Surgical management of neonatal limb ischaemia: a technique for open thrombectomy and the novel use of Integra.

Neonatal limb ischaemia (NLI) is a rare but potentially catastrophic condition. Although medical therapy remains as first-line treatment, surgery has an important role when limb-threatening events are present. In this paper we outline the milking technique for open thrombectomy used by the senior author in the treatment of 5 NLI cases. We also present the use of Integra and it's specific benefits in the management of wounds in these challenging situations. Skin grafts over the Integra can be avoided by staged excision of the silicone layer from the margins. We believe this is a novel approach to the use of Integra.

Dual benefit procedures: combining aesthetic surgery with burn reconstruction.

Burn accounts for a significant proportion of injuries, and of these, the face, neck, and anterior torso are commonly affected. Burn scars remain a lasting reminder of the insult both for the patient and the outside world. There is little doubt that the changes in appearance, and limitations imposed by the burn scar contribute to a negative body image. We present a series of four women, who sustained full thickness burns in childhood with subsequent burn scarring and contracture. These women were noted to have poor body image in areas less affected by burn injury, notably breast ptosis, breast asymmetry and abdominal skin laxity. They were suitable candidates for planned aesthetic procedures, and the skin excised was used to effect synchronous burn reconstruction or contracture release. We believe the potential to use areas of skin excised during aesthetic procedures as possible donor sites of full thickness skin, confers the dual benefits of improved aesthetic and functional outcome, while minimising unnecessary donor site morbidity.