Anal stenosis with megarectum: an unusual complication of a perineal burn.

A case of a 3-year-old boy with anal stricture and megarectum is described. Overflow incontinence and soiling were corrected by local flaps and skin graft and were maintained by frequent dilatations after downward traction of the whole anus was performed. The options of immediate and late treatment of such burns and the colostomy procedure are discussed.

Suicide attempts by self-immolation--our experience.

Of 5934 patients admitted to our Burns' Unit at the Soroka University Hospital, Beer-Sheva, Israel between the years 1965 and 1986, 22 had attempted suicide by fire (0.37 per cent). Seventeen of them (77 per cent) died from their burns. The use of flammable liquids was the most common method of immolation. Fifty per cent of the victims were known to have previous mental disorders.

Radiator scald burns: a preventable hazard.

During the last 13 years 80 patients have been admitted to our department suffering from burns caused by a vehicle's radiator. Ten of them were deeply burned and had to be treated surgically. The preventive aspect of this injury is emphasized.

Full skin thickness burns caused by contact with the pavement in a heat-stroke victim.

A 70-year-old woman, with a previous history of heat-stroke, suffered another heat-stroke on a hot summer day (air temperature 43 degrees C (109 degrees F)). She presented the rare complication of a heat-stroke plus deep burns sustained while lying unconscious on the pavement. In addition to age, obesity, previous illness, incidental fever, drugs, dehydration and physical effort, a previous history of heat-stroke is probably an important risk factor for a second heat-stroke. Burns from contact with the pavement are uncommon but possible, especially if the patient is obese, immobile and poorly insulated.

'Sabbath' electric plate burn: a ritual hazard.

This report describes the burns caused by an electric hot plate which is used by orthodox Jews for keeping food and liquids warm during the Sabbath (Saturday). An illustrative case is presented and the preventable aspects of this particular burn are discussed.

Bilateral hip resection for closure of trochanteric pressure sores: case report.

Bilateral resection of the proximal femur, an orthopaedic procedure advocated in selected cases of infected hip joints, can be useful in the treatment of extensive pressure sores in paraplegics. It is especially indicated in those cases where a total thigh flap is considered with the advantage of saving the limb, and by shortening the leg providing more skin and soft tissue for closure of the pressure sores.

Treatment of the burned hand: early surgical treatment (1975-85) vs. conservative treatment (1964-74). A comparative study.

Our experience with early tangential excision and grafting for burns of the hands is presented. The advantages of the early surgical approach are proven by comparing this technique with the 'old' conservative treatment in two different populations. It is clearly concluded that early excision and grafting, combined with adequate physiotherapy and pressure garments, offer favourable results for the burned hand. Early excision of the burn eschar, before the appearance of contamination, may prevent infection, long and unfavourable delay in healing, scar formation with its incapacitating sequellae and a non-aesthetic appearance. Such a delay was characteristic of the 'conservative period', which was dominated by 'fibroblast', 'good granulation tissue', and hypertrophic scarring. Early surgery, as described and advocated here, shortens the healing time, lessens the hospital stay, minimizes reconstructive surgery and leads to a good functioning hand with a reasonable aesthetic appearance, enabling the affected patient to return quickly to work and normal routine life.

A ten-year-old boy with dermatofibrosarcoma protuberans of the face.

A rare case of dermatofibrosarcoma protuberans on the face of a 10-year-old boy is presented. The patient's young age and the localization of the tumor led to limited excisions that resulted in two local recurrences. Primary wide excision with 2.5 cm of free margins is recommended to avoid local recurrences that are otherwise frequent.

Burns caused by bromine and some of its compounds.

Our experience with infrequent and unfamiliar types of injury caused by various compounds of bromine are described and discussed. While bromine containing compounds share some of the characteristics of other common causes of chemical burns, they also have a specific, exclusive mode of affecting the skin. The delay in the appearance of clinical signs and symptoms is an important factor to be considered by those who treat injuries caused by bromine or some of its compounds, or by those who may be the first to see persons who are injured by these agents. As most of the injuries occur at work (92 per cent) it is in these industrial premises that considerable stress should be made of the importance of wearing protective clothing in order to reduce local damage and prevent systemic effects. Prompt first aid, by thorough washing with large volumes of water reduces the extent and depth of the injury.

