Imran Ahmad

Epidemiology and outcome of chemical burn patients admitted in burn unit of JNMC hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India: A 5-year experience

Aims and Objective: The objectives of this study were to evaluate the epidemiology, clinical variable of chemical burns, and their outcomes to prevent or reduce the frequency and morbidity of such injuries. Materials and Methods: A retrospective analysis was performed on all the patients with chemical burns admitted at authors center between November 2008 and December 2013. All the patients were evaluated in terms of age, sex, total body surface area, etiology, treatment given, morbidity, mortality, final outcome, and then educated regarding specific preventive measures. Results: A total of 96 patients (2.4% of total burn admissions) (42 males and 54 females) were admitted to our hospital with chemical burn injuries. Most of the patients were in the age group of 16–30 years. Incidence in females was slightly higher than in males. Acid was found to be the most common cause of injury. We found 55% patients admitted had <10% total body surface area (TBSA) involvement, 35% had burns involving between 11 and 20% TBSA, and 4% had burns involving 21–30% TBSA, and 6% had burns in >30% TBSA. Morbidity was noticed in the form of skin defect in 80% of cases, soft tissue defect with exposed tendon, bone, or vessels in 16% of cases, and 4% of patients developed contracture and hypertrophic scar. Eighty-six percent of patients required operative intervention. A total of three deaths (3%) were recorded. Conclusion: It was found that chemical burns, though not very common, are deeper burns and can be accidental or non-accidental, and the high-risk age group is 16–25 years. Chemical burns are largely preventable and if properly managed have a good outcome.

Wide surgical excision with split rib graft reconstruction of mandible for ameloblastoma; our 10 year experience.

Ameloblastoma or adamantinoma is a benign odontogenic tumour arising in facial bones mostly in mandible. There are different modalities of treatment for ameloblastoma viz.xa0chemotherapy,xa0radiation therapy, curettage and liquid nitrogen but surgical resection or enucleation remains the most definitive treatment for this condition. After surgical excision mandibular defect can be reconstructed by non vascularised bone graft or free tissue transfer. we are presenting a detailed study of 50 patients in which mandible was reconstructed with non vascularised split rib graft after surgical resection of ameloblastoma. This is easy, less time consuming and requires no expertise with excellent results.

Modalities of soft-tissue coverage in diabetic foot ulcers.

OBJECTIVE: The objective of this study was to establish an algorithm for surgical reconstruction of diabetic foot ulcers (DFUs). STUDY DESIGN: Retrospective study MATERIALS AND METHODS: In this series, 75 patients with diabetic foot ulceration were treated at the Jawaharlal Nehru Medical College from October 2008 to August 2013, and were retrospectively reviewed. All patients in the study underwent surgical reconstruction of the foot in the form of a skin graft, local flaps, or free flaps, depending upon the characteristic of the defect, general condition of the patient, and vascular status of the limb. The medical notes of the patients were retrospectively analyzed according to age, gender, ankle-brachial pressure index, and comorbidities. RESULTS: Twenty-eight patients (37%) underwent skin grafting, 39 (52%) underwent local pedicled flaps, and 8 (11%) underwent free flap transfers. Sixty-eight patients (91%) achieved complete healing, and amputation of the lower extremity could be avoided. With the exception of 1 patient who experienced ulcer recurrence within the following year and 6 patients in whom amputation of the lower extremity was performed, all patients healed completely. The mean hospital stay was 4.0 ± 1 week. CONCLUSIONS: From the results of this study, the authors conclude that radical debridement and soft-tissue cover in the form of a skin graft/flap is an effective method of managing DFUs.

Inferiorly based thigh flap for reconstruction of defects around the knee joint

Background: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. Conclusions: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh.

Changes in sleep architecture after burn injury: 'Waking up' to this unaddressed aspect of postburn rehabilitation in the developing world.

BACKGROUNDnChanges in sleep architecture are common phenomena observed in post-traumatic patients; such altered sleeping patterns have negative implications on various phases of rehabilitation. Sleep is an essential process, without which one cannot function effectively and, hence, any aberrations in the quality of sleep in such patients need to be critically analyzed.nnnOBJECTIVEnTo probe the quality of sleep in postburn patients at one year compared with a group of adequately matched controls.nnnMETHODSnQuality of sleep in postburn patients at one year was measured using the Pittsburg Sleep Quality Index questionnaire and compared with a group of adequately matched controls. Data were tabulated and subjected to statistical analysis using Pearsons χ(2) test.nnnRESULTSnThe relationship between the postburn state and sleep disturbances was found to be statistically significant. Other relevant parameters are also highlighted and discussed.nnnDISCUSSIONnSleep is one of aspect of functioning that may be least taken into account by professionals during the phase of postburn rehabilitation because more obvious threats receive preferred treatment. Unless these problems are dealt with in the postburn period, rehabilitation can never be complete.nnnCONCLUSIONnPostburn patients experience significant changes in sleep architecture, which need to be taken into account to enable complete rehabilitation of the patient.

Use of dorsalis pedis artery flap in the coverage of distal lower leg defects

Aim: To evaluate the role of dorsalis pedis artery flap in the coverage of distal lower leg defect. Materials and Methods: a retrospective review of patients who underwent soft tissue coverage over distal lower leg with dorsalis pedis artery flap was performed. A total of 16 patients were identified and included in this study. Soft tissue defects ranged in size from 3 × 7 cm to 6 × 10 cm were located over lower one-third of leg either, anteriorly (n = 8), posteriorly (n = 4), laterally (n = 2), or medially (n = 2). Associated injuries included open fractures of only tibia (n = 5), fibula (n = 2), both tibia and fibula (n = 3), or calcaneum (n = 2). Results: all flaps survived uneventfully except in three cases there was mild venous congestion in the distal part of the flap, two resolved within 4 days without further surgical intervention but one required skin grafting. Three patients developed donor site problems. Wound coverage was achieved in a mean duration of 14 days (range: 11 to 30 days). Conclusion: The dorsalis pedis artery flap is a reliable procedure to cover difficult wound such as distal lower leg.

