Sudip J. Ghosh

Smartphones and the plastic surgeon.

Surgical trainees are facing limited training opportunities since the introduction of the European Working Time Directive. Smartphone sales are increasing and have usurped computer sales for the first time. In this context, smartphones are an important portable reference and educational tool, already in the possession of the majority of surgeons in training. Technology in the palm of our hands has led to a revolution of accessible information for the plastic surgery trainee and surgeon. This article reviews the uses of smartphones and applications for plastic surgeons in education, telemedicine and global health. A comprehensive guide to existing and upcoming learning materials and clinical tools for the plastic surgeon is included. E-books, podcasts, educational videos, guidelines, work-based assessment tools and online logbooks are presented. In the limited resource setting of modern clinical practice, savvy plastic surgeons can select technological tools to democratise access to education and best clinical care.

Obesity and Burns

The population of overweight patients presenting to burn facilities is expected to increase significantly over the next decades due to the global epidemic of obesity. Excess adiposity mediates alterations to key physiological responses and poses challenges to the optimal management of burns. The purpose of this study is to document the general epidemiological aspects of thermal injuries in the obese population, outline relevant physiological aspects associated with obesity, and draw attention to topics relating to the management, rehabilitation, and prognosis of burns in this emerging subpopulation of patients.

Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification.

To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ‘gold standard’ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.

Histoacryl glue: A burning issue

Cyanoacrylate glue was originally discovered by Coover and colleagues at the Kodak Research Laboratories [Tennessee] in 1942 [1] with methyl-2-cyanoacrylate becoming commercially available as ‘Eastman #910’0, later ‘Super Glue’ in 1958 [2]. Today cyanoacrylate glues such as methyl 2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Super Glue and Krazy Glue – Figs. 2–4) are widely available and commonly used by the general public in domestic and industrial environments. The surgical applications of cyanoacrylate glues were suggested soon after their commercial release, in 1959 [3] and their use first reported in the literature in 1969 [4]. In 1998, 2-octyl-cyanoacrylate received United States Food and Drug Administration (FDA) approval as a tissue adhesive in skin closure. Today it is employed in most surgical specialities and being applied in novel circumstances in an ever increasing number of procedures [5–7]. Cyanoacrylate glues bond rapidly via an exothermic reaction which inevitably has the potential to cause burns. Surprisingly, given the widespread availability of cyanoacrylate glues such injuries are very rarely reported. We here present a case of an accidental burn following spillage of cyanoacrylate glue onto cotton fabric trousers.

Burn injuries from in-car cigarette lighters.

Burns as a result of disposable cigarette lighters have been widely reported [1]. However, cigarette lighters fitted in cars also have the potential to harm, especially in the paediatric population. Traditionally, 12 V outlets have been used to power in-car cigarette lighters. Recently these devices have been used to power in-car entertainment facilities such as mobile DVD players, satellite navigation systems or mobile phone chargers. The cigarette lighter is traditionally a small button like device which is stored in the 12 V outlet. When the button is pressed in, the metal core of the device heats up before the device pops out. It can then be removed and used to light a cigarette. Burn injuries can occur by direct contact with in-car cigarette lighters by children who may mistakenly use these as toys. While these injuries may be categorised as minor burns, the long term implications for patients can be significant in terms of scarring, altered pigmentation, sensation and function. Furthermore, hospital based assessment and treatment for the burn injury is often necessary, consuming both hospital and family resources. In this report, we present two clinical cases of partial thickness burns occurring in the hand sustained as a result of contact with in-car cigarette lighters. In addition, we present the results of a survey of the popular family cars in the UK as featuredbyWhatCar Magazine [2] and The GuardianNewspaper