Josef Haik

The use of video capture virtual reality in burn rehabilitation: the possibilities.

We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy™ is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy™ as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.

Health Related Quality of Life in burn patients – A review of the literature

The burn trauma is multifactorial and involves pathophysiologic processes of all of the bodys systems. The impact it could have on a persons life includes impairments on their esthetic appearance, interpersonal relationships, psychological, social and physical functioning. Previously, the outcomes of burn care were confined in the context of mortality and length of hospital stay. Currently, a shift is afoot from defining good health care as merely the reduction of morbidity and mortality to a more holistic approach that involves aspects of Health Related Quality of Life. In this article we aim to present a concise review of the relevant literature and relevant topics pertaining Health Related Quality of Life and burn.

Treatment of deep sternal wound infections post-open heart surgery by application of activated macrophage suspension

Postoperative sternal wound infection remains a significant complication and generally causes considerable morbidity and mortality. Macrophages play a major role in the process of wound healing. In order to evaluate the efficacy of local injection of activated macrophage suspensions into open infected sternal wound space, a retrospective case‐control study was conducted. Sixty‐six patients with deep sternal wound infection treated by activated macrophages (group 1) and 64 patients with deep sternal wound infection treated by sternal reconstruction surgery with various regional flaps (group 2), were matched for gender, age, and risk index. In up to 54 months of follow‐up of group 1, 60 patients (91%) achieved complete wound closure. Two (3%) late deaths occurred unrelated to the procedure. Mortality rate in group 2 was 29.7% (19/64). Duration of hospitalization was 22.6 days in group 1 vs. 56.2 days in group 2. Patients with deep sternal wound infection following open heart surgery that were treated by activated macrophages had significantly less mortality as well as significant reduction of hospitalization in comparison to the surgically treated group. These results illustrate the advantages of using a biologically based activated macrophage treatment.

A new modality in the treatment of actinic cheilitis using the Er:YAG laser.

Background. Cheilitis is a precancerous skin lesion most often affecting the lower lip. We describe a technique in which this disorder can be treated using Er:YAG laser vaporization. The Er:YAG laser wavelength at 2940 nm lies in a very strong water absorption peak; tissue interaction results mainly in vaporization with minimal heat conduction to adjacent tissue. Objective. To evaluate the efficacy and outcome of a new modality in the treatment of actinic cheilitis with the Er:YAG laser. Methods. Between 2002 and 2005, 12 patients with actinic cheilitis were treated at our institute with the Er:YAG laser. All patients were cured with no recurrence to date, and none suffered postoperative complications. Results: Patients were men and women aged between 37 and 71 years. The healing duration varied from 7 to 30 days (mean 22.33±6.91 days) and the follow‐up ranged from 8 months to 3 years (mean 23.16±9.48 months). No recurrences were detected in our study. Conclusion. Using the Er:YAG laser provides accurate tissue ablation, giving a very satisfactory cosmetic result, with a short healing period, no lip deformity and no sensation loss.

Myiasis with Lund's Fly (Cordylobia rodhaini) in Travelers

Myiasis is an infestation of human tissue by the larvae of certain flies. There are many forms of myiasis, including localized furuncular myiasis, creeping dermal myiasis and wound and body cavity myiasis.1 Cordylobia anthropophaga (the Tumbu fly) and Dermatobia hominis (the human botfly) are the most common causes of myiasis in Africa and tropical America respectively. The genus Cordylobia also contains two less common species, C. ruandae and C. rodhaini. The usual hosts of C. rodhaini are various mammals (particularly rodents), and and humans are accidentally infested. Figure 1 shows the life cycle of C. rodhaini, which occurs over 55 to -67 days.3 The female fly deposits her eggs on dry sand polluted with the excrement of animals or on human clothing. In about 3 days, the larva is activated by the warm body of the host, hatches and invades the skin. As the larva matures, it induces a furuncular swelling. In 12 to -15 days, the larva reaches a length of about 23 mm, exits the skin and falls to the ground to pupate. The adult fly emerges in 23 to -26 days, and the life cycle resumes. In humans, the skin lesion starts as a red papule that gradually enlarges and develops into a furuncle. In the center of the lesion an opening forms, through which the larva breaths and discharges its serosanguinous feces. The lesion is associated with increasing pain until the larva exits the skin. The disease is usually uncomplicated and self-limiting.

