Cutaneous basal cell carcinoma arising within a keloid scar: a case report.

Basal cell carcinomas (BCCs) are one of the most frequent cutaneous malignancies. The majority of BCCs are reported to occur on the auricular helix and periauricular region due to ultraviolet light exposure. Despite the frequency of BCCs, those that develop within scar tissue are rare, and the phenomenon of keloid BCCs has rarely been reported in the literature. Keloid collagen within BCCs is associated with morphoeiform characteristics, ulceration, or necrosis. Extensive keloid collagen is often seen in BCCs of the ear region, a site prone to keloid scarring. This article presents a rare case of a secondary tumor (BCC) which arose on top of a primary tumor (keloid scar) on the right auricle region in a healthy 23-year-old female after an ear piercing 2 years prior. To our knowledge, the tumor described in this case, in contrast to keloidal BCCs, has never been reported in the literature.

The Impact of Autologous Fat Grafting on Breast Cancer: An Experimental Model Using Magnetic Resonance Imaging.

BACKGROUND: Although fat grafting is a common technique to repair defects after breast cancer reconstruction surgery and has a low complication rate, the relation between fat grafting and the risk of breast cancer is unknown. Clinical trials to investigate this connection can elucidate the benefits and potential risks of fat grafting in oncology patients. OBJECTIVES: To establish an efficient experimental model, using magnetic resonance imaging (MRI) scans, for comparing different breast tumor study groups post-fat grafting. METHODS: Breast tumor cells were injected into immunocompromised mice. After tumors formed they were removed. Liposuction was performed in a female human donor and fat was collected. Cells were extracted from the fat by enzymatic digestion. Immunocompromised mice were randomized into four groups: a preliminary experiment group and three equal groups according to the type of fat graft: (i) fresh fat enriched with adipose-derived mesenchymal stem cells (AdMSCs), (ii) fresh fat without cell enrichment, and (iii) no fat injected. Tumor volume was assessed by serial MRI scans. RESULTS: The rate of tumor growth was higher in the enriched fat group compared to the non-enriched fat group. CONCLUSIONS: This experimental model is an effective measurable method, allowing future investigation of the effect of autologous fat on breast cancer.

Adipocytes Viability After Suction-Assisted Lipoplasty: Does the Technique Matter?

BACKGROUND: Suction-assisted lipoplasty (SAL; liposuction) is an established aesthetic procedure in plastic surgery. The main parameters differentiating one method of lipoplasty from another are safety, consistency of results, and other more technical parameters. Due to the recent popularity of lipotransfer, the quality of extracted fat has become a relevant parameter. We compare the viability of extracted adipocytes after dry SAL, hyper-tumescent PAL (power-assisted lipoplasty), and water-assisted lipoplasty (WAL). METHODS: We used fluorescent microscopy to differentiate viable from necrotic/apoptotic cells after liposuction using each of the mentioned methods. RESULTS: The ratio of living cells between the three methods was significantly different with dry liposuction yielding inferior ratios (p = 0.011). When omitting extreme results, we found that the body-jet technique (WAL) yielded higher ratios of living cells than the hyper-tumescent technique (p < 0.001). The total number of cells was highest in the hyper-tumescent method (p = 0.013). CONCLUSIONS: Our results indicate that the hyper-tumescent technique yields the highest number of cells, whereas the body-jet technique yields the highest living cells ratio. The dry technique is clearly inferior to both. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Corrigendum: Examining the Correlation between Objective Injury Parameters, Personality Traits and Adjustment Measures among Burn Victims.

[This corrects the article on p. 49 in vol. 3, PMID: 25874193.].

Increased serum NKG2D-ligands and downregulation of NKG2D in peripheral blood NK cells of patients with major burns.

