Mirror foot.

Mirror image polydactyly is a rare congenital abnormality that may occur in isolation, or in association with multiple congenital anomalies. A case of unilateral mirror foot with an ipsilateral short, broad tibia is described. The clinical, radiologic, and operative findings are presented, and current theories of embryo-pathogenesis are reviewed.

Trigger thumb in children--results of simple surgical treatment.

The effectiveness of simple surgical release of trigger thumb/finger in children was assessed and the onset of this condition relative to age was investigated in a retrospective study between 1977 and 1992. Referrals to the congenital hand clinic at Red Cross War Memorial Children's Hospital, Cape Town, were studied. A total of 53 children (68 digits) with a mean age of 1.9 years were treated during this period (as day cases). The thumb was involved in 60 digits and involvement was bilateral in 11 children. Symptoms had been present since birth in 43 children. In 51 children (96%) the trigger digit was released successfully; the 2 recurrences were due to inadequate surgical release. Trigger digit in children appears to be a congenital condition. Simple surgical release is effective treatment and can be performed on an ambulant basis.

Shack fires: a consequence of urban migration.

Shack fire burns are the second most common reason for admission of patients to the burns unit in Cape Town. A retrospective analysis of 99 patients between January 1993 and June 1995 was undertaken to investigate the demographics and mortality associated with shack fire burns. There were 58 males and 41 females with an average age of 34 years (range 13-17 years). The average total burn surface area (TBSA) was 31 per cent (range 3-98 per cent) and in 67 of these patients a full-thickness component to the burn was noted. The upper limbs and head and neck were the most commonly burnt areas. Inhalation injury affected 61 patients, 18 of whom required admission to an intensive care unit for assisted ventilation due to respiratory failure. Thirty nine patients (39.4 per cent) died. Shack burns are a specific entity associated with significant morbidity and a high mortality. The injuries had a major impact on the victim's life and prevention is the best form of treatment.

Primus stove burns in Cape Town: a costly but preventable injury.

The management and outcome was evaluated in 33 patients during an 18-month period, who sustained burns as a result of working with a primus stove. There were 17 females and 16 males with an average age of 32.5 years. Twenty-nine patients were black skinned and four were coloured skinned. The average burn surface area was 16.8 per cent and the burns were deep dermal in all; 48 per cent of patients also had areas of full thickness skin loss. Twenty-seven patients were burned in more than one anatomical area. Patients spent an average of 24 days in the burns unit and all patients required tangential excision and skin grafting at least once. The average number of units of blood required was four. Only one patient died. Primus stove burns occurred in people of poor social circumstances. Primus stove burns place a heavy burden on the economic resources available. Prevention is the key to management.

Evaluation of a commercial kit for detection of Streptococcus pyogenes in a burns unit.

The presence of Streptococcus pyogenes (group A Streptococcus) may increase morbidity in burns patients. A rapid detection system enabling early therapeutic intervention is therefore desirable. A commercial kit (Wellcome Diagnostics Reveal Colour Strep A) was evaluated in a burns unit. Two separate studies were undertaken. The first compared two swabs taken from a particular burn site, one of which was cultured conventionally and the other processed for rapid detection. In the second study, swabs were processed routinely and then subjected to the rapid detection test in order to assess reproducibility of results. In our hands the rapid test was easy to perform and correlated well with conventional culture. We recommend the use of a rapid detection system for S. pyogenes as a useful adjunct to conventional culture methods.

Metabolic response to localized surgical fat removal in nonobese women.

Although suction lipectomy and dermolipectomy are common surgical procedures, the body's response to localized removal of fat and the long-term efficacy of these procedures remain controversial. Seven women who underwent liposuction or abdominoplasty were studied prior to surgery and between one and two months postoperatively. All patients were weight-stable prior to surgery and the reported daily food intake and nutrient composition of the diet did not change. The following parameters were measured: resting oxygen uptake (VO2), glucose-induced increment in VO2, anthropometry, and site-specific fat cell size. Fat samples were taken by needle aspiration from abdominal and femoral regions. Resting energy expenditure and the response to glucose feeding were not significantly different postoperatively. Furthermore, site-specific fat cell size did not change, nor were there any significant differences in the sum of four skinfold thicknesses. These results suggest that energy balance was not altered as a result of localized fat removal in previously weight-stable women. Thus, short-term follow-up suggests that surgical fat removal does not result in a compensatory change in metabolic efficiency or fat cell size and distribution in these weight-stable women. Therefore, this technique may prove effective for body contouring in nonobese women.

Thermal injury in pregnancy--the neglected tragedy.

Thermal injury sustained during pregnancy presents special management problems for the gravid woman and her unborn child. Because of the reported high morbidity and mortality and lack of available data in South Africa, a multicentre retrospective review was undertaken by five burn centres. Thirty-three patients (average age 25,7 years) with mean 30% (range 1-80%) total body surface area burn were assessed. A review of the clinical material led to the following observations and conclusions. Pregnancy does not influence maternal outcome after thermal injury and maternal survival is usually accompanied by fetal survival in the absence of significant maternal complications. Maternal survival is less likely if the burn wound exceeds 50% total body surface area. Thermal injury does increase the risk of spontaneous abortion and premature labour, and fetal survival depends on fetal maturity. Early obstetric intervention is only indicated in the gravely ill patient where complications (hypoxia, hypotension, sepsis) jeopardize the life of a viable fetus. The mode of delivery should be determined by obstetric considerations.

Site selection for fat autotransplantation: some observations.

The use of autologous fat for implantation has recently received renewed attention in the plastic surgery literature. Autologous fat reportedly has been used for the treatment of wrinkles and Romberg's disease, and for buttock and breast augmentation. While some measure of success has been achieved, many surgeons report that substantial resorption of fat tissue occurs at the site of implantation. There is lack of unanimity regarding the ideal site for extraction or injection in order to minimize fat resorption. Adipose tissue samples were taken from women undergoing surgical procedures on the abdomen, gluteal-femoral region, and breast. Facial adipose tissue samples from men and women were also analyzed. Adipocytes were isolated chemically and sized microscopically. Activity of the lipogenic enzyme adipose tissue lipoprotein lipase (ATLPL) was measured in frozen samples. Results suggest that femoral site samples are somewhat larger (NS) and have greater lipogenic activity (p less than 0.03) than other sites. In our study, small facial samples had very low or unmeasurable levels of ATLPL activity. Perhaps cell size and lipogenic activity should be considered when selecting tissues for autotransplantation.

Breast reconstruction after mastectomy. The Cape Town experience.

As methods have advanced, trends in breast reconstruction after mastectomy have changed considerably with more emphasis being placed on reconstruction by means of tissue expansion. Indications for using the various methods available are discussed and their advantages and disadvantages enumerated. By May 1987, 95 breasts in 88 patients had been reconstructed at Groote Schuur Hospital with few complications. The challenge remains one of improving the appearance of reconstructed breasts.

Macrodactyly simplex congenita. A case series and considerations of differential diagnosis and aetiology.

Macrodactyly simplex congenita (MSC) is a rare congenital anomaly comprising some 10% of cases of isolated congenital macrodactyly. The essential elements in MSC are mentioned and a differential diagnosis from other forms of enlarged digits is given, in the light of the natural history of the condition. The distinction is shown to have practical therapeutic implications. The causation is discussed and a hypothesis advanced of a possible somatic mutation in an inhibitory chalone receptor allowing the switch-on of unimpeded local growth.