Factors affecting length of stay among pediatric and adult patients admitted to the Lebanese Burn Centre: a retrospective study.

Burn injuries are serious lesions requiring specialized medical care, and are associated with prolonged length of hospital stay (LOS). This study aims to elucidate the epidemiological and clinical factors affecting the LOS of pediatric and adult patients with burn wounds. A single-centre retrospective study was conducted at the Hopital Libanais Geitawi Burn Centre in Lebanon. Medical records of patients admitted to the centre between January 2014 and December 2018 were retrieved. Epidemiological and clinical data, such as age, gender, LOS, co-morbidities, and clinical burn and operative characteristics were collected and subjected to statistical analysis. A total of 321 adult and 154 pediatric patients met the inclusion criteria. Mean LOS in the total population was 23.58 days. Univariate analysis revealed inconsistent correlations between the studied factors and the LOS of pediatric and adult patients. Factors positively affecting both populations were: undergoing an operation, number of operations, burn degree, infection, blood transfusion, and need for burn excision and grafting. Additionally, among pediatric patients LOS significantly increased with age, total body surface area (TBSA) burn wound, cause of burn, sepsis, wound dressing under anaesthesia, and escharotomy. On the other hand, female gender and fever were significant additional positive influencers of adult LOS. Multivariate analysis showed that both pediatric and adult LOS was significantly associated to number of operations, need for burn excision and skin grafting, and receiving a blood transfusion. Adult LOS was further affected by mechanical ventilation, infection and age. Our study demonstrated the differential influence of epidemiological and clinical factors among adult and pediatric populations, which allows better prediction of LOS and management of patients with burn injuries.

Les brûlures sont des pathologies sévères nécessitant une prise en charge spécialisée avec des durées de séjour élevées. Cette étude a pour but de préciser les facteurs épidémiologiques et cliniques influençant la durée de séjour, chez les adultes (321) et les enfants (154) brûlés. Elle a été réalisée dans le CTB de l'hôpital libanais Geitawi, en utilisant les dossiers des patients hospitalisés entre janvier 2014 et décembre 2018. Nous avons colligé et comparé le sexe, l'âge, la durée moyenne de séjour (DMS), les comorbidités, les données cliniques concernant la brûlure y compris la nécessité de chirurgie. La DMS était de 23,58 j. L'analyse univariée a retrouvé des paramètres influençant la DMS différents chez les enfants et les adultes. La DMS augmentait, dans les 2 populations, avec la nécessité de chirurgie (excision/greffe) et le nombre d'interventions, la profondeur de la brûlure, la survenue d'infection, la transfusion. Chez les enfants, on trouvait en plus l'augmentation de l'âge, la surface brûlée, certaines causes de brûlure, les incisions de décharge et les pansements sous AG. Chez l'adulte, la DMS augmentait chez les femmes et les patients fébriles. En analyse multivariée, le nombre d'interventions (excisions et greffes) et la transfusion restaient corrélés à l'augmentation de DMS. Chez l'adulte, l'infection, la ventilation mécanique et l'âge étaient 3 autres paramètres significatifs. Cette étude montre qu'il existe des paramètres différents corrélés à l'augmentation de DMS dans les populations brûlées d'adultes et d'enfants, ce qui permet une évaluation plus fine de la charge de soins et de la DMS à l'admission d'un brûlé.

Osteoarthritis of the pisiform-triquetral compartment. A review of eight cases of an underrecognized entity.

Seven patients (eight hands) with pain suggestive of the pisiform-triquetral compartment were studied to compare outcomes after surgical excision of the pisiform (four hands) and after conservative therapy (four hands). All patients were reevaluated by a rheumatologist who was not involved in their treatment. The efficacy of conservative therapy was mediocre in every case. Although it is reasonable to assume that the surgically-treated patients had more severe manifestations at baseline, all were free of symptoms at reevaluation, versus none of the conservatively-treated patients. After two years, excision of the pisiform yielded excellent results with no adverse effects on range of motion or grip strength. Despite the small size of our sample and the relatively low incidence of pisitriquetral osteoarthritis, our data suggest that surgery is preferable over conservative therapy in this condition.

[Flaps of the gastrocnemius muscles]. / Lambeaux de jumeaux.

The authors expose different techniques and maneuvers used for dissection of gastrocnemius flaps with reference to the data reported in the literature and to the anatomical vascular basis. The use of muscular and myocutaneous gastrocnemius flaps and some modifications of the standard surgical technique aiming to gain more versatility are described, so that, the range of these flaps can be planned to cover the greatest part of the lower extremity of the leg.