Multi-digit contracture release using medial sural artery perforator flap with syndactylization-desyndactylization method.

BACKGROUND: The medial sural artery perforator flap, with a long pedicle, has tremendous potential for applications in a variety of soft tissue defects. It can be used for reconstruction of multi-digit contractures of the palmar region. MATERIALS AND METHODS: We present herein the key features of the management of postburn multi-digit volar contractures, using medial sural artery perforator flaps with the syndactylization and desyndactylization method. We describe the use of the free medial sural artery perforator flap in two patients, to reconstruct complex composite hand defects including the second, third, fourth and fifth digits following thermal burns. RESULTS: Both flaps healed uneventfully. In both patients, the hand contractures released completely and adequate joint motion was achieved after a 3-month period of physiotherapy. CONCLUSIONS: The thin medial sural artery perforator flap permits high accuracy of soft tissue reconstruction of the hand and reduces the morbidity at the donor site. The MSAPF is a useful flap in areas such as the hands, in the case of soft tissue deficiency and tendon exposition. Hippokratia 2015; 19 (4): 366-368.

Frostbite injury of the breast: a case report.

This paper presents an unusual case of frostbite injury to the breast area caused by faulty cryotherapy application. Cryotherapy, commonly used by patients and health professionals, relieves pain and edema after trauma and sports injuries. However, applying cold therapy is not common for surgical procedures involving soft tissue. The frostbite injury to the breast presented here occurred due to persistent use of a self-prepared ice pack following a needle aspiration biopsy. Cold exposure to soft tissue may cause frostbite. It is crucial to inform patients about proper application of cryotherapy and possible complications, particularly for the procedures in which cold therapy is not widely used.

Cet article présente un cas inhabituel d'engelures à la zone de la poitrine provoqué par l'application inappropriée de la cryothérapie. La cryothérapie, couramment utilisée par les patients et les professionnels de la santé, soulage la douleur et l'oedème après un traumatisme et les blessures sportives. Toutefois, l'application de thérapie par le froid n'est pas commune pour les procédures chirurgicales impliquant les tissus mous. Les engelures au sein présentées ici ont eu lieu en raison de l'utilisation persistante d'un sac de glace auto-préparé à la suite d'une biopsie à l'aiguille. L'exposition au froid des tissus mous peut causer des gelures. Il est essentiel d'informer les patients sur la bonne application de la cryothérapie et les complications possibles, en particulier pour les procédures dans lesquelles la thérapie par le froid n'est pas largement utilisée.

Prospective analysis of nosocomial infections in a burn care unit, Turkey.

BACKGROUND & OBJECTIVE: Prevention of infection in burned patients poses a great challenge as infection is the most common cause of mortality after burn injury. An analysis of burned patients, admitted and treated between January 2004 and December 2005 in a nine-bed burn unit in Turkey, was performed prospectively to identify the common pathogens and incidence of nosocomial infection in these patients. METHODS: Of the 182 burn cases admitted to Burn Care Unit during the study period, 169 met the inclusion criteria. Information related to nosocomial infection (NI) was collected. Samples were collected for culture and microorganisms isolated were tested for antimicrobial sensitivity. RESULTS: Of the 169 burn patients, 127 acquired 166 nosocomial infection (NI) (15.7% pneumonia, 56.0% burn wound infection, 8.4% urinary tract infection and 19.9% blood stream infection) with an overall NI rate of 18.2 per 1000 patient-days. The mean age (38 +/- 21 yr), the mean length of hospitalization (45.06 +/- 11.67 days) and the total burned surface area (TBSA) (34.58 +/- 18.46%) of the patients with NI were higher than those of the patients with non NI (23 +/- 17 yr), (16.38 +/- 11.14 days) and (12.44 +/- 8.69%) (P=0.03, P=0.001, P=0.01) respectively. By multiple logistic regression analysis, TBSA co-morbidities, broad spectrum antibiotic usage and invasive devices usage were significantly related to acquisition of NI. Pseudomonas aeruginosa (57%), Acinetobacter baumannii (21%) and Staphylococcus aureus (14%) were the most common resistant organisms isolated. INTERPRETATION & CONCLUSION: Our findings emphasize the need for careful disinfection and more strict infection control procedures in areas that serve immunosupressed individuals, such as burn patients.

