Silicones in the rehabilitation of burns: a review and overview.

This article gives an overview of the use of silicones in the treatment and prevention of hypertrophic (burn related) scars. Of all non-invasive treatment modalities the use of continuous pressure and occlusive contact media, e.g. silicones, seem to be generally accepted as the only ones that are able to manage hypertrophic scarring without significant side-effects. A summary of the current opinions of the assumed working mechanisms of pressure as well as silicones is given. The use of silicones, either alone or in combination with pressure, is discussed. The recent development of custom made silicone devices has led to combinations of both modalities. Some of these, including the inflatable silicone insert systems (ISIS), are shown and discussed.

[Cardiac arrest in an adolescent with arrhythmogenic right ventricular dysplasia]. / Arrêt cardiocirculatoire chez une adolescente et dysplasie arythmogène du ventricule droit.

We report the case of a 16-year-old girl who experienced sudden cardiac arrest from ventricular fibrillation, complicating an arrhythmogenic right ventricular dysplasia, a rare heart muscle disorder, occurring typically in young adults, characterized by a fibrofatty replacement of the right ventricular myocardium. Symptomatic ventricular arrhythmias are frequent, and sudden death has been reported. In our case, diagnosis of arrhythmogenic dysplasia was based on the association of one major criterion and two minor criteria as suggested by the relevant task force. In contrast with most other reports, the chest ECG did not display the typical features. An automatic transvenous pectoral cardioverter-defibrillator was implanted. The authors emphasise that juvenile forms are more exposed to ventricular fibrillation and sudden cardiac death, and consequently require the early detection of the disease. Family cases have been described and the occurrence in one individual must lead to investigations in the relatives.

Total auricular repair: bone anchored prosthesis or plastic reconstruction?

Major breakthroughs in implantology and prosthetic materials, but also in reconstructive surgery of the auricle, have opened new possibilities in the rehabilitation of patients with an absent auricle. The management of such cases and the surgical results in 62 cases are presented. Thirty-five bone-anchored prostheses have been adapted and 27 total auricular reconstructions performed. As long as the conditions of osseo-integration are respected, surgery for an epithesis is easy and comprises no major risks. The side effects of the percutaneous connection (mainly skin reactions) are often minor. All patients are satisfied with their prosthesis and wear it all day long. For the total auricular repair, mainly in major congenital malformations, two techniques were adopted: first the Brent technique followed by the Nagata technique, preferred nowadays. The Brent technique was found safe with good results, but the modification by NAGATA offered two additional advantages: a reduction of the operative stages from 4 to 2 and a better definition of the auricular reliefs by the more elaborate fabrication of the framework. With increasing experience the results of the total auricular reconstructions improved significantly and became more predictable. Also the advantages and disadvantages of both (the reconstructive and prosthetic) approaches are discussed.

The bone anchored hearing aid and auricular prosthesis.

The bone anchored hearing aid (B.A.H.A.) has been fitted to 10 of our patients presenting a bilateral profound conductive hearing loss and who were unable to wear a classical hearing aid. The group of patients with bilateral inoperable aural atresia (n = 5) formed the main indication and were found to give the best results. Cases with bilateral chronic otitis media (n = 5), presenting otorrhea each time a classical hearing aid was worn, formed the second indication. Audiometric performances are dependent on the bone conduction thresholds. The auricular epithesis has been adapted in 11 cases, mainly for atretic ears. The surgery for B.A.H.A. and epithesis is now routinely performed in one stage and has been found safe and reliable. The skin reactions around the abutments (total number fixtures = 32) were found to be rare and often easy to treat. Only around one abutment further subcutaneous tissue reduction was necessary to stabilize the skin. The B.A.H.A. and auricular epithesis are valuable alternatives in those cases where the limits of reconstructive (middle or outer ear) surgery are reached.