconstructed with pre-expanded extended island parascapular flaps. Results. All flaps survived completely, providing thin skin coverage of the neck defect with satisfactory natural appearance. The size of the flaps ranged from 32 to 44 cm in length and 11 to 16 cm in width (mean: length 38.2; width, 14.2 cm). No debulking was done but secondary revisions such as Z-plasty and scar revision were performed for all flaps. The donor site was closed primarily in all patients but delayed wound healing was recorded in two. Widening and hypertrophic scar changes developed at the donor site of seven patients. Conclusions. The utilization of pre-expanded extended island parascapular flap is an effective way for reconstruction of post-burn neck contracture. It provides a large good-quality skin flap that can cover all the aesthetic units of the neck without any microvascular anastomosis. However, the protracted time required for the procedure and the requirement of two operations, plus the repeated follow-up visits, may constitute major disadvantages.
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LES PROTHÈSES D'EXPANSION DANS LE TRAITEMENT DES SÉQUELLES DE BRÛLURES
(TOURABI K., RIBAG Y., ARROB A., MOUSSAOUI A., IHRAI H. - MAROC)
Les Auteurs présentent leur protocole pour l'expansion cutanée et rapportent quatre cas colligés au service des brûlures de leur hôpital au Maroc. Ils décrivent leur technique opératoire et les résultats obtenus. L'expansion cutanée reste la méthode de choix pour la couverture des pertes de substance étendues et la correction des séquelles de brûlure, et l'expérience rapportée par les Auteurs confirme les bons résultats que l'on peut obtenir avec cette technique, y compris les résultats esthétiques.
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LAMBEAU EXPANSÉ DU CUIR CHEVELU DANS LA COUVERTURE DES ALOPECIÉS CICATRICIELLES SUR SEQUELLES DE BRÛLURES. A PROPOS D'UNE OBSERVATION
(EL MAZOUZ S., HAFIDI J., FEJJAL N., MEJJATI H., CHERKAB L., GHARIB N., ABBASSI A. - MAROC)
Les séquelles esthétiques des alopécies cicatricielles sur séquelles de brûlures sont responsables de préjudices empêchant parfois la réinsertion sociale du patient, surtout chez les sujets de sexe féminin. Le cuir chevelu permet la réalisation de lambeaux permettant de couvrir ces alopécies. Les Auteurs décrivent le cas d'une jeune patiente victime d'une alopécie cicatricielle sur séquelles de brûlures chez qui ils ont réalisé un lambeau expansé du cuir chevelu et mettent le point sur la prise en charge de ces lésions à travers ce cas clinique et une revue de littérature.
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LA GREFFE DE PEAU DANS LE TRAITEMENT DES SÉQUELLES DE LA MAIN BRÛLÉE. A PROPOS DE 152 CAS - EXPERIENCE DU SERVICE DE CHIRURGIE PLASTIQUE DU CENTRE HOSPITALIER UNIVERSITAIRE IBN-SINA, RABAT, MAROC
(EL MAZOUZ S., FEJJAL N., HAFIDI J., CHERKAB L., MEJJATI H., BELFQIH R., GHARIB N., ABBASSI A. - MAROC)
La main est fréquemment exposée aux brûlures, entraînant des séquelles esthétiques et fonctionnelles. Le traitement de ces séquelles est surtout chirurgical et consiste en la greffe de peau, dont le type dépend de la localisation de la brûlure et du type des séquelles. Dans ce travail rétrospectif, nous rapportons une série de 152 cas de brûlures des mains colligés au service de chirurgie plastique du Centre Hospitalier Universitaire Ibn-Sina de Rabat sur une période de dix ans, allant de 1998 à 2007. Les indications thérapeutiques dépendent du type de séquelles et de la localisation de la brûlure. En tout, 97 patients ont bénéficié d'une greffe cutanée, dont 76% par greffe de peau totale, 21% par greffe de peau demi-épaisse et 3% par peau fine. Les séquelles des brûlures des mains posent un problème thérapeutique majeur, malgré la diversité des procédés chirurgicaux, d'où l'intérêt de la prévention.
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CASE REPORT: PURPURA FULMINANS IN MENINGOCOCCAL SEPTICAEMIA IN AN ADULT: A CASE REPORT
(BOLLERO D., STELLA M., GANGEMI E.N., SPAZIANTE L., NUZZO J., SIGAUDO G., ENRICHENS F. - ITALY)
Purpura fulminans is a rare and severe complication of meningococcal septicaemia. It presents as a petechial rash spreading rapidly in extent and depth, evolving into full-thickness skin necrosis. The condition is extremely uncommon in the adult population. We report the case of a 28-yr-old man with extensive meningococcal-related skin necrosis. The initial diagnosis was made and first treatment given in the emergency department of a local hospital, from where after 12 days he was transferred to our hospital. Our approach was based on the continuation of intensive treatment and on staged aggressive debridement. Temporary alloplastic skin grafts were used to prepare the wound bed and the wounds were closed with autologous skin grafts. The patient survived but subsequently, owing to chronic skin ulceration and scar instability, he underwent late bilateral below-the-knee amputation. The patient returned to normal deambulation with an orthopaedic prosthesis 18 months after the onset of meningococcal septicaemia.
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CASE REPORT: VACUUM-ASSISTED CLOSURE AND PRIMARY CUTANEOUS ASPERGILLOSIS IN A BURN - A MANAGEMENT DILEMMA!
(LOHANA P., HOGG F.J. - UNITED KINGDOM)
The advent of vacuum-assisted closure (VAC) devices has changed many wound management practices by application of topical negative pressure. A 20-year-old male sustained 21% total body surface area circumferential full-thickness burns to both legs from knees to feet. The VAC dressing was used in the management of his wounds. The patient had persistent pyrexia and graft destruction and subsequently the wounds cultured Aspergillus fumigatus. The increasing popularity of the VAC dressing is well deserved in the management of complex burn wounds. This case highlights the fact that in the care of complex burn patients the development of opportunistic infections should be considered, especially in situations such as persistent pyrexia or following the breakdown of healed grafts, particularly during the use of topical negative pressure.
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