The use of Osmed(TM) tissue expanders in paediatric burns reconstruction.

Background. Tissue expansion has been a major advance in reconstructive burn surgery. The conventional tissue expander requires serial filling with the possibility of painful procedures, which can be a major challenge and source of anxiety in children. The osmotic self-inflating tissue expander, on the other hand, is a device that does not require external filling, offering apparent benefits particularly in the paediatric population. We used Osmed(TM) tissue expanders for secondary burn reconstruction in children and teenagers who had sustained burns during childhood. Methods. Patients who were treated with Osmed(TM) expanders for secondary burns reconstruction were recorded. Patient demographics (i.e. burn injury data, indications for surgery), Osmed(TM) tissue expander data (i.e. operative data, complications, problems encountered during and after treatment, explantation time, final expander volume) and overall success were recorded. Results. Twelve Osmed(TM) self-inflating tissue expanders were used in patients for secondary burns reconstruction between October 2007 and January 2009. All our patients sustained their burns during childhood. There were three females and one male; the age range was 14-19 yr (mean age, 16 yr). Tissue expanders were removed on average at 6-7 weeks except in two patients. We noted four complications in our cohort. Overall the mean expansion was 65% of the proposed final volume. Discussion. We found the Osmed(TM) tissue expander simple to implant and well tolerated by our patients. However, none of the devices achieved full expansion and overexpansion was not possible. We believe conventional tissue expanders are still the gold standard, although osmotic expanders may have a role in burn reconstruction in younger children.

Paediatric injuries due to home treadmill use: an emerging problem.

INTRODUCTION: The use of home exercise equipment is increasing and treadmills are becoming more popular. This has brought with it an emerging but preventable problem. We present our experience, highlight the importance and promote public awareness of this type of injury. To our knowledge this has not been reported previously in the UK. METHODS: A retrospective review was conducted of the medical records at two regional burn units of children who sustained treadmill-related injuries between July 2003 and July 2009. Data on patient demographics, mechanism of injury, management, surgical intervention and outcome were recorded. RESULTS: Twenty-nine children (15 boys, 14 girls) sustained treadmill-related injuries. The mean age was 3.8 years (range: 1-13 years). All injuries occurred at home and the majority of children trapped their hand under the running belt when an adult was using the machine. Most of the injuries were to the upper limb (97%) with less than 1% of the total body surface area burnt. More than two-thirds of patients had deep burns and 17 (58%) required surgical intervention. Five patients developed hypertrophic scars. All patients achieved a good functional outcome. CONCLUSIONS: Treadmills can pose a significant danger to children. These injuries are preventable. Regulatory authorities, manufacturers and parents should take steps to prevent this emerging health problem.

Epidemiology and outcome of burns at the Saud Al Babtain Burns, Plastic Surgery and Reconstructive Center, Kuwait: our experience over five years (from 2006 to 2010).

Aim To determine the epidemiology and clinical presentation, and any contributing factors responsible for burns and outcome of care in Kuwait over the 5-yr period January 2006 to December 2010. Patients and methods. The study reviewed 1702 burn patients admitted over the study period to the Saud Al Babtain Burns, Plastic and Reconstructive Surgery Center, Kuwait. Patient characteristics, including age, sex, type of burn, nationality, total body surface area (TBSA) burn, hospital stay in days, and mortality were recorded. Results. Seventy-one per cent of the 1702 burn patients admitted were males; 540 were children. The majority of patients (64%) had less than 15% TBSA burns and only 14% had more than 50% TBSA burns. Flame burns were the most common cause of burn injuries (60%), followed by scalds (29%). Scalds were most common in children. The mortality rate was 5.75%. Flame burn was the leading cause of mortality. Lethal dose 50 (% TBSA at which a certain group has a 50% chance of survival) for adults (16-40 yr) and for the elderly (>65 yr) was 76.5% and 41.8% TBSA respectively. Conclusion. Burn injury is an important public health concern and is associated with high morbidity and mortality. Flame and scald burns are commonly a result of domestic and occupational accidents and they are preventable. Effective initial resuscitation, infection control, and adequate surgical treatment improve outcomes.

