RESUMO
Inhalation injury greatly increases the incidence of respiratory failure and acute respiratory distress syndrome. It is also the cause of most early deaths in burn victims. The aim of this research is to study the incidence, early diagnosis, complications, and management of inhalation injury and to discuss the relationship between inhalation injury and death in burn patients. The study included 130 burn patients (61 male and 69 female) with inhalation injury admitted to Menoufiya University Hospital Burn Center & Chest Department (Egypt) from January 2008 to January 2010. It was found that the presence of inhalation injury, increasing burn size, and advancing age were all associated with increased mortality (p < 0.01). The incidence of inhalation injury was 46.3% (the 130 patients came from a total number of 281 burn victims). The overall mortality rate among patients with inhalation injury was 41.5% (54/130) compared with 7.2% (11/151) among patients without inhalation injury. These statistics clearly indicate that inhalation injury was an important factor for predicting burn patient mortality. Approximately 80% of fire-related deaths are due not to the airway burn injury itself but to the inhalation of toxic products, especially carbon monoxide and hydrogen cyanide gases. Inhalation injury is generally caused by thermal burns, and is mostly confined to the upper airways. Major airway, pulmonary, and systemic complications occur after inhalation injury, and this increases the incidence of mortality among burn patients.
RESUMO
Background. Since it was described by Nassif et al. in 1982, the parascapular flap has been used as a pedicled or island flap for axillary contractures and as a free flap for neck reconstruction. To the best of our knowledge, there are no reports in English describing its use as an island flap for neck reconstruction. Methods. Nine patients with severe post-burn neck contracture scars were reconstructed with pre-expanded extended island parascapular flaps. Results. All flaps survived completely, providing thin skin coverage of the neck defect with satisfactory natural appearance. The size of the flaps ranged from 32 to 44 cm in length and 11 to 16 cm in width (mean: length 38.2; width, 14.2 cm). No debulking was done but secondary revisions such as Z-plasty and scar revision were performed for all flaps. The donor site was closed primarily in all patients but delayed wound healing was recorded in two. Widening and hypertrophic scar changes developed at the donor site of seven patients. Conclusions. The utilization of pre-expanded extended island parascapular flap is an effective way for reconstruction of post-burn neck contracture. It provides a large good-quality skin flap that can cover all the aesthetic units of the neck without any microvascular anastomosis. However, the protracted time required for the procedure and the requirement of two operations, plus the repeated follow-up visits, may constitute major disadvantages.
RESUMO
Inhalation injury greatly increases the incidence of respiratory failure and the acute respiratory distress syndrome. It is also the cause of most early deaths in burn victims. The aim of our research was to study the incidence, early diagnosis, complications, and management of inhalation injury and to discuss the relation between inhalation injury and death in burn patients.This study included 130 burn patients with inhalation injury admitted to Menoufiya University Hospital Burn Center, Egypt, from January 2004 to April 2008 (61 males and 69 females). We found that the presence of inhalation injury, increasing burn size, and advancing age were all associated with increased mortality (p < 0.01). The incidence of inhalation injury in our study was 46.3% (130 patients were identified as having inhalation injury out of 281). The overall mortality for patients with inhalation injury was 41.5% (54 patients out of 130) compared with 7.2% (11 patients out of 151) for patients without inhalation injury. These statistical data make it clear that inhalation injury is an important factor for the prediction of mortality in burn patients. Approximately 80% of fire-related deaths are due not to the burn injury to the airway but to the inhalation of toxic products, especially carbon monoxide and hydrogen cyanide gases. Inhalation injury is generally caused by thermal burns, mostly confined to the upper airways.Major airway, pulmonary, and systemic complications may occur in cases of inhalation injury and thus increase the incidence of burn patient mortality.
RESUMO
PURPOSE: The aim of this study was to test the effectiveness of a modified Foley catheter for improving the results of hypospadias repair by decreasing the incidence of obstruction. MATERIALS AND METHODS: Seventy-two patients (age 3 to 21 years) with variable types of hypospadias were treated. Bladder drainage was performed by urethral catheter insertion. The patients were divided equally into two groups of 36 patients each, according to the type of catheter used. In the first group of patients, a Foley catheter was inserted; in the second group, a modified Foley catheter (hole-end catheter) was introduced for urine drainage. RESULTS: Fourteen patients (19.4%) required secondary surgical repair: 8 (22.2%) in the first group and 6 (16.7%) in the second group. The rate of complications was lower in the second group than in the first group (25% and 50%, respectively). In the first group, 4 patients (11.1%) had urethral catheter obstruction: one was relieved by catheter flushing using sterile normal saline and three by suprapubic diversion. In the second group, urine retention was recorded in 2 patients (5.5%) and relieved by saline wash. CONCLUSION: The hole-end catheter provides better bladder drainage with the ability to easily dislodge precipitations.
