An analysis of resuscitative requirements of petrol (gasoline) burns.

A retrospective study was carried out to confirm the clinical impression that petrol (gasoline) burns had a greater resuscitation requirement than other types of thermal injury. A total of 450 admissions to the St Andrews Hospital Regional Burn Unit from 1982 to 1988 were reviewed. Patients with pre-existing cardiovascular disease, respiratory disease, inhalation injury and fatalities occurring within the first 72 h of admission were excluded from the study. Forty-four patients met all requirements for inclusion within the study. These 44 patients consisted of 15 with petrol burns and 29 with non-petrol burns, all of whom were resuscitated using the modified Muir and Barclay formula, with adjustments made on the basis of clinical and laboratory monitoring. Comparison of resuscitation requirements of the two groups by the Wilcoxon Rank Sum Test showed that the petrol burns group had a significantly greater fluid resuscitation requirement (P less than 0.01).

IgG subclass response to gamma globulin administration in burned children.

Sixteen children admitted to the North East Thames Regional Burn Unit, Billericay, were given immunoglobulin in the form of Sandoglobulin (0.3 g/kg body wt) between 36 h and 72 h after burn injury. In addition, children who developed a prodromal illness, similar to the toxic shock syndrome (TSS), prior to the administration of Sandoglobulin, were also given fresh frozen plasma and packed red blood cells where indicated. Mean serum levels of IgG1, IgG2 and IgG3 were obtained on a daily basis for the first 7 days postburn. All children survived the injury and a noticeable improvement in the clinical condition of the ill children was noted after immunoglobulin administration. A rise in serum levels of the subclasses investigated also correlated with the immunoglobulin administration and was sustained over the study period, which is the time a burned child is maximally at risk of developing TSS on our unit. There may be an 'at risk' group of children in the general population who have naturally low levels of serum IgG2.

Extended application of the biceps femoris musculocutaneous flap.

Since its description in 1977, the use of the biceps femoris musculocutaneous flap has been largely limited to reconstructions around the hip and perineum in paraplegic patients. The safety with which this flap can be transposed has been questioned owing to the segmental nature of its blood supply. Cadaver dissections in 10 fresh lower limbs showed that anterolateral transposition could be achieved without the need to sacrifice any of the major vascular pedicles (numbering two to three) which penetrate the long head of the muscle within 10 to 14 cm of the ischial tuberosity. We report on the use of this flap to resurface the anterolateral aspect of the lower thigh and restore stability and extension to the knee joint following extensive damage to the quadriceps mechanism.

Facial resurfacing in xeroderma pigmentosum: are we spoiling the ship for a ha'p'orth of tar?

A case of xeroderma pigmentosum (XP) is reported whose treatment included sub-total excision of facial skin and resurfacing in aesthetic units with grafts of relatively undamaged buttock skin. The principle of resurfacing is logical and supported by this and other reports which are reviewed. Though control was achieved in the grafted areas, tumours continued to develop in adjacent ungrafted skin. The importance of radical excision of exposed skin in severe cases of XP is emphasised.

Electrical burns to the hand from lawn-mowers.

Fifteen cases of electrical burns to the hand are described resulting from the use of electric lawn-mowers. These injuries caused significant morbidity and time off work, and one death. Most of the burns appear to have been preventable, and ways of averting these injuries are discussed.

Layered shaving of venous leg ulcers.

A method for the quick preparation of refractory venous ulcer beds for autografting is described. Irrespective of their clinical or bacteriological state, ulcer granulations and other products of frustrated healing are shaved in layers down to an even and surgically clean base using an ordinary skin grafting knife. Our experience with 32 consecutive patients (58 ulcers) is reported. The mean duration of hospital stay, the patient being completely healed on discharge, was 18.3 days. This represents a decrease of more than 3 weeks when compared to a previously used standard method. No investigation into the question of recurrence was carried out as available evidence, which is critically reviewed, indicates no significant relation between the method of grafting and the incidence of recurrence.

The role of endorphins in septicaemic shock: a pilot study in burned patients.

There is recent evidence that circulating opioid peptides, or 'endorphins', act as chemical messengers responsible for the induction of the complex cardiovascular changes leading to hypotension in septicaemic shock. The pilot study of an investigation of opioid peptides in septicaemia in burned patients is presented. Serial measurements of plasma beta-endorphin and metenkephalin were performed throughout the recovery of six patients with large burns (20-70 per cent BSA). Our preliminary findings concur with previous evidence that opioid peptides may play a role in the hypotension of septicaemic shock.

Transcutaneous oxygen tension as an index of maturity in hypertrophic scars treated by compression.

Sixteen patients undergoing compression treatment for scar hypertrophy were included in a study to evaluate physical indices of scar maturity. The results show that while thermographic measurements of scar temperature were not clinically valuable, rising levels of transcutaneous oxygen tension in treated scars correlated well with a reduction in scar thickness assessed both clinically and by ultrasound. It is postulated that low levels of tcpO2 in immature scars result from low oxygen diffusibility through scar tissue rather than from rapid metabolic consumption of oxygen by scar tissue.

The toxic shock syndrome in burned children.

Seven cases of presumed Toxic Shock Syndrome (TSS), occurred in burned children admitted to the Regional Burn Unit at St Andrew's Hospital, Billericay. Four patients died, and three caused concern. 30 per cent of Staphylococcus aureus isolates available for retrospective study were found to be toxin producing. On reviewing children in this age group admitted between September 1982 and April 1984 we feel that a form of TSS has occurred commonly, in some cases where the burned area was less than 5 per cent. Certain recommendations are made.

Desmoplastic malignant melanoma: the first British report.

A case report from Louisville, Kentucky was recently published in this Journal describing a patient with a desmoplastic malignant melanoma of the cheek (Man et al., 1981). Reference was made in that report to 15 previously described cases of this tumour, all from the United States of America. We wish to report a recent patient of ours with a tumour that was histologically consistent with a desmoplastic malignant melanoma but showed several atypical clinical and histological features. This is, as far as we know, the first recorded occurrence of the tumour outside the USA.

The value of thermography in peripheral vascular disease.

The value of thermography as a reliable, noninvasive, and rapid method of investigating patients with peripheral vascular disease is discussed. Thermography has great value in managing deep venous thrombosis, in estimating the optimal site of amputation, in evaluating vasoactive drugs, and correctly timing the division of pedicled skin flaps. Its use in localizing incompetent perforating veins of the leg and in monitoring patients with cerebrovascular disease after surgery to the carotid arteries is also briefly described.

A simplified method of recording in nasal pharyngoscopy.

In view of Pigott's work, it would appear that a pharyngoplasty without prior pharyngoscopy is similar to an operation on the bladder without cystoscopy. Now that a simple method of recording, which we consider invaluable, is available, we hope that nasal pharyngoscopy will become a routine examination in patients with speech defects.