Scorched eyelashes--do we treat them right?

Scorched eyelashes and burned eyelids are a common finding in facial burns, though the eye itself is often spared. Affected patients often complain of foreign body sensation and ocular discomfort in the absence of objective physical findings, other than scorched eyelashes and burned eyelash particles in the conjunctival sacs. This study was designed to evaluate the efficacy of prophylactic trimming of scorched eyelashes as a treatment for these findings and complaints. Eleven consecutive facial burn patients with bilateral eyelash scorching and no accompanying ocular damage were included. The eyelashes of one eye were trimmed, and those of the fellow eye served as untreated controls. Ophthalmic examinations were performed and eye-related complaints noted every other day for 10 days. We found that symptoms of foreign body sensation and discomfort occurred at a lower rate in the treated eyes (P<0.002) and no scorched eyelash particles were found in their conjunctival sacs (P<0.004) as compared to the untrimmed side. Conjunctival hyperemia was reduced. We suggest that shedding of scorched eyelash particles is a major cause of the ocular complaints in facial burn patients. Trimming the eyelash affords a simple and effective method of prophylactic treatment.

Female breast burns: conservative treatment with a reconstructive aim.

We retrospectively reviewed 421 burn patients treated in our burn unit in the past 3 years, focusing on breast burns in female patients. The aim of our study was to review the epidemiology, establish the mechanism of breast burn occurrence, and review the treatment plan. We evaluated 138 female burn patients, 38 (9%) of whom had non-isolated breast burns. In this group 25 burns (66%) were caused by scalds and 13 (34%) by fire. Scalds were responsible for first- to second-degree burns (50%), and cooking oil and fire for second- to third-degree burns (50%). A statistically significant difference was noted in the incidence of breast burns, which occurred mainly in late summer and fall (P = 0.03). There was a direct correlation between burn depth and duration of hospitalization, with average hospitalization time of 1.45 days for each percent of burn. Most breast burns were domestic, with children constituting the majority of the victims. Most breast burn patients were treated conservatively. Breast deformity on recovery varied in severity from minor deformity correctable with simple breast reduction surgery in older patients to severe deformity requiring further reconstructive surgery in infants.

Elevation of eyeglasses from the nasal bridge--a simple solution.

Wearing eyeglasses following nose surgery is a problem faced by many patients who require glasses for clear vision. The solutions offered for this seemingly minor problem are unsatisfactory and usually mandate special spectacle frames. We developed a simple apparatus, using a baseball cap and a tie clip, that enables suspension of eyeglasses with no pressure on the nasal bridge. This solution utilizes readily available components and maintains clear vision with possible frequent readjustment of the glasses. It also avoids contact of the glasses with any part of the face, namely the operative site, dressing, and wound discharge. We find this technique a simple and useful solution for a disturbing problem in plastic surgery.

[Epidemiology and prognostic factors in cutaneous malignant melanoma].

207 patients with primary cutaneous malignant melanoma were admitted between August 1, 1988 and July 31, 1992 for local excision and treatment. The female to male ratio was 1.4:1 and the peak age was in the seventies. The most frequent site in males was the back and in females the legs. Superficial spreading melanoma was the most frequent type (40%); there was also a high rate of nodular melanoma (20%), particularly in males. Thin melanomas accounted for most of the cases. On follow-up 27 (13%) developed metastases in transit or in regional lymph nodes and 10 (5%) developed distant metastases; 2 (1%) had locally recurrent melanoma and 2 died of metastatic melanoma. There was a significant positive correlation between Breslow thickness, Clark's level of invasion, histopathological ulceration, nodular and acral lentiginous type of lesion and development of metastases. These data may be valuable for public and professional education and in the prediction of outcome of melanoma.

Double-opposed Z plasty for upper eyelid entropion correction.

Recurrent cicatricial entropion of the upper eyelid creates a surgical problem. We present a 53-year-old patient with complicated postsurgical fibrotic and scarred upper eyelid entropion. Double-opposed Z-plasty incisions were used at the anterior approach. The outer Z incision included the skin and the orbicularis oculi muscle underneath, whereas the inner Z incisions included the tarsal plate and conjunctiva, in a mirror-image fashion. Two goals were achieved, i.e., release of the vertical traction vector of the conjunctiva and balance of forces between the anterior and posterior layers of the lid. Symptomatic and clinical improvement was observed, and there was no recurrence 2 years after surgery.

Epidemiology of burns in the Tel Aviv area.

Between 1 August 1988 and 31 January 1992, 421 burn patients were admitted to the Burn Unit at Beilinson Medical Center. Name, age, sex, month of the year, cause of burn, area and degree of burn and duration of stay in hospital were recorded. Of these patients, 37 per cent were treated surgically and the remainder were treated conservatively. The male to female ratio was 2:1. Burns occurred most frequently in July and January; the peak average age was the first decade of life. The most frequent cause in children was scalding (domestic burns), and in adults open fires (work accidents). Patients treated by early tangential excision and skin grafting (204 operations on 157 patients) had a shorter stay in hospital than conservatively treated patients. In accordance with others, we suggest that early surgery of burn injuries decreases morbidity and mortality and leads to better aesthetic results and improved motor function. Secondly, burn injury can be prevented in children and the elderly by increasing safety measures at home, and in adults by enforcing strict safety measures at work.