Objectif. Déterminer l'épidémiologie et décrire la présentation clinique et les éventuels facteurs responsables des brûlures et des résultats des soins au Koweït au cours des dernières cinq années. Patients et méthodes. Un nombre total de 1702 patients brûlés hospitalisés dans le Centre de Chirurgie Plastique et Reconstructive Saud Al Babtain au Koweït Center entre janvier 2006 et décembre 2010 ont été pris en considération. Les caractéristiques des patients (âge, sexe, type de brûlure, nationalité, surface corporelle totale (SCT) brûlée, journées de séjour à l'hôpital, mortalité) ont été enregistrées. Résultats. Soixante-et-un pour cent des 1702 patients brûlés hospitalisés étaient des hommes; 540 patients étaient des enfants. La majorité des patients (64%) avaient des brûlures en moins de 15% de la SCT et seulement 14% avaient plus de 50%. Les flammes étaient la cause la plus commune des brûlures (60%), suivies par les brûlures (29%). Les ébouillantements étaient plus fréquents chez les enfants. Le taux de mortalité était de 5,75%. Les brûlures dues aux flammes étaient la principale cause de la mortalité. La dose létale 50 pour les adultes (16-40 ans) et pour les personnes âgées (> 65 ans) était respectivement de 76,5 et de 41,8% SCT. Conclusion. La brûlures constitue un important problème de santé publique et est associée à une morbidité et une mortalité élevée. Les brûlures dues aux flammes et aux ébouillantements sont souvent provoquées par des accidents domestiques. Pour améliorer les résultats il faut avoir une réanimation initiale efficace, un bon contrôle de l'infection et un traitement chirurgical adéquat.

A systematic review of the evidence for telemedicine in burn care: with a UK perspective.

A comprehensive systematic review of telemedicine in burn care was carried out. Studies published between 1993 and 2010 were included. The main outcome measures were the level of evidence, technical feasibility, clinical feasibility, clinical management and cost effectiveness. The search strategy yielded 24 studies, none of which were randomised. There were only five studies with a control group, and in three of these the patients act as their own controls. Four studies performed quantitative cost analysis, and five more provide qualitative cost analysis. All studies demonstrate technical and clinical feasibility. If the significant potentials of telemedicine to assist in the acute triage, management guidance and outpatient care are to be realised, then research needs to be undertaken to provide evidence for such investment.

Mild hypothermia protects against ischaemia-reperfusion injury in rabbit skeletal muscle.

In three groups of rabbits, the rectus femoris muscle was subjected to 4 hours of total ischaemia. In Group 1 (normothermia, n = 5) the core temperature was maintained within the range 36-38 degrees C for the duration of ischaemia. In Group 2 (total hypothermia, n = 5) the core temperature was allowed to fall to 31.5-33.5 degrees C. In Group 3 (muscle only hypothermia, n = 5) core temperature was maintained as in Group 1 but the muscle temperature was allowed to fall to 29.5-31.5 degrees C. After 24 hours of reperfusion the muscles were harvested and measurements made of muscle viability, oedema and myeloperoxidase content. The mean (s.e.m.) muscle viability of Group 1, 19.5 (3.8)%, was significantly less than that of both Group 2, 86.0 (2.0)%, and Group 3, 87 (4.1)%, (P < 0.001). Muscle oedema and myeloperoxidase levels were elevated in all experimental groups, but differences were not significant. These findings indicate that ischaemia-reperfusion injury in skeletal muscle in this model is highly temperature-sensitive, small reductions in muscle temperature during ischaemia providing significant protection against ischaemia-reperfusion injury.

Use of free interpositional vein grafts as pedicles for prefabrication of skin flaps.

Pedicles created from a long vein graft increase the scope and applications of prefabricated skin flaps. This study reports the survival and pattern of neovascularization of lower abdominal skin flaps in rabbits based on a pedicle formed by interposition of a long vein graft between the divided ipsilateral femoral artery and vein. Flaps were elevated 2-5 weeks after pedicle implantation and the surviving area quantitated and vascular patterns examined 1 week later. Only 8 out of 35 flaps were greater than 50% alive, the most frequent cause of flap failure being pedicle non-patency. If the pedicle remained patent, complete flap survival was possible as early as 2 weeks after implantation. In non-patent pedicles, recanalization or formation of a new vascular network may, given at least 4 weeks, be sufficient to ensure partial flap survival. The findings indicate that implantation of a long, skeletonized vein graft is an unreliable method of prefabrication of abdominal skin flaps in this model.

Afferent arteriovenous anastomosis for thumb replantation: a case report.

Described is a case where an afferent arteriovenous anastomosis was successfully employed in the replantation of a large piece of composite tissue amputated from a patient's thumb. The operative procedure is described and aspects of arterialized venous vascular networks are discussed.