Outcomes and complications of diabetic burn injuries: a single center experience.

INTRODUCTION: Comorbid conditions may adversely affect burn outcomes. Burn injuries remain one of the most prevalent injuries presenting to emergency departments. The current study compares the outcomes of burn injuries in diabetic and non-diabetic patients. METHODS: A retrospective review of 705 burn patients admitted to the burn unit was performed. All adult patients (18 years old and above) who were admitted to the burn unit were included. The study compared the complications and outcomes of the diabetic and non-diabetic burn patient. RESULTS: Patient were divided into diabetic (14%) and non-diabetic groups (86%). Diabetic burn patients were more likely to be older with a mean age of 58.7 years compared to 33.6 years in non-diabetic group (P=0.000). Inhalation injury was found in 3% of diabetic group compared to 14% of non-diabetic group (P=0.009). Diabetic patients were more likely to have associated medical comorbidities especially hypertension. Overall mortality rate was 13% and overall length of stay (LOS) was 28.4 days with no significant differences between groups. CONCLUSION: Older age, hypertension and contact burns are significantly associated with DM in burn patients. No increased risk of burn-related infections, mortality and LOS were observed in the DM group.

Hemi-hypoglossal nerve transfer for obstetric brachial plexus palsy: report of 3 cases.

Use of the entire hypoglossal nerve for nerve transfer in obstetric palsy is not recommended because of major donor nerve morbidity in terms of feeding and speech problems. We used a hemi-hypoglossal nerve transfer for biceps reinnervation in obstetric palsy in 3 infants with multiple root avulsions. Two of the 3 infants recovered normal or near-normal elbow flexion. There was no donor nerve morbidity in terms of feeding. Speech was assessed at age 20 to 27 months and was appropriate for age, which indicates that early speech development (speech intelligibility and articulation) were not affected. However, phonological development (expected to develop by age 3 y) and full consonant development (expected to be complete by age 5 y) could not be assessed because all children were younger than age 3 years at final follow-up. Our results confirm the relative safety of using a hemi-hypoglossal nerve transfer in infants. The transfer deserves study in a larger series and with longer follow-up, particularly regarding speech development.

Bacillary angiomatosis presenting as a pyogenic granuloma of the hand in an otherwise apparently healthy patient.

Bacillary angiomatosis is a rare opportunistic infection caused by the gram-negative bacteria Bartonella. The infection is strongly related to human immunodeficiency virus (HIV) infection, and hence, the diagnosis is usually considered based on the fact that the patient is HIV positive. We report on a case of bacillary angiomatosis presenting as a pyogenic granuloma of the hand in an otherwise apparently healthy man. The report is aimed to increase the awareness of hand surgeons that this serious disease may be the first clinical manifestation of HIV infection. The case also demonstrates that once the correct diagnosis is made, medical treatment alone may be sufficient to cure massive recurrent lesions.

Triceps innervation pattern: implications for triceps nerve to deltoid nerve transfer.

There are multiple nerve branches supplying the triceps. Traditionally, the nerve to the long head of triceps is utilized for nerve transfer to neurotize the deltoid muscle in patients with brachial plexus injuries. However, no anatomical studies were done to investigate which triceps nerve would be preferred for nerve transfer. This anatomical study was carried out to describe the innervation pattern of the triceps muscle to investigate the preferred triceps nerve for nerve transfer. Twenty-five cadaveric arms were dissected. The long head of the triceps received a single branch in 23 cases (92%) and double branches in 2 cases (8%) only. The medial head had a single branch in 22 cases (88%) and double branches in 3 cases (12%). The lateral head was the most bulky one and received more than one branch in all cases (100%), ranging from 2 to 5 branches. The transfer of the most proximal branch to the lateral head of the triceps seems to be the most preferred choice for deltoid muscle innervation.

Buttock necrosis and paraplegia after bilateral internal iliac artery embolization for postpartum hemorrhage.

BACKGROUND: Endovascular embolization has become part of the management of postpartum hemorrhage. CASE: We report a case of bilateral extensive gluteal skin and muscle necrosis with concurrent severe lumbosacral plexopathy after bilateral internal iliac artery embolization for postpartum hemorrhage. The ischemic plexopathy was treated conservatively, with a fair outcome. The complex gluteal wound was treated successfully with debridement and skin grafting. CONCLUSION: Pregnancy is known to increase the pelvic collateral blood vessels, and, hence, such a complication in a healthy pregnant woman is extremely rare. The risk of such a severe complication may be minimized by more selective embolization.

Ambulatory cleft lip repair.

BACKGROUND: Ambulatory cleft lip repair has been practiced in developed countries, but its safety has never been examined in developing countries. This study compares the outcomes of ambulatory cleft lip repair with the inpatient setting. METHODS: A retrospective cohort study of 122 patients who underwent repair between 2000 and 2008 was conducted. All patients underwent primary cleft lip repair performed by the same surgeon. Patients were divided into two groups: ambulatory (n = 58) and inpatient (n = 64). Demographics, surgical parameters, and outcomes were obtained. The main outcome measure examined was the overall readmission rate. RESULTS: Mean patient age was 133 days in the ambulatory group and 154 days in the inpatient group. Six patients (10.3 percent) in the ambulatory group and 15 (23.4 percent) in the inpatient group had associated medical problems. Both groups were homogeneous for other parameters. Three patients (5.2 percent) in the ambulatory group and two (3.1 percent) in the inpatient group were readmitted. There were no significant differences in the readmission rate, intraoperative or postoperative complications, or rate of return to the emergency room (p > 0.05). However, the reason for readmission was different in the two groups, consisting of respiratory problems in the ambulatory group and late wound dehiscence in the inpatient group. CONCLUSIONS: This study confirms the safety of ambulatory cleft lip repair in a developing country. However, the authors suggest hospital admission for patients with preexisting cardiac problems and those who experience any respiratory problems in the immediate postoperative period in the ambulatory group.