Immune suppression following major thermal injury directly impacts the recovery potential. Limited data from past reports indicate that natural killer cells might be suppressed due to a putative soluble factor that has remained elusive up to date. Here we comparatively study cohorts of patients with Major and Non-Major Burns as well as healthy donors. MICB and ULBP1 are stress ligands of NKG2D that can be induced by heat stress. Remarkably, serum concentration levels of MICB and ULBP1 are increased by 3-fold and 20-fold, respectively, already within 24h post major thermal injury, and are maintained high for 28 days. In contrast, milder thermal injuries do not similarly enhance the serum levels of MICB and ULBP1. This kinetics coincides with a significant downregulation of NKG2D expression among peripheral blood NK cells. Downregulation of NKG2D by high concentration of soluble MICB occurs in cancer patients and during normal pregnancy due to over production by cancer cells or extravillous trophoblasts, respectively, as an active immune-evasion mechanism. In burn patients this seems an incidental outcome of extensive thermal injury, leading to reduced NKG2D expression. Enhanced susceptibility of these patients to opportunistic viral infections, particularly herpes viruses, could be explained by the reduced NKG2D expression. Further studies are warranted for translation into innovative diagnostic or therapeutic technologies.

A Literature Review of Burns in Reconstructed Breasts After Mastectomy.

OBJECTIVE: The goal of this literature review is to review and combine case studies of accidental burns to the breast, following mastectomy and immediate breast reconstruction with autologous tissue, implants, or tissue expanders. METHODS: The authors searched PubMed and Cochrane Library and reviewed cases of burns of reconstructed breasts after mastectomy from July 1985 to May 2015. Only studies in the English language were included in their search. They also report 5 new cases of burns in patients with burns to the breast, which were either reconstructed with implants or tissue expanders at Sheba Medical Center (Ramat Gan, Israel). RESULTS: The authors found 21 publications regarding burns after breast reconstruction dating from 1985 to 2014, which equaled 59 cases of reported burns in the 21 included publications. The most common causes of burns were due to heat conduction (37/59) followed by solar radiation (19/59) and heat convection (3/59). The majority of the cases were treated by a conservative approach. The 5 new cases added were all due to thermal radiation (5/5). Two of these cases were treated conservatively (2/5), and 3 underwent surgery (3/5). CONCLUSION: The removal of thermoregulatory capabilities of the skin and the thickness of the remaining tissue in the mastectomy procedure are key to understanding the cause of burns to reconstructed breasts.

Characteristics of Improvised Explosive Device Trauma Casualties in the Gaza Strip and Other Combat Regions: The Israeli Experience.

OBJECTIVE: Low-intensity conflict is characterized in asymmetrical conventional and nonconventional warfare. The use of improvised explosive devices (IEDs) in the Israeli-Palestinian conflict has evolved over the past few decades to include the addition of diesel, biological agents, shrapnel, and nitroglycerin to the explosive content. Due to its nature and mechanism, an IED injury might present as a multidimensional injury, impairing numerous systems and organs. MATERIALS AND METHODS: The authors present a case series of 5 Israeli Defense Forces (IDF) soldiers wounded by an IED presenting a typical and similar pattern of burns to their faces, trunks, and limbs, in addition to ocular, ear/nose/throat, and orthopedic injuries. An analysis of the experience in treating the aforementioned injuries is included. RESULTS: Improvement in casualties' burns and traumatic tattoos was observed following debridement, aggressive scrubbing with or without dermabrasion, and conservative local dressing treatment protocol. The authors found a positive correlation between improvement degree and treatment timing. Injury pattern was correlative to the protective gear worn by the soldiers. Wearing protective eye gear and wearing ceramic vests can diminish the extent of IED injuries, while creating typical patterns of injuries to be treated. CONCLUSION: Based on these experiences, such injuries should be brought to a trauma center as soon as possible. Treating multidimensional trauma should be done in a facility with abilities to treat head injuries, eye injuries, penetrating injuries, blast injuries, and burns. Such specialized disciplines and facilities that have past experience with IEDs and war injuries are able to assess and treat these injuries in a more dedicated manner, resulting in better long-term rehabilitation.

Adhesive skin closure technique for closure of fasciotomy wounds in pediatric patients: a case series.