Dermodress: a new, temporary skin substitute for extensive deep burn coverage.

A chemically treated bovine skin, Dermodress, is presented as a long-term skin substitute. Dermodress was applied over denuded surfaces of debrided deep burns and was kept in place for up to 56 days. Dermodress adheres to all contours of the debrided surfaces, has hemostatic effect and does not present any signs of infection or rejection. Dermodress can be removed in stages according to the availability of autografts, which may be applied immediately, since the exposed areas are clean and suitable for immediate grafting. Our clinical experience shows that Dermodress has most of the required properties of a long-term temporary skin substitute.

Plantar ulcers in hereditary sensory neuropathy. A plea for conservative treatment.

Hereditary sensory neuropathy is a rare syndrome characterized by the occurrence, in childhood or early adult life, of perforating ulcers of the feet, lightning pains, and loss of cutaneous sensation and tendon reflexes in the lower extremities. Three patients with hereditary sensory neuropathy were family members. Trophic ulcers may be caused by diseases other than diabetes, syphilis, and leprosy.

Aplasia cutis congenita in two sibs discordant for pyloric atresia.

We report two sibs who were the products of a consanguineous mating, and who had an extensive form of aplasia cutis congenita (ACC). In one of them the generalized skin disorder was manifested by slipping off of the epidermis and mucous membranes with the slightest trauma. This sib also had pyloric atresia and other congenital malformations. Two hypotheses are presented to explain the discordance between the siblings for the abnormalities other than the ACC. One hypothesis assumes varying degrees of severity of the same autosomal recessive disease. The second suggests linkage between the gene for ACC and the gene for an epidermolysis bullosa (EB)-like disorder and pyloric atresia. a recombination event involving the EB-pyloric atresia gene in one carrier parent would then lead to an offspring with only ACC. Prenatal diagnosis is suggested by monitoring alpha-fetoprotein levels in aminotic fluid.

The vascular response of the "delay" procedure.

Delay of a flap apparently enhances its vitality during later transfer. At the present time, although we have a better understanding of the mechanism of skin flap delay, there are still controversies regarding the details. The purpose of our research was to study the vascular response of the delay phenomenon and compare the results with those obtained by others. This was accomplished by raising and delaying flaps in rats and histologically counting, at regular intervals, the number of arterioles, at a point of 2 cm distally to the base of the flap. Our data shows a decline in the number of arterio-venous shunts, from one week toward the third week post-operatively, thus sustaining those who advocate that the optimum time for transfer after delay procedure, is towards the third week. It is of empiric knowledge that a delay of a flap apparently enhances its chances for survival during later elevation, rotation, and transfer. Hynes (1) suggested that the reason for necrosis in the distal part of the flap is due to the opening of a significant number of arterio-venous shunts. The work of Reinisch (2) contributed to this idea by demonstrating a change in the microvascular circulation in the flap. In this work, an attempt is made to give further proof of Hynes' theory by counting histologically the number of arterioles during the delay period in a flap as an indication of the number of patent arterio-venous shunts.

Linear verrucous nevus.

Linear verrucous nevi may be troublesome lesions to extirpate with satisfactory cosmetic results. Conventional practice has been to excise then in full-thickness skin. A simpler technique of shaving them off to a depth between the papillary and reticular dermis and allowing spontaneous re-epithelization from the remaining portions of adnexa is recommended as better and cosmetically more satisfactory.

The pedunculated malignant melanoma: a misunderstood and neglected variant.

A case of a truly pedunculated malignant melanoma is described. It is a rare form of malignant melanoma. Accurate description of it and statistics of its frequency are difficult to come by in the literature because of the prevailing confusion between this form and the "polypoid" type of malignant melanoma.