Awf Quaba

The distally-based dorsal hand flap

The planning and clinical applications of a series of reverse dorsal hand flaps are described. This new flap is based on a direct cutaneous branch of the dorsal metacarpal artery. It is particularly useful in resurfacing web spaces as well as dorsal metacarpal and phalangeal skin defects. The behaviour of 21 such flaps, all raised in the form of an island, was that of a conventional axial pattern flap.

The systemic stress response to thermal injury in children

Thermal injury is extremely stressful, but data characterizing the endocrine stress response to this injury in children are sparse. The objective of this study was to measure the effects of thermal injury on the levels of stress hormones in children and to assess the temporal changes associated with them.

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.

The distally based islanded dorsal foot flap

A modification of the distally based first web space flap on the dorsum of the foot is described. This flap, originally described by Earley and Milner, has been completely islanded on its blood supply and used to resurface defects following release of post-burn hyperextension contractures of the toes. Our experience with 14 consecutive flaps is presented. Partial necrosis occurred in three flaps, one leading to slight residual contracture. We have found this flap reliable and easy to raise, and the donor site morbidity is minimal.

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.

Bilobe modification of the deep inferior epigastric artery flap for abdominal wall defect reconstruction

Abstract A case is reported of a large upper abdominal wall secondary tumour which was excised and the defect closed in a single stage with a combination of a Gortex patch and a bilobe modification of the oblique rectus abdominis musculocutaneous flap.

The Humoral Blood Pressure (BP) Drive in Thermal Injury 152

Aim: Hypertension is a known complication following thermal injury, increasing morbidity still further. The objective was to examine the relationship of hormones known to affect blood pressure with burns in children.

SECRETION PROFILES OF THE MAJOR FLUID AND ELECTROLYTE REGULATORY HORMONES FOLLOWING SEVERE THERMAL INJURY

Little is known about the changes in the secretion patterns of the major fluid and electrolyte regulatory hormones following severe thermal injury in children. Resuscitation protocols are based mainly on data derived from studies in adults. The aim of our study was to investigate the changes in secretion of the major fluid controlling (actors, vasopressin, (AVP), atrial natriuretic peptide (ANP), angiotensin (All), plasma renin (PRA), aldosterone (ALD) and the catecholamines ( NOR, ADR, DA) in children with severe burn injuries.Methods: 7 children, 0.6 - 4.8 yr (median 1.9 yr) admitted to the Plastic Surgical Unit of the Royal Hospital for Sick Children, Edinburgh, with severe thermal injuries, 12 - 61 %body surface area (median 21%), were evaluated over the first 4 days following injury. An extra 1.5ml of blood for hormone determinations was obtained whenever a sample was taken for clinical evaluations.Results: As data was not normally distributed, geometric mean hormone levels were calculated. Values are given in pg/ml (peptides), pmol/mlhr (PRA) and pmol/ml (CATS)Conclusions: We believe that these are the first reported data showing secretion profiles of the major fluid and electrolyte regulating factors in burn injured children.

IS FLUID HOMEOSTASIS FOLLOWING THERMAL INJURY RELATED TO BURN SURFACE AREA (BSA)

Disorganisation of fluid balance is common following thermal injury, with fluid shifts between intra and extracellular compartments and fluid losses being recognised contributors. We therefore wished to examine whether the extent of the thermal injury would be related to the derangement. As measurement of fluid losses from the skin and movoment bteween compartments is clinically difficult, we initially evaluated the hormonal response to the injury.Methods: 25 children, 0.12- 10.83yr (median 2.25yr) admitted to the Plastic Surgical Unit of the Royal Hospital for Sick Children. Edinburgh, were evaluated on admission, 0.25-14.5hr (median 2.25hr) after injury. The BSA was measured using standard methodology. An additional 1.5ml of blood was taken with the admission blood sample for the measurement of the major fluid and electrolyte regulatory hormones by radioimmunoassay.Results: Highly significant correlations were found between plasma hormone concentrations in admission samples and %BSAConclusions: We believe this is the first reported data showing that plasma concentrations of the major fluid and electrolyte regulatory hormones are related to the size ot thermal injury in children.