BACKGROUND: Closure of fasciotomy wounds poses a challenge, particularly in pediatric cardiac patients who are too high risk for general anesthesia and often require anticoagulant treatment. The adhesive skin closure technique enables wound closure without the need for a secondary procedure such as surgery requiring anesthesia. OBJECTIVES: This study sought to describe a treatment modality that assists in fasciotomy wound edge approximation without the need for surgery, while additionally aiding in achieving fast and aesthetic results in the aforementioned patient population. A case series of 4 pediatric patients with fasciotomy wounds is presented. MATERIALS AND METHODS: Adhesive skin closure strips (Steri-Strips, 3M, St. Paul, MN) were placed perpendicular to the cleansed wound leaving small gaps for drainage, thus achieving complete propinquity. The strips were replaced sequentially with new strips every 2 to 3 days. Digital pictures of the wounds were obtained until complete closure of the wounds was achieved. Outcome variables included wound closure success rates and complication rates including infection, bleeding, and late scar formation. RESULTS: Patient ages ranged from 2 weeks to 2 years, 9 months (mean: 10.5 months), average period of open wound prior to closure was 6.75 days (range: 5-11 days), treatment duration ranged from 15 to 26 days (mean: 21 days), and average follow-up was 4.5 months. One patient died due to their primary condition. No local infections, wound dehiscence with the treatment regimen, or any other immediate complications were encountered. There was a late complication in 1 patient who presented with a hypertrophic scar. CONCLUSIONS: Use of the adhesive skin closure method to close fasciotomy wounds in pediatric patients in which surgical procedures were nonadvisable produced favorable results.

RBM28, a protein deficient in ANE syndrome, regulates hair follicle growth via miR-203 and p63.

Alopecia-neurological defects-endocrinopathy (ANE) syndrome is a rare inherited hair disorder, which was shown to result from decreased expression of the RNA-binding motif protein 28 (RBM28). In this study, we attempted to delineate the role of RBM28 in hair biology. First, we sought to obtain evidence for the direct involvement of RBM28 in hair growth. When RBM28 was downregulated in human hair follicle (HF) organ cultures, we observed catagen induction and HF growth arrest, indicating that RBM28 is necessary for normal hair growth. We also aimed at identifying molecular targets of RBM28. Given that an RBM28 homologue was recently found to regulate miRNA biogenesis in C. elegans and given the known pivotal importance of miRNAs for proper hair follicle development, we studied global miRNA expression profile in cells knocked down for RBM28. This analysis revealed that RBM28 controls the expression of miR-203. miR-203 was found to regulate in turn TP63, encoding the transcription factor p63, which is critical for hair morphogenesis. In conclusion, RBM28 contributes to HF growth regulation through modulation of miR-203 and p63 activity.

Examining the Correlation between Objective Injury Parameters, Personality Traits, and Adjustment Measures among Burn Victims.

BACKGROUND: Burn victims experience immense physical and mental hardship during their process of rehabilitation and regaining functionality. We examined different objective burn-related factors as well as psychological ones, in the form of personality traits that may affect the rehabilitation process and its outcome. OBJECTIVE: To assess the influence and correlation of specific personality traits and objective injury-related parameters on the adjustment of burn victims post-injury. METHODS: Sixty-two male patients admitted to our burn unit due to burn injuries were compared with 36 healthy male individuals by use of questionnaires to assess each group's psychological adjustment parameters. Multivariate and hierarchical regression analysis was conducted to identify differences between the groups. RESULTS: A significant negative correlation was found between the objective burn injury severity (e.g., total body surface area and burn depth) and the adjustment of burn victims (p < 0.05, p < 0.001, Table 3). Moreover, patients more severely injured tend to be more neurotic (p < 0.001), and less extroverted and agreeable (p < 0.01, Table 4). CONCLUSION: Extroverted burn victims tend to adjust better to their post-injury life while the neurotic patients tend to have difficulties adjusting. This finding may suggest new tools for early identification of maladjustment-prone patients and therefore provide them with better psychological support in a more dedicated manner.

The arterial blood supply of the helical rim and the earlobe-based advancement flap (ELBAF): a new strategy for reconstructions of helical rim defects.

BACKGROUND: Several techniques are currently available for reconstruction of helical rim defects including Antia and Buch's technique. Some of these techniques produce unsatisfying aesthetic results or are time consuming or technically challenging. Herein, we present the earlobe-based advancement flap (ELBAF) technique and its anatomical basis for reconstruction of helical rim defects. METHODS: A case series of 13 patients with helical rim defects of up to 3.8 cm in length were reconstructed using the ELBAF technique solely or with additional procedures. Patients were followed for the occurrence of complications and evaluation of aesthetic results for up to 8 years. An anatomical assay that included cadaver dissection and anatomical corrosion technique was performed in order to support the ELBAF technique. RESULTS: Thirteen patients (68.5 ± 9 years, two females) with full-thickness helical rim defects of up to 3.8-cm length caused by basal cell carcinoma in 92.3% underwent reconstruction surgery using the ELBAF technique solely or with additional procedures. No complications related to the ELBAF technique were encountered during follow-up. Cadaver dissections demonstrated a consistent arterial blood supply emerging from the earlobe area, producing arteries that run circularly along the helical rim. CONCLUSIONS: Based on the axial vessel pattern, the ELBAF technique seems to be a useful strategy to reconstruct full-thickness helical defects of up to 3.8 cm in length. This procedure can be regarded as a valid addition to the ear reconstruction repertoire, which can be used alone or in combination with other established techniques. LEVEL OF EVIDENCE: Level 4, case series.