Burn injury associated with comorbidities: Impact on the outcome

Aims and Objectives: To evaluate the impact of comorbidities on the outcome of burn injuries. Materials and Methods: A retrospective analysis of 108 patients, treated between August 2010 and July 2013, was carried out. All patients were admitted, assessed and managed. The medical notes on 72 patients with comorbidity (Study group) were analyzed and matched with 36 other patients, without comorbidities (Control group), according to age, gender, and interval time between injury and admission. Information regarding types of burn injuries, depth of burn, comorbidities, operative procedures and final outcome were noted. Results: Patients were evaluated in terms of their duration of stay in the hospital and mortality. The comorbidities that influence these factors are renal disease, liver disease, cancer, pulmonary disorders, cardiac disease, obesity, peripheral vascular disorders, alcohol abuse, smoking and neurological disorders. Conclusion: It was found that the associated comorbid conditions influence the outcome of patients, injured due to burn, in terms of the duration of their stay in the hospital and mortality.

Pregnancy in burns: Maternal and fetal outcome

Background : Burns occurring in conjunction with pregnancy can be a potentially life-threatening scenario as it may lead to a rapid depletion of the already diminished maternal reserves. The management protocol in a pregnant burn female has to be tailored, taking into consideration the additional factor of fetal well-being and the fetal susceptibility to various agents. For such alterations to be incorporated, it is imperative on part of the treating doctor to correctly ascertain the pregnant/nonpregnant status of an adult burn female. Though most cases of pregnancy can be diagnosed on the basis of history/ examination but it is not a totally reliant method and hence liberal use of the urine pregnancy test should be done. Material and Methods : This is a retrospective study of a total of 2217 burn patients who were admitted to JNMCH, AMU between July 2007 and July 2011. All burned women have been included and no exclusion criteria were used. Incidence of pregnancy in burned females, etiology, gestational age, total burn surface area, fate of pregnancy, duration of hospitalization, and the relationship between mentioned items were studied. Results : Out of a total of 2217 patients studied 954 of them were female of whom 685 were in the reproductive age group and 87 of these females were pregnant. 76 burnt mothers had sustained burns less than 50% TBSA. 19 mothers died as a result of burns of whom 14 had burns more than 50% TBSA. All fetuses died of mothers burnt more than 50% TBSA, while fetal mortality was 62.5% in burns involving 31-50% of TBSA and fetal mortality was 2.5% in burns with TBSA less than 30%. Conclusion : Both maternal and fetal mortality are directly proportional to the TBSA and best care should be offered to such patients suffering burns during pregnancy by a special multidisciplinary team experienced in managing such critical patients.

Modified T-Plate Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A New and Versatile Option.

Background This study has been conducted with the aim of evaluating modified T-plate interpositional arthroplasty. Methods A prospective comparative study in patients admitted with temporomandibular joint ankylosis. Ankylotic temporomandibular joint arthroplasty included condylectomy gap arthroplasty in 7, temporalis muscle flap interpositional arthroplasty in 8, and modified T-plate interpositional arthroplasty in 13 cases. The patients were followed for three years. Collected data were tabulated and subjected to Fishers exact test, chi-square test and probability estimation. Results A significant increase in interincisal distance of 32 mm was seen in 12 (92.31%) patients in the T-plate interposition group, in 2 (25%) cases of the temporalis muscle flap interposition group, and in 1 case (14.28%) of the condylectomy group at 12, 24, and 36 months. Re-ankylosis was observed in 1 case (9.69%) of the T-plate interposition group, while as it was observed in 4 (50%) cases in the temporalis muscle flap interposition group and 4 (57.14%) cases in the condylectomy group, and these differences were statistically significant. Conclusions Our clinical experience with the use of the T-plate over the past 5 years has been encouraging, and our physiotherapy technique is quite simple. Even illiterate parents can assess it easily. Hence, we recommend this easy technique that does not damage the temporalis muscle for the management of temporomandibular joint ankylosis.

Use of Vein Conduit and Isolated Nerve Graft in Peripheral Nerve Repair: A Comparative Study

Aims and Objectives. The aim of this study was to evaluate the effectiveness of vein conduit in nerve repair compared with isolated nerve graft. Materials and Methods. This retrospective study was conducted at authors centre and included a total of 40 patients. All the patients had nerve defect of more than 3u2009cm and underwent nerve repair using nerve graft from sural nerve. In 20 cases, vein conduit (study group) was used whereas no conduit was used in other 20 cases. Patients were followed up for 2 years at the intervals of 3 months. Results. Patients had varying degree of recovery. Sensations reached to all the digits at 1 year in study groups compared to 18 months in control group. At the end of second year, 84% patients of the study group achieved 2-point discrimination of <10u2009mm compared to 60% only in control group. In terms of motor recovery, 82% patients achieved satisfactory hand function in study group compared to 56% in control group (P < .05). Conclusions. It was concluded that the use of vein conduit in peripheral nerve repair is more effective method than isolated nerve graft providing good sensory and motor recovery.