Stensen duct rupture (sialocele) and other complications of the Aptos thread technique.

Background: The Aptos thread technique is a mode of uplifting the flabby soft tissue of the aging face. Permanent suture material made of polypropylene monofilament with dents is used in this technique. This procedure is gaining popularity throughout the world. According to the literature, several hundred Aptos procedures have been performed, and no major complications have been reported yet. Methods: Two adult women presented shortly after the Aptos thread insertion. They sustained devastating results. A close study was performed to understand and learn the potential complications. Results: The authors present two major complications, a rare case of Stensens duct laceration and a case of chronic inflammation mandating surgical treatment. Conclusions: Describing complications may teach plastic surgeons more about this method and how to avoid similar devastating side effects in the future.

Treatment of Postdermabrasion Facial Hypertrophic and Keloid Scars with Intralesional 5-Fluorouracil Injections

Hypertrophic and keloid scarring is a known complication of dermabrasion facial resurfacing, although only a very small fraction of patients experience it. Treatment with intralesional corticosteroid injections and flashed pumped vascular dye laser is recommended in the literature. The treatment of keloid and hypertrophic scars using intralesional 5-fluorouracil (5-FU) injections has been well described, but there is no literature regarding use of the same treatment for postdermabrasion hypertrophic and keloid scars. In this case report, we describe a 67-year-old woman with persistent postdermabrasion facial hypertrophic and keloid scars that were treated at our scar clinic using intralesional 5-FU injections.

Breast augmentation with fresh-frozen homologous fat grafts.

Abstract. The purpose of this report is to present a patient who underwent breast augmentation with fresh-frozen fat homografts in Russia 10 years ago, despite the publication of major complications following this procedure.

Amniotic fluid embolism following blunt abdominal trauma in pregnancy

Amniotic fluid embolism (AFE) was first described by Meyer in 1926, and became established as a clinical entity following the classic paper by Steiner and Lushbaugh in 1941’. These authors described autopsy findings in women who died suddenly during or following labour and labeled the phenomenon as maternal pulmonary embolism by amniotic fluid. Amniotic fluid embolism has been described as ‘The most catastrophic and untreatable condition in obstetrics”. Although it is widely accepted as a clinical entity, AFE is incompletely understood. The diagnosis is based on a combination of clinical presentation, laboratory findings and exclusion of other pathologies’. AFE has been reported during labour and the immediate postpartum period, but may also occur during Caesarean delivery, abortion+ and, extremely rarely, following blunt abdominal injury’. We present a case clinically and histologically compatible with traumatic amniotic fluid embolism which occurred in a pregnant woman following an automobile accident and caused an associated disseminated intravascular coagulopathy (DIC) and postoperative maternal death.

Measuring Alterations in Intra-Abdominal Pressure During Abdominoplasty as a Predictive Value for Possible Postoperative Complications

Abstract. The purpose of this study was to measure the changes in Intra-Abdominal Pressure (IAP) during abdominoplasty and the relevance of these changes to the immediate postoperative recovery period. Eighteen patients (17 females and one male) who underwent abdominoplasty for aesthetic reasons participated in the study. The data collected included measurements of height, weight, and measurements of the intra-urinary bladder pressure prior to surgery, immediately post operative, and 18–24 hours postoperative. Changes in tidal volume and ventilation pressures were also measured prior to surgery and immediately postoperative. The weight of the excised tissue ranged between 1150 g–6500 g with an average of 2700 g. Three patients had significant diasthesis recti repair during surgery. In these patients the measured intra-vesicular pressure was above 24 cm of H2O by the end of the operation and above 20 cm of H2O the day following surgery. Two out of the three patients were treated with anticoagulants and the symptoms subsided within a week. The third patient recovered spontaneously by the third day. In conclusion, patients with an intra-urinary bladder pressure above 20 cm of H2O following abdominoplasty were felt to be at significant risk for development of respiratory distress in the immediate postoperative period.