five-year burn unit experience at King Hussein Medical Center: 2005 to 2009

To describe the demographic characteristics, age, gender, monthly distribution, causes of burns, burned Total Body Surface Area, site of injury and mortality among burn patients referred to the burn unit at the Royal Rehabilitation Center. The medical records of 400 patients [range, one day to 95 years of age] admitted to the Royal Rehabilitation Center Burn unit at King Hussein Medical Center during the period between January 2005 and December 2009 were retrospectively reviewed. A specially designed medical record abstract form was used to collect the relevant data. Simple descriptive statistics [frequency, mean, percentage, Pie and Bar charts] were used to describe the study variables. The highest risk age group of burn injuries was from one day to 14 years of age [n=156, 39%], with the greatest number of injuries occurring to children who were between one to two years of age. The overall male-to-female ratio was 1.5:1. Seasonal variations had an influence on the increased number of admissions to the burn unit where the frequency increased in the winter season, and mainly in January and February. Scalding was the major cause among pediatric burns. Direct flame burns were the most frequent cause of burns in adults and the second-leading cause in children. Trunk and arms were mostly affected by burns. Fifty- seven patients died, with an over all mortality of 14.3%, the mortality rate in children was 2.3%, and the mortality rate in adult males and females were 7.0% and 5.0%, respectively. The average percentage of burns for all patients was 27.2%, while it was 59.9% in the deceased patients. Children are at high risk from burn injuries, the main cause of which is scalding. Among adults, the main cause of burn injuries was flame burns. The mortality rate is highly related to the percentage of burn. Most burns are preventable and, hence, educational programs should be included in the school and university curriculum to inform the public about the causes of burns and methods of prevention social network media should be in the program

vertical scar reduction mammaplasty: a review of 50 cases using Hall Findlay's Technique

To present our experience in treating mammary hypertrophy using the vertical scar reduction mammaplasty with a superomedial pedicle [the Hall Findlay's Technique]. A total of 120 patients were treated at the Royal Rehabilitation Center for mammary hypertrophy during the period between January 2004 and November 2010, 50 [41.7%] of these patients were treated using the vertical scar reduction technique. There medical records were reviewed regarding age, risk factors, reduction size, patient's satisfaction and complications. All patients were followed for a mean period of 3 years. The mean age of the patients was 37 years, six patients were smokers, two patients had a controlled hypertension, and none had diabetes mellitus. The mean amount of tissue removed per breast was 650g for the right breast and 710g for the left breast [with a range of 250g to 2400g] from each side, the procedure resulted in abatement of preoperative symptoms with a good overall patient satisfaction. Three patients [6%] had wound dehiscence, 5 patients [10%] had partial areolar sloughing, with no loss to the nipple areolar complex either partially or completely. Three patients [6%] had minor asymmetry. This technique for vertical scar reduction mammaplasty has been applied to breast reductions of all sizes and has consistently produced a good breast shape and projection, leaving less scarring than standard breast reductions. The technique needs good preoperative planning but it is a straightforward procedure and easy to learn, it offers a safe, effective, and predictable way for treating mammary hypertrophy

Syndactyly release without using skin grafts

Syndactyly is one of the most common congenital hand deformities. Web space reconstruction is an important component of syndactyly treatment. Our objective is to evaluate the method of web space defect closure in syndactyly repair, using a V-Y dorsal metacarpal advancement flap, without using skin grafts. Over the period of six years [May 2003 through May 2009], a total of 20 patients [24 hands, 25 web spaces] with simple syndactyly were operated upon using a dorsal metacarpal skin flap based on a direct coetaneous branch of the dorsal metacarpal artery. This flap was advanced in a V-Y fashion to aid in web space defect closure, without using skin grafts. There were 15 males and five females. Four cases had bilateral, three had right sided and the remaining 13 had left sided syndactyly. Fourteen cases had complete type and six had incomplete type. The mean age at operation was 4.7 years [range 1-12]. The web spaces affected were the thumb-index, middle-ring, ring-little in one, 18, and six web spaces respectively. The mean follow up period was 10 months [range 6-35 months]. All patients had uneventful postoperative period. There was no flap necrosis or digital vascular compromise. One case showed hypertrophic scarring of the repair but all patients had acceptable range of motion at follow up. Dorsal metacarpal skin flap advancement is a good way of repairing the web space defect during syndactyly release, eliminating the need for skin grafts

Hernia repair under local anesthesia

To describe hernia repair under local anesthesia with regard to the technique, morbidity and hospital admissions after the procedure. Two-hundred hernia repairs were performed under local anesthesia for 178 patients at King Hussein Medical Center and at Prince Hashem Hospital between January 2005 and January 2007. All patients were assessed preoperatively by a senior surgeon and written consent was obtained. The anesthesia protocol used included 0.5% lignocaine and 0.25% bupivacaine as local anesthesia supplemented with intravenous sedation by the anesthesiologist as necessary. Patients were monitored intraoperatively for heart rate, blood pressure and pulse oximetry. The procedure was successfully performed for 197 hernias under local anesthesia. Only three patients required general anesthesia. The first 50 patients were admitted overnight for observation, the rest were all planned as day case surgeries and were followed up over a three month period. Four patients developed wound hematoma, two patients developed wound infection, one patient developed post operative urine retention, and two patients showed evidence of recurrence when reviewed after one year. Our study confirmed the safety and convenience of using local anesthesia for hernia repair. Less post operative discomfort and low morbidity rate was obtained. Hernia repair under local anesthesia can be learnt easily and quickly, therefore it is the recommended procedure to be used in our practice for the repair of inguinal hernia