Validation of the Hebrew version of the Burn Specific Health Scale-Brief questionnaire.

BACKGROUND: The Burns Specific Health Scale-Brief (BSHS-B) questionnaire is a suitable measurement tool for the assessment of general, physical, mental, and social health aspects of the burn survivor. AIM: To translate, culturally adapt and validate the BSHS-B to Hebrew (BSHS-H), and to investigate its psychometric properties. METHODS: Eighty-six Hebrew speaking burn survivors filled out the BSHS-B and SF-36 questionnaires. Ten of them (11.63%) completed a retest. The psychometric properties of the scale were evaluated. Internal consistency, criterion validity, and construct validity were assessed using interclass correlation coefficient, Cronbach's alpha statistic, Spearman rank test, and Mann-Whitney U test respectively. RESULTS: BSHS-H Cronbach's alpha coefficient was 0.97. Test-retest interclass coefficients were between 0.81 and 0.98. BSHS-H was able to discriminate between facial burns, hand burns and burns >10% body surface area (p<0.05). BSHS-H and SF-36 were positively correlated (r(2)=0.667, p<0.01). CONCLUSIONS: BSHS-H is a reliable and valid instrument for use in the Israeli burn survivor population. The translation and cross-cultural adaptation of this disease specific scale allows future comparative international studies.

An Improvised "Blow Glove" Device Produces Similar PEP Values to a Commercial PEP Device: An Experimental Study.

BACKGROUND: Postoperative positive expiratory pressure (PEP) therapy promotes increased lung volume, secretion clearance, and improved oxygenation. Several commercial devices exist that produce recommended PEP values (10-20 cmH2O) when the patient breathes through a fixed orifice resistor. It was hypothesized that an inexpensive, improvised "blow glove" device would produce similar PEP values over a wider range of expiration volumes and flow rates. METHODS: PEP for different expiration volumes (400-2000 mL) and expiratory flow rates (10-80 L/min) was compared between a commercial PEP device (Resistex, Mercury Medical, Clearwater, FL) and an improvised "blow glove" device, recorded by a Vela ventilator (CareFusion, San Diego, CA). Dynamics in positive end expiratory pressure (PEEP) values were evaluated following five consecutive expirations. The "blow glove" device was evaluated using various glove compositions and sizes. RESULTS: The improvised "blow glove" device produced a significantly higher rate of PEP values in the recommended range than the Resistex device (88.9% vs. 20%, p<0.0001). No significant difference was observed between small and large glove sizes (88.9% vs. 82.9%, p>0.05), but the powdered latex glove showed a significantly higher rate of PEP values in the recommended range than the powder-free latex glove (88.9% vs. 44.4%, p<0.001). CONCLUSIONS: A "blow glove" PEP device using a powdered latex glove produces PEP values in the recommended range over a wider spectrum of expiratory flow rates and expiration volumes than a commercial PEP device.