A geriatric patient with major burns:case report.

As is predictable, mortality and morbidity among geriatric patients are higher in patients with major burns. Decreased radiopulmonary reserves and malnutrition characterized by protein/energy deficiency and ageing of skin are predisposing factors which increase mortality and morbidity. In this study, we present a 90-yr-old patient with 46% total body surface area of 2nd-3rd degree burns. We had to overcome difficulties which can be seen in elderly patients and which succeeded in our treatment.

Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury.

Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.

Skin grafting of the naso-orbital region as a single aesthetic unit.

With improved acute care, a higher percentage of more severely injured facial burn patients are surviving their burns. When the full face needs resurfacing, total facial resurfacing should ideally be done with a single sheet of full-thickness skin. Unfortunately, this type of single sheet total facial resurfacing is rarely possible or practical in the case of acute extensive burns. The nasoorbital region is a focal point of interpersonal communication and needs special emphasis. This report presents two patients with deep facial burns whose midface regions were resurfaced with thick split-thickness skin graft as a single aesthetic unit. Since there is no skin graft junction line on this region, a more homogeneous appearance and an aesthetically superior result could be achieved.

Prolonged intermittent hydrotherapy and early tangential excision in the treatment of an extensive strong alkali burn.

It is well known that the first step in the treatment of cutaneous strong alkali burn is very early and persistent washing of the site of injury with large volumes of water. However, ideal duration and the technique of hydrotherapy has not yet been established. Besides hydrotherapy, tangential excision of the injured skin might prevent further tissue damage if it is performed early enough. We report the treatment of a 36-year-old male who sustained 53% body surface area (BSA) cutaneous burn due to caustic soda (NaOH). Prolonged intermittent hydrotherapy, early tangential excision and autografting of the injured skin are the keys for the proper management of extensive strong alkali burn.

Treatment of burn scar depigmentation by carbon dioxide laser-assisted dermabrasion and thin skin grafting.

Permanent depigmentation occasionally develops after deep partial-thickness and full-thickness burn injuries, which heal by secondary intention. This problem can be solved by dermabrasion and thin split-thickness skin grafting. However, mechanical dermabrasion is a bloody procedure that risks exposing medical professionals to infectious diseases transmitted by blood products, and it is difficult to assess the extent of tissue ablation. In this study, dermabrasion of depigmented burn scar area was performed by using flash-scanned carbon dioxide laser treatment, followed by thin split-thickness skin grafting. This method was applied to 13 patients on whom burn scar depigmentation sites were located as follows: two in the facial area, four on the trunk, and seven on the extremities. Skin graft take was excellent in all patients except for one. The follow-up period for these patients ranged from 1 to 12 months, with an average of 8 months. Repigmentation appeared soon after grafting, and no depigmentation occurred again in the treated areas. In conclusion, depigmented burn scar areas can be dermabraded in a short time; depth of tissue ablation can be well controlled; and a bloodless and smooth raw surface can be created by using a flash-scanned carbon dioxide laser. These raw surfaces sustain thin skin grafts well.

Replantation of an avulsive amputation of a foot after recovering the foot from the sea.

A foot avulsion case, with the dismembered body part submerged in sea water for 1 hour, is presented. This report is unique in that it is the first to document the reattachment of a body part that had been submerged in sea water. It was not known how salt-water exposure would affect wound management. Differences in osmolarity and bacterial flora between the sea water and foot tissues have not caused any problems, and the patient has not suffered any vascular or infectious complications after replantation. Neurotization of the plantar surface by the tibial nerve, which was stripped off during amputation and replaced in its original traces, was the most critical part of convalescence. After management of such an interesting case, we conclude that exposure to sea water of the dismembered part should not be a contraindication for replantation surgery.