Sildenafil Therapy in Patients With Digital Burns and Raynaud's Syndrome.

The Raynaud's phenomenon (RP) is characterized by an exaggerated vascular response to cold temperature or emotional stress causing temporary ischemia. It is more prevalent in the digits of the hands and feet, and when occurring in conjunction with a rheumatological condition, it is also termed Raynaud's syndrome, or secondary RP. Healing following a burn requires appropriate tissue perfusion to promote primary restoration of the skin, prevent further burn progression, and to promote skin graft take in wounds requiring autologous split skin grafting. The addition of vascular compromise caused by RP to a burn wound is therefore hypothesized to impair burn wound healing and worsen burn wound progression. The authors describe a 51-year-old female with digital burns on a background of scleroderma and Raynaud's syndrome successfully treated with oral sildenafil therapy and autologous split skin grafting. The case report further highlights the potential role for sildenafil therapy in wound healing and patients requiring autologous skin grafting or local skin flaps. In future cases, we plan to involve rheumatology services early in the course of the injury aiming to improve outcomes.

A Prognostic Dilemma of Basal Cell Carcinoma with Intravascular Invasion.

Basal cell carcinoma is the most common malignancy; however, it very rarely metastasizes. Despite the low mortality caused by this cancer, once it spreads, it has dim prognosis. We report a case of basal cell carcinoma with rare intravascular invasion and review the literature for risk factors and management of metastasis.

The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care.

OBJECTIVE: Analysis of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating units in treatment and in specific outcomes during the first 4 years of its operation. DESIGN: BRANZ, an initiative of the Australian and New Zealand Burn Association, is a clinical quality registry developed in accordance with the Australian Commission on Safety and Quality in Healthcare national operating principles. SETTING: Patients with burn injury who fulfil pre-defined criteria are transferred to and managed in designated burn units. There are 17 adult and paediatric units in Australia and New Zealand that manage almost all patients with significant burn injury. Twelve of these units treat adult patients. PARTICIPANTS: Data on 7184 adult cases were contributed by ten acute adult burn units to the registry between July 2010 and June 2014.Major outcomes: In-hospital mortality, hospital length of stay, skin grafting rates, and rates of admission to intensive care units. RESULTS: Considerable variations in unit profiles (including numbers of patients treated), in treatment and in outcomes were identified. CONCLUSIONS: Despite the highly centralised delivery of care to patients with severe or complex burn injury, and the relatively small number of specialist burn units, we found significant variation between units in clinical management and in outcomes. BRANZ data from its first 4 years of operation support its feasibility and the value of further development of the registry. Based on these results, the focus of ongoing research is to improve understanding of the reasons for variations in practice and of their effect on outcomes for patients, and to develop evidence-informed clinical guidelines for burn management in Australia and New Zealand.

The use of frozen section in the excision of cutaneous malignancy: a Queensland experience.

Frozen section is known to be a valuable tool in the setting of indistinct lesions, lesions in cosmetically or functionally important areas, and those with recurrent or residual tumors. Most non-Mohs surgery studies comparing frozen section with paraffin sections suggest a concordance rate of 85% to 90%, whereas studies with Mohs surgery often suggest concordance rates of 95% to 98%. We do not perform Mohs surgery at our institutions but feel that the accuracy of frozen section is relatively high. Frozen-section data from between 2005 and 2011 was analyzed, and a total of 150 cases was found and assessed. Most of the cases were basal cell carcinomas and squamous cell carcinomas, with most arising in the head and neck region. Half of the resections were for previous incomplete margins with the other half being primary excisions. The frozen section was accurate in 97.7% of the cases when compared with the formal paraffin sections. However, the incomplete rate was higher at 14.8% because of patients with known positive margins on frozen section and the use of less accurate techniques of specimen analysis. We feel that, when used appropriately, frozen section can be a reliable tool and that a negative result should provide the surgeon enough reassurance as to undertake immediate reconstruction.