Contexte : La thérapie postopératoire à pression expiratoire positive (PEP) favorise l'augmentation du volume des poumons, le dégagement des sécrétions et une meilleure oxygénation. Plusieurs appareils commerciaux sur le marché produisent les valeurs de PEP recommandées (de 10 à 20 cmH2O) lorsqu'on souffle dans un dispositif de résistance à ouverture fixe. On a fait l'hypothèse qu'un appareil bon marché et improvisé à partir d'un « gant dans lequel on souffle ¼ produirait des valeurs de PEP semblables dans une plus vaste plage de volumes d'expiration et de débits. Méthodes : La PEP pour différents volumes d'expiration (de 400 à2 000 mL) et débits expiratoires (10-80 L/min) a été comparée en utilisant un appareil commercial de PEP (Resistex, Mercury Medical, Clearwater, Floride) et un appareil improvisé à partir d'un gant, puis enregistrée par un respirateur Vela (CareFusion, San Diego, Californie). La dynamique des valeurs de la pression positive en fin d'expiration (PPFE) a été évaluée après cinq expirations consécutives. L'évaluation de l'appareil fabriqué à l'aide d'un gant a été effectuée en utilisant des gants de compositions et de tailles diverses. Résultats : L'appareil improvisé à partir d'un gant a produit un taux considérablement plus élevé de valeurs de PEP dans la plage recommandée que l'appareil Resistex (88,9% c. 20%, p<0,0001). Aucune différence importante n'a été observée entre les petites et les grandes tailles de gants (88,9% c. 82,9%, p>0,05). Le gant en latex poudré affichait un taux considérablement plus élevé de valeurs de PEP dans la plage recommandée que le gant en latex non poudré (88,9% c. 44,4%, p<0,001). Conclusions : Un appareil de PEP improvisé à l'aide d'un gant en latex poudré produit de plus grandes plages de PEP recommandée par spectre de débit d'expiration comparativement à un appareil commercial de PEP.

Treatment of wounds following breast reduction and mastopexy with subsequent wound dehiscence with charged polystyrene microspheres.

BACKGROUND: Lower T-junction wound dehiscence following breast reduction surgery or mastopexy constitutes a vexing and grievous complication both to the surgeon and the patient. Treatment modalities that can expedite wound healing and reepithelialization rates are highly craved. The objective of this study was to assess wound healing and epithelialization rates of open wounds following breast reduction and mastopexy wound dehiscence treated with charged polystyrene microspheres (CPM). MATERIALS AND METHODS: Five female patients with wound dehiscence and subsequent open wounds following breast reduction and mastopexy were treated with daily with CPMsoaked dressings. Wound closure rates were documented. RESULTS: The wounds showed both accelerated granulation tissue formation as well as swift epithelialization rates. No complications or side effects were encountered. CONCLUSIONS: Charged polystyrene microspheres may offer a new and efficacious way to heal open wounds due to wound dehiscence following aesthetic breast surgery. Further research with a larger patient population is still needed to verify these findings. .

The origin of human mesenchymal stromal cells dictates their reparative properties.

BACKGROUND: Human mesenchymal stromal cells (hMSCs) from adipose cardiac tissue have attracted considerable interest in regard to cell-based therapies. We aimed to test the hypothesis that hMSCs from the heart and epicardial fat would be better cells for infarct repair. METHODS AND RESULTS: We isolated and grew hMSCs from patients with ischemic heart disease from 4 locations: epicardial fat, pericardial fat, subcutaneous fat, and the right atrium. Significantly, hMSCs from the right atrium and epicardial fat secreted the highest amounts of trophic and inflammatory cytokines, while hMSCs from pericardial and subcutaneous fat secreted the lowest. Relative expression of inflammation- and fibrosis-related genes was considerably higher in hMSCs from the right atrium and epicardial fat than in subcutaneous fat hMSCs. To determine the functional effects of hMSCs, we allocated rats to hMSC transplantation 7 days after myocardial infarction. Atrial hMSCs induced greatest infarct vascularization as well as highest inflammation score 27 days after transplantation. Surprisingly, cardiac dysfunction was worst after transplantation of hMSCs from atrium and epicardial fat and minimal after transplantation of hMSCs from subcutaneous fat. These findings were confirmed by using hMSC transplantation in immunocompromised mice after myocardial infarction. Notably, there was a correlation between tumor necrosis factor-α secretion from hMSCs and posttransplantation left ventricular remodeling and dysfunction. CONCLUSIONS: Because of their proinflammatory properties, hMSCs from the right atrium and epicardial fat of cardiac patients could impair heart function after myocardial infarction. Our findings might be relevant to autologous mesenchymal stromal cell therapy and development and progression of ischemic heart disease.

Examining disaster planning models for large scale burn incidents--a theoretical plane crash into a high rise building.

