Khalid Khan

The Use of the Second Dorsal Metacarpal Artery for Vascularized Bone Graft An anatomical study

We present the results of fresh cadaver hand dissections and dye injection studies to help in raising a vascularized bone graft from the index or middle metacarpals based on the second dorsal metacarpal artery. This vascularized bone graft could be used for treating nonunion of the scaphoid and other carpal bones.

Mortality estimates in the elderly burn patients: the Northern Ireland experience.

There is a relative paucity of mortality data in the medical literature from UK burn units. The objective of this study was to audit our mortality in the elderly during a 10-year period and compare it with the most robust data available in the UK from Birmingham. Data were collected on all patients 65 years of age and older between 1st January 1996 and 31st December 2005. Data included age, burn size, cause of thermal injury, outcome (survival/death) and the expected mortality derived from the revised Bull mortality grid. Notes on 143 patients were available for review. The mean age was 76.7 years and the maximum burn size treated was 65%. Ten patients were diagnosed with smoke inhalation. All but 22 patients had a pre-morbid condition, predominantly cardiovascular disease. Surgical procedures were performed on 113 patients. We performed excision and grafting of burned tissue, in 50% of patients, within 72 h of sustaining thermal injury. There were 18 deaths in the group while the expected number of deaths was estimated to be 33. This difference was found to be statistically significant (x(2)=8.92, d.f.=1, p<0.005). In conclusion, our experience has shown better survival in the elderly than was expected. This we mainly attribute to an aggressive therapy approach including admission to the intensive care unit and early surgery.

Bacterial toxicosis/toxic shock syndrome as a contributor to morbidity in children with burn injuries

When a child with a thermal injury suddenly becomes unwell, it is often difficult to obtain an accurate diagnosis in the early stages of the illness. Out of 71 children admitted to our burns unit over a 15-month period, 13 became acutely toxic. Most of the cases had relatively small burns and the exact reason for their sudden deterioration was not apparent in the immediate stages. Several children required admission to the intensive therapy unit and there was one death. The number of children experiencing this significant morbidity over a relatively short period of time prompted us to perform a detailed retrospective study to ascertain the exact cause of the deterioration and to identify any patterns in their presenting signs and symptoms. There was considerable variation in the clinical picture of the children who developed the toxicosis, however, several features were frequently observed which resembled those seen in the toxic shock syndrome (TSS). In order to be more specific, we applied the criteria for TSS as defined by the Centres for Disease Control (CDC) to each of the 13 children. All of the criteria were noted in six children and the majority in the other seven. This was a much higher incidence than we would normally have expected. The clinical features of children with TSS are not always easy to distinguish from those observed in other illnesses. We therefore explored the possibility of alternative diagnoses that may have caused the toxicosis in these children. The mortality associated with TSS can be high, especially if there is a delay in recognition and subsequent management of the disease. Clinicians should be alerted to the fact that TSS is probably more prevalent than previously thought and should practise with a high index of suspicion in any child with a burn whose clinical condition suddenly deteriorates.

Complications associated with suction drains after microvascular anastomeses

Two head and neck cases in which free flaps were used for reconstruction are presented. The circulation of the flaps was compromised due to problems directly associated with suction drains. The methods of drain fixation are discussed.

Drug induced blistering and the plastic surgeon: a case of amitriptyline induced skin necrosis

We report a case of patchy full thickness skin necrosis following drug overdose with amitriptyline, that required excision and split skin grafting. To our knowledge this is the first report of amitriptyline induced skin necrosis that can be definitively attributed to this drug. The implications of drug related skin necrosis for the surgeon are discussed.