Daniel Hauben

Epidemiology of burns in the Tel Aviv area

Between 1 August 1988 and 31 January 1992, 421 burn patients were admitted to the Burn Unit at Beilinson Medical Center. Name, age, sex, month of the year, cause of burn, area and degree of burn and duration of stay in hospital were recorded. Of these patients, 37 per cent were treated surgically and the remainder were treated conservatively. The male to female ratio was 2:1. Burns occurred most frequently in July and January; the peak average age was the first decade of life. The most frequent cause in children was scalding (domestic burns), and in adults open fires (work accidents). Patients treated by early tangential excision and skin grafting (204 operations on 157 patients) had a shorter stay in hospital than conservatively treated patients. In accordance with others, we suggest that early surgery of burn injuries decreases morbidity and mortality and leads to better aesthetic results and improved motor function. Secondly, burn injury can be prevented in children and the elderly by increasing safety measures at home, and in adults by enforcing strict safety measures at work.

Occult and overt submucous cleft palate: from peroral examination to nasendoscopy and back again

Peroral examination of the soft palate is of greater value than generally recognized. The nasendoscopic examination provides essential information on the velopharyngeal valve physiology and pathology. However, nasendoscopy cannot be performed in individuals who are uncooperative such as young children, patients with personality disturbances or those mentally retarded, or in the presence of severe deformity of the nose. In these patients the peroral examination is of particular practical clinical application. Forty cases of occult and overt submucous cleft palate were included in the present study. We describe the contribution of systematic assessment of the soft palate intraorally, based on a correlation with nasendoscopic examination of the velopharyngeal valve in speech. An accurate peroral examination can provide additional information on abnormality of the velar musculature as well as the existence of Passavants ridge. This information is particularly important in children who are too young for nasendoscopix examination, but because of their poor speech intelligibility, early diagnosis and treatment are imperative.

The effect of allopurinol on experimental island skin flap survival under prolonged periods of arterial ischaemia

The aim of this study was to assess the effect of allopurinol on rat groin flaps rendered ischaemic by selectively occluding the feeding femoral artery and reperfused by means of microsurgical anastomosis. For the establishment of the critical arterial ischaemia time, the femoral artery of 29 rat groin flaps isolated on the inferior epigastric pedicle was occluded for 10, 12 and 14 h. Following 12 h or more of ischaemia, 5.25% of the flaps survived, compared to 40% survival after 10 h (p = 0.04). In the second stage of the study, 34 rat groin flaps were subjected to arterial ischaemia for 12 h. Of these, 12 rats received allopurinol solution I.V. 30 min prior to reperfusion, 10 received the vehicle solution (control) and 12 underwent no treatment (control). After 7 days, survival of the groin flaps was observed in 41.7%, 0 and 8.3% of the groups, respectively (p = 0.0164). This study suggests that systemic administration of allopurinol has a beneficial effect on rat arterial ischaemic groin flaps and may prolong their critical ischaemia time.

SUCCESSFUL TREATMENT OF A 95 PER CENT BODY SURFACE AREA BURN

Survival after sustaining a 95 per cent body surface area burn is uncommon. We report the successful treatment of a 21-year-old patient who sustained such an extensive burn injury. This report stresses the importance of early aggressive excision of the burn eschar and early coverage with allografts (homografts) and later coverage with autogenous keratinocytes.

Perianal burn caused by using the bidet

Scald burns caused by hot water in the bath are common among the elderly. We present a case of scald burn in the perianal region caused by using the bidet.

Scorched eyelashes—do we treat them right?

Scorched eyelashes and burned eyelids are a common finding in facial burns, though the eye itself is often spared. Affected patients often complain of foreign body sensation and ocular discomfort in the absence of objective physical findings, other than scorched eyelashes and burned eyelash particles in the conjunctival sacs. This study was designed to evaluate the efficacy of prophylactic trimming of scorched eyelashes as a treatment for these findings and complaints. Eleven consecutive facial burn patients with bilateral eyelash scorching and no accompanying ocular damage were included. The eyelashes of one eye were trimmed, and those of the fellow eye served as untreated controls. Ophthalmic examinations were performed and eye-related complaints noted every other day for 10 days. We found that symptoms of foreign body sensation and discomfort occurred at a lower rate in the treated eyes (P<0.002) and no scorched eyelash particles were found in their conjunctival sacs (P<0.004) as compared to the untrimmed side. Conjunctival hyperemia was reduced. We suggest that shedding of scorched eyelash particles is a major cause of the ocular complaints in facial burn patients. Trimming the eyelash affords a simple and effective method of prophylactic treatment.

Mycetoma of the foot — surgical treatment with free flap reconstruction

Mycetoma (Madura foot) is a chronic fungal or bacterial infectious process characterized by a discharging mass. Medical treatment is generally insufficient, and surgical eradication, sometimes by amputation, is advocated. Although a benign disease, the tumors nature may be considered malignant in view of limbs fate. Reconstruction of a foot with a free tensor fascia lata musculocutaneous flap, following large mycetoma mass resection in a 28-year-old patient is described. A year after surgery, the patient uses the leg without limitation and no recurrence is evident. This limb preservation technique, which enables rapid rehabilitation and ambulation, is superior to amputation.

Reliability of plain X-ray and computed tomography in diagnosis of invasive tumors of the scalp

SummaryThe reliability of plain X-ray and computed tomography (CT) in the diagnosis of a penetrating tumor of the scalp to the calvarium was examined on the basis of the histopathologic reports following surgery. The correlation of other tumor characteristics, such as size, ulceration, duration and previous excisions or irradiation to the skull, with calvarial invasion was also studied. Of the 29 scalp tumors suspected clinically of invasion, four were proven histopathologically as penetrating to the bone. Only two of the four tumors diagnosed by plain X-ray of the skull as penetrating to the bone, and two of the six so diagnosed by CT, were histopathologically substantiated. No statistical correlation was found between the radiologic reports and the histopathology relating to the diagnosis of calvarial invasion by scalp tumor. The other tumor characteristics also did not correlate statistically with invasion. We conclude that the radiologic reports of plain X-ray and CT concerning penetration to the calvarium by scalp tumor are not reliable. In addition, there are no other tumor characteristics that correlate with histopathological penetration.