Early intervention reduces morbidity in extravasation injuries from 'lighter fuel' injection.

Injection of 'lighter fuel' with suicidal intent is rare. Extravasation of the chemical may rarely cause systemic toxicity, but usually it results in extensive soft tissue damage. Such injuries when managed by the traditional expectant policy are associated with considerable morbidity. Early aggressive surgical management using 'saline flush out' limits the tissue damage by stopping the natural progression of the chemical mediated injury and the subsequent inflammatory response, thereby allowing better skin preservation and functional outcome in these cases. We report a case of 'lighter fuel' subcutaneous extravasation injury managed by 'saline flush out' technique soon after presentation.

Use of distally based superficial sural island artery flaps in acute open fractures of the lower leg.

The reverse sural artery flap is a fasciocutaneous flap based on the median superficial sural artery and its communication with the perforating branch of the peroneal artery situated in the region of the lateral malleolar gutter. Reverse flow is established after elevation of the flap and with division of the sural artery and the nerve proximally. The authors present resurfacing of acute open fractures of the lower third of the leg in 7 patients immediately after the acute phase of injury. Reconstruction was carried out within an average of 3 days after injury. All 7 patients sustained low-velocity injuries. Although 2 patients had partial necrosis of the distal tip of the flap, all patients had excellent recovery with minimal donor site morbidity.

Cutaneous malignant melanoma in children and adolescents in Scotland, 1979-1991.

All cases of cutaneous malignant melanoma in Scotland have been registered by the Scottish Melanoma Group since 1979, and there are currently more than 4700 cases on the registry. Of these, only 50 cases are in patients 18 years of age and younger (1.04 percent of all melanomas); 15 of these were prepubertal, i.e., 14 years or younger (0.3 percent of all melanomas). The nine cases of documented metastases occurred in children with tumor thickness of 1.50 mm or more, with only one of these metastases occurring in a prepubertal child. Eight of these patients with metastatic disease died, with a maximum survival of 4 years. A reliable clinical history was obtained from the families of 23 patients. Eight of them had a history of preexisting congenital nevocellular nevus. In this series, no case arose in a large congenital nevocellular nevus. Histological review showed that the majority of cases (58 percent) exhibited typical cytological and architectural features of malignant melanoma. In the remaining cases, the lesions were difficult to fit into any of the classic patterns of malignant melanoma or of the known benign nevocellular lesions.

Duplication of the thumb. A 20-year retrospective review.

Thumb duplication is a common congenital abnormality accounting for 6.6% of all hand deformities. The object of the primary surgery is to achieve a thumb with aligned joint surfaces and epiphyses perpendicular to the long axis, central flexor and extensor tendons, and adequate collateral ligaments. Experienced surgeons with an understanding of the abnormal anatomy and knowledge of the numerous refinements in technique cannot guarantee a flawless result. Of 43 cases treated in this Unit during the period 1970-1989 49% were noted to have secondary deformities. Angulation at the IP and/or MP joints were the most commonly observed problems. Unsatisfactory results were seen with a greater frequency following correction of the more complex deformities.

Morbidity of otoplasty: a review of 562 consecutive cases.

Otoplasty is a routinely performed procedure in virtually all plastic surgery units. However, there are few comprehensive reports in the literature on the incidence of complications. In a review of 562 consecutive patients we found significant morbidity. Residual deformity, haemorrhage, infection, keloid/hypertrophic scarring and anterior skin necrosis were recorded and incidence determined. Cases requiring revision i.e., those with residual deformity were analysed further. The fault at the primary procedure was mostly that of design (73.4%), although many other residual problems were due to poor execution of technique (26.6%). Steps are described to minimise the need for such revision.

The double cross plasty: a new technique for nasal stenosis.

Atresia and stenosis of the anterior nares is caused by a lack of the normal mucous membrane lining the nasal vestibule. The condition may be congenital but is usually acquired. In most cases the external contour of the nose is not affected but an extensive deficiency of the mucosal lining may alter the shape of the cartilagenous part of the nose. The width of the obstruction, the state of the surrounding lining and the degree of the external deformity are the main factors to be assessed in any attempt at surgical correction. A new technique is presented which has successfully corrected severe unilateral stenosis in two children.

Successful transfer of two reverse forearm flaps despite disruption of both palmar arches.

The advantages of the ipsilateral forearm flap in emergency post-traumatic hand reconstruction are now well-established. A prerequisite for such a transfer has always been the presence of at least one intact palmar arch. We report the successful transfer of two reverse forearm flaps despite disruption of both palmar arches. In both cases the flap was raised on the vascular axis which had ceased to contribute significantly to the hand circulation. The anatomical basis of this transfer is discussed.

Reconstruction of the oral commissure by vascularised toe web transfer.

Reconstruction of a large post-excisional defect of the oral commissure by free transfer of the great/second toe web is reported. A comparison with other methods of repair is briefly made.