Alethea Tan

Smoke inhalation increases intensive care requirements and morbidity in paediatric burns

Burn survival has improved with advancements in fluid resuscitation, surgical wound management, wound dressings, access to antibiotics and nutritional support for burn patients. Despite these advancements, the presence of smoke inhalation injury in addition to a cutaneous burn still significantly increases morbidity and mortality. The pathophysiology of smoke inhalation has been well studied in animal models. Translation of this knowledge into effectiveness of clinical management and correlation with patient outcomes including the paediatric population, is still limited. We retrospectively reviewed our experience of 13 years of paediatric burns admitted to a regional burns intensive care unit. We compared critical care requirements and patient outcomes between those with cutaneous burns only and those with concurrent smoke inhalation injury. Smoke inhalation increases critical care requirements and mortality in the paediatric burn population. Therefore, early critical care input in the management of these patients is advised.

Re: Outcome in body-contouring surgery after massive weight loss: A prospective matched single-blind study.

The structures to be anastomosed or repaired are dissected, prepared and set out using the surgeon’s preferred method. The visibility background is then sized away from the patient, and cropped as necessary to fit behind the nerves or vessels. The visibility background is then folded, ligaclipped to prevent unfolding, and a series of ‘drainage’ fenestrations are cut out along the fold. A modification of using scissors to create these fenestrations is to use a 3 mm punch biopsy; allowing the cut out sections to be collected easily. The feeding tube is then placed through an adjacent muscle within the operative field. Alternatively, it may be secured along the dermal border. The tip of the tube is then inserted into the folded background and secured with a series of further ligaclips as shown. Finally, the combined background-drain is placed behind the vessels at the surgical site. The residual length of the feeding tube is looped away from the operative field and secured using one or more size 35 mm skin staples (Reflex TLWide). The proximal port of the feeding tube is joined to an available suction valve unit, set to the surgeons chosen pressure, and tested prior to use. The video (Figure 3, online only) demonstrates assembly, placement and testing of the suction device prior to a DIEP flap anastomosis of the deep inferior epigastric vessels to the internal mammary vessels in the left 3rd intercostal space. The following is the supplementary data related to this article: Supplementary video related to this article can be found at http://dx.doi.org/10.1016/j.bjps.2015.08.038. As demonstrated, the vessels and the field can be irrigated as required, and the constant gentle suction applied immediately clears the field of fluid without distorting the vessels. We hope that our simple, cost effective and easily reproducible adjunct will aid the readership in their microsurgical practice.

A useful alternative surgical technique to reconstructing large defects following excision of recurrent pilonidal sinus disease in the intergluteal region: An operative approach for the transverse lumbar artery perforator flap

The reconstruction of defects in the intergluteal region following pilonidal sinus excision is challenging due to its anatomical location, close proximity to the anus, and being a high‐tension area prone to wound‐healing problems. Excision and primary closure is known to carry a higher risk of recurrence and subsequent complications compared with using nearby local healthy tissue, such as a flap, to reconstruct defect. Extra due diligence should be given to patient selection and flap choice when deciding the reconstruction of a defect. The senior author, who has briefly reviewed complication rates in previous published literature, prefers the transverse lumbar artery perforator (TLAP) flap for reconstruction following pilonidal sinus excision in the intergluteal region. This paper illustrates the operative approach used by the senior author when raising a TLAP flap.

A challenging case of calcific myonecrosis of tibialis anterior and hallucis longus muscles with a chronic discharging wound

The occurrence of calcific myonecrosis of the anterior compartment of the leg is rare. Common risk factors include a history of trauma, although little is known about the exact pathophysiology, latency period or triggering factors resulting in disease progression. Macroscopically, it begins with a single muscle being replaced by a fusiform calcified mass, which progresses peripherally.

Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon

Primary tendon repairs are often difficult in patients with delayed presentation. Tendons are contracted and shortened with extensive scarring occurring along the path of the tendon. Pulleys and the wound bed can be filled with granulation tissue which obstructs the passage of the tendon. Many of such patients would then be treated with a two stage tendon reconstruction, which involves the insertion of a silicone rod for pseudosheath formation[1] before tendon grafting at a second stage. This however, would set the patient back for roughly six months, especially involving multiple visits to physiotherapy and being off work. We would like to describe several tips and tricks in our armamentarium and illustrate these using a case we recently encountered [Figure 1].

Bubble bath burns: an unusual case

Abstract We present an unusual case of flash burn injury in an adolescent following accidental combination of foaming bath bubbles and tea light candle flame. There has not been any reported similar case described before. This serves as a learning point for public prevention and clinicians managing burn injuries.

Flaming alcoholic drinks: flirting with danger.

Alcohol-related burn injuries carry significant mortality and morbidity rates. Flaming alcoholic beverages served in trendy bars and clubs are becoming increasingly popular. The dangers associated with an ignited alcoholic drink are often underestimated by party goers whose risk assessment ability is already impaired by heavy alcohol consumption. The authors present two cases demonstrating the varied severity of burn injuries associated with flaming alcoholic drinks, and their clinical management. Consumption of flaming alcoholic drinks poses potential risks for burn injuries. Further support is required to enable national and local agencies to implement effective interventions in drinking environments.