Laser doppler analysis of blood perfusion in burn wounds.

Objective: Laser Doppler Flowmetry (LDF) is a non-invasive tool for immediate measurement of cutaneous circulation which has been satisfactory applied in burn wound depth assessment. With variety of LDF models and assessment methodology, the standardization of LDF and criteria of burn wound depth diagnosis remain an inconclusive topic. Our study aimed to provide analytical data of LDF in burn wound assessment. This protocol was approved by the Institution Ethics Committee (Certificate of approval no. Si 017/2006). Methods: From January 2006 to May 2007, cutaneous perfusion measurement with LDF model LASERFLO BPM2® (Vasamedics, USA) in day 1,3,5 and 7 were recorded and analysed. The data were analysed with a one-way ANOVA test. Results: The data included 53 burn areas in 6 patients. The patients’ mean age was 26.5 (range 2-48) years. There were 22 areas of superficial second degree burn, 20 areas of deep second degree burn and 11 areas of third degree burn. The LDF at the burn area revealed 100% sensitivity, 87.5% specificity, 92.5% PPV and LDF ratio demonstrated 92.0% sensitivity, 50.0% specificity, 73.0% PPV whilst early clinical assessment at first post burn day had 67.0% sensitivity, 87.5% specificity, 89.0% PPV. Conclusion: The laser doppler flowmetry is a reliable device in determining burn wound severity. With high correlation in measurement of LDF perfusion data at burn area and LDF ratio to clinical diagnosis, this method helps as an adjunctive procedure to diagnose the degree of burn in early post burn day. The more accurate burn wound assessment can facilitate the optimal wound management and fluid resuscitation for burn patients.

An alternative technique for arch bar fixation.

Another technique for the fixation of an arch bar which is needed to maintain proper occlusion is described. It gives secure fixation for the treatment of maxillo-mandibular fracture with shorter fixation and removal time from about thirty minutes to fifteen minutes. This technique can also be used in orthognathic surgery.

Multiple pterygium syndrome (escobar syndrome).

Escobar (multiple pterygium) syndrome is a rare autosomal recessive disorder characterized by short stature, multiple pterygium, joint contractures, vertebral fusions and minor facial anomalies. There is extreme phenotypic variability. The etiologic and genetic basis of multiple congenital pterygium is very heterogenous. Mutidisciplinary approach includes primary care physician or pediatrician, orthopedist, physical therapist and plastic surgeon. We report a case of multiple pterygium syndrome most likely the first reported case in Thailand that still alive and have had successful operative treatment of the spine and left foot. This 5-year-old Thai girl with short stature, ptosis of both eyelids, antimongoloid slant of palpebral fissures, hypertelorism, micrognathia, flat facies with emotionless expression, pterygium at neck, axillae, antecubital, popliteal, thumbs in palms, talipes equinovarus deformity, scoliolordosis at thoracic spine was described. She went through successive operations : plastic surgical correction of ptosis of both eyelids; anterior spinal fusion at thoracic spine; postero medical release at left foot with good result.