BACKGROUND: The escalation of global terrorist attacks has resulted in a rise of traumatic injuries. Planning for mass casualty incidents (MCIs) is critical to decrease the morbidity and mortality that ensues after large-scale terrorist attacks. This study provides criteria for the management of burn victims following large-scale disasters. METHODS: Mass casualty outcomes from three disasters involving commercial aircraft crashes were analyzed. The three events included the El-Al cargo Aircraft crash near the Amsterdam Schiphol Airport in 1992, the World Trade Center attacks in New York and the attack against the Pentagon in Washington, DC on 9/11/01. RESULTS: Using the data obtained from these events, the severity of injuries in patients were determined. The result is a general template that may be customized with locally or regionally specific data, in order to evaluate the preparedness of a specific burn alignment for such a scenario. CONCLUSION: Recommendations based on the analysis of previous MCI's were put forth. Based on the needs recognized during these past events, suggestions were made to enhance the preparedness of burn units, hospitals and national agencies as well as municipal authorities.

The effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction.

In recent years the acellular dermal matrix (ADM) has gained popularity in prosthetic breast reconstruction. These procedures involve placement of a closed suction drain in the reconstructed breast. Although it is now widely accepted that ADM has an overall positive effect on the outcome of breast reconstruction, data regarding its effect on postoperative drain secretions is lacking. This study was designed to quantitatively evaluate the influence of ADM on postoperative drain secretions in the setting of immediate prosthetic breast reconstruction (IPBR). This is a prospective, comparative controlled study. Two groups of 16 patients each underwent skin sparing mastectomies (SSM) and IPBR with or without ADM. Closed suction drains were left in all the reconstructed breasts and daily secretion volumes were recorded and compared. Postoperative complications were also noted. Patients in the ADM group showed higher daily and overall secretion volumes compared with patients in the control group (p = 0.014) and the time for removal of the drains was higher by an average of 5 days (13 compared with 8 days, respectively; p = 0.004). There was no correlation between ADM and infection. This study provides the first objective evidence that ADM contributes to elevated and prolonged drain secretions when used for IPBR. This might affect possible prosthesis-related complications (e.g., rotation and malposition, capsular contraction, seroma formation, and infection). This study also noted erythema of the post-mastectomy skin flaps in selected patients, which may be attributable to a local inflammatory reaction to the ADM rather than infection.

Custom-fit polymeric membrane dressing masks in the treatment of second degree facial burns.

Second degree facial burns usually impart high wound site pain levels and patient discomfort due to the abundance of facial sensory innervation, as well as the development of edema and inflammation that accompany wound healing. Frequent changing of adherent dressings causes additional procedural pain and may prolong healing due to recurring damage to the wound bed. We applied face masks, made on-site from a drug free polymeric membrane dressing, to 8 patients with superficial and deep 2nd degree facial burns. Time to full re-epithlialization was recorded during treatment. Pain, overall comfort, and result satisfaction were evaluated using a questionnaire (10-point Likert scales. From 1=minimum to 10=maximum) on follow-up (mean follow up 14.4 months, range 9-18). These results were compared to a historical cohort of patients with facial burns that were treated with an antibiotic ointment. Results showed mean re-epithelialization time of 6.5 days (as compared to 8.5 days in the cohort group), low pain ratings (mean: 2.6; range: 4.7 in the control group), mixed comfort levels (mean: 4.7/10; 4 in the control group) and high result satisfaction (mean: 7.8; 6.2 in the control group). Nursing staff described pain-free dressing changes and positively noted non-adherence and high absorbance capacity of the polymer, necessitating less dressing changes. Inflammation was contained to the actual site of injury. No complications in terms of infection or allergic reaction were observed. Overall, the polymeric membrane facial dressing seems to be a promising means of reducing pain and ensuring uninterrupted wound healing in 2nd degree facial burns.

Birth wind and fire: raising awareness to operating room fires during delivery.

OBJECTIVE: We researched whether the obstetric operating room (OR) qualified as a fire-risk environment so as to take preventive measures accordingly. METHODS: We analyzed a series of iatrogenic burns inflicted during birth by collecting clinical data and comparing it with known OR fire risk factors and with other factors that repeated in all cases in search of unique characteristics of the obstetric OR. RESULTS: All three cases shared in common the same type of oxygen-rich open ventilation system, alcohol-based prepping solution, and the hastiness of cesarean delivery while spontaneous vaginal delivery was already in progress. CONCLUSION: The obstetric OR is, as suspected, a fire-prone zone in more ways than the regular OR. Therefore, preventive measures should be undertaken and awareness for the possibility for such occurrences should be raised.