Iatrogenic Thermal Burns Secondary to Marine Sting Treatment.

Hot water immersion (HWI) therapy is an effective and validated treatment for a variety of marine stings. Unsupervised, however, it poses a significant risk of thermal injury. Herein, we describe our experience of iatrogenic thermal injury secondary to marine sting treatment. A 5-year retrospective review of all iatrogenic thermal burns secondary to marine stings referred to the State Adult Burn Service was conducted. Nine patients were identified, all sustaining stings to the feet from estuarine cobblerfish, stonefish, and stingrays. All patients continued unsupervised HWI at home and sustained thermal injury to their feet. The majority were treated conservatively with dressings and elevation. One patient required surgical debridement. While heat application is an effective treatment for marine stings, further patient education is required following discharge from point of care. We recommend that first-aid treatment guidelines be updated to reflect that patients are not recommended to continue scalding water immersion at home. However, if patients wish to continue HWI, water temperature should be checked manually with a thermometer or with a nonstung limb and limited to 30 minutes immersion, with 30-minute skin recovery time between.

Acute radial artery ischemia following therapeutic steroid injection.

Intra-arterial corticosteroid injection at the wrist can have devastating consequences. Anatomic arterial variation of the hand can lead to atypical presentation. A careful history and examination, with appropriate investigations, can lead to an accurate diagnosis in such difficult cases.

Surgeons and scars: differences between patients and surgeons in the perceived requirement for reconstructive surgery following burn injury.

BACKGROUND: Reconstruction of the burn patient presents a challenge to the burns surgeon. The variety of issues and the timing of surgery can be a daunting task. A group of 11 patients who were injured 1 year previously at the time of the Bali bomb blast were reviewed. METHODS: A customised assessment form was developed in order to quantify the patient's perceived need for reconstruction. Each patient was asked to prioritise, in order of preference any injured area they might consider for further surgery. These patients were then assessed independently by a consultant plastic and reconstructive surgeon and a senior trainee, using an identical form. The surgeons were asked to prioritise, in order of preference any area they might consider for further surgery and to indicate from a list the procedure they would employ. This list ranged from simple excision to free flap encompassing the entire reconstructive ladder. RESULTS: The patients all showed a strong reluctance to undergo further reconstruction. However there was a strong correlation between the surgeons, concurring on issues of function but there were discrepancies regarding "aesthetic" reconstruction. CONCLUSIONS: This study highlights the absolute need for secondary burns reconstruction to be a patient driven service.