1/49. microstomia following facial burns.Deep burns to the face and lips often lead to the formation of scar tissue and contracture of the perioral tissues with marked reduction of the ability of the patient to open his mouth. The mouth tends to be turned into a wrinkled, rigid, unyielding structure, resembling the semi-rigid mouth of the fish. Such burns are most frequently caused by electricity or flames, and less frequently by chemical substances. The deformity caused by microstomia is painful both to the patient and to his family. Additionally, there is serious functional loss, it is practically impossible to smile, speech becomes difficult, and the movement of the mandible is limited. In severe cases feeding has to be performed with a straw. oral hygiene is compromised and access for the administration of dental care is impossible, hence limited to extractions. Techniques to prevent or, if not prevented, surgically correct the resultant microstomia are described, followed by a case report on a pediatric patient, whose microstomia was surgically corrected several years following the injury.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
2/49. Malignant glaucoma after diode laser cyclophotocoagulation.PURPOSE: To report a case of malignant glaucoma after diode laser cyclophotocoagulation. METHOD: Case report. RESULTS: A 45-year-old man with uncontrolled secondary glaucoma in his right eye after corneoscleral graft and cataract extraction underwent diode laser cyclophotocoagulation. The right eye was aphakic, with an intact posterior capsule. Two weeks later, the patient presented with blurred vision, edematous cornea, and flat anterior chamber. The posterior capsule was touching the endothelium. intraocular pressure was 20 mm Hg. Repeated Nd:YAG laser capsulotomy was effective in reversing the malignant glaucoma attack, and the anterior chamber deepened. CONCLUSION: Malignant glaucoma can occur after diode laser cyclophotocoagulation.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
3/49. Full-thickness burn to the hand from an automobile airbag.An 18-year-old male was involved in a single car motor vehicle accident in which the driver's side airbag was deployed. He presented to the trauma center with complex injuries to the left hand, lacerations to the scalp, and a full-thickness burn to the ulnar aspect of the right hand that included the hypothenar area and the fifth digit. The patient was admitted to the trauma center and received immediate consultation from the burn service. He underwent debridement and split-thickness skin grafting of 50 cm2 of the right hand on postburn day 3. The graft became necrotic and the patient underwent debridement of the skin and the abductor minimi muscle of the right hand on postburn day 32. Split-thickness skin grafting and release of flexion contracture were successfully completed 18 days later. The police and fire departments reported that the airbag showed signs of thermal destruction. Upon request, Honda motors submitted information from the TRW safety systems and material safety data sheet (Mesa, Ariz, issued 1989) that showed that airbag canisters contain the chemicals sodium azide and cupric oxide. water may react with sodium azide to form highly toxic and explosive hyfrazoic acid. These chemicals are converted to sodium hydroxide, which can cause significant chemical burns. In addition, these chemicals may ignite when exposed to live electrical wires or temperatures greater than 300 degrees F. We conclude that burns associated with damaged deployed airbags in motor vehicle accidents may be the results of both chemical and thermal injury. The extent of the burn wound may be underestimated, as our case illustrates. Full-thickness burns resulting from airbag deployment may require more aggressive initial debridement and treatment.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
4/49. Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review.OBJECTIVE: The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck. methods: A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily. RESULTS: Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results. CONCLUSION: The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.- - - - - - - - - - ranking = 4.5keywords = tract (Clic here for more details about this article) |
5/49. colon interposition in a patient with total postcricoid stenosis after caustic ingestion and preservation of full laryngeal function.Caustic burns of the upper aerodigestive tract continue to be a significant clinical problem. However, the available literature uncommonly mentions changes affecting the larynx. We could find only one publication in which four cases of high hypopharyngeal stenosis were described in detail and where the functional outcome of the laryngeal function was stated as partially saved. We describe here a case of total retrocricoid stenosis in a 28-year-old woman that was caused by lye ingestion. A life-saving gastroesophagectomy was performed by the Department of general surgery. Reconstruction of the esophagus was carried out with mobilized right colon, which was meticulously sutured circumferentially behind the arytenoids and on the prevertebral fascia. The anatomy of the larynx and its nerve supply were scrupulously maintained intact. We believe that our patient's rehabilitation was due mainly to an intensive 18-month program of care, following which all laryngeal functions recovered with normal voice and swallowing patterns.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
6/49. The use of the prepuce for reconstruction of an intraoral burn.Intraoral and commissural burns present a complex challenge for the reconstructive surgeon, with contractures being the main sequela encountered. Various reconstructive techniques have been described, none of which offers an ideal solution. A case of a severe intraoral contracture due to a caustic burn, and the modality of treatment is described. Once the contractures were released, a full-thickness preputial graft was used to cover the resultant buccal mucosal defect, with a satisfactory result. Due to its unique properties, the prepuce should be included as an additional tool in the reconstructive surgeon's armamentarium.- - - - - - - - - - ranking = 1.5keywords = tract (Clic here for more details about this article) |
7/49. Microsurgical reconstruction for caustic injuries of the oral cavity and esophagus.Ingestion of caustic material often produces profound and irreversible pathologic changes that require reconstructive surgery of the organs damaged. This report describes the authors' successful experience with microsurgical techniques that allowed adequate reconstruction in three patients with cicatricial contracture of the oral cavity and esophagus following ingestion of caustic substances. All patients had attempted suicide by ingesting liquid alkali. patients #1 and #2 complained of limited mouth opening and impaired tongue movement due to oral scar contracture. contracture release in the first patient resulted in a defect from the anterior border of the mandible to the retromolar region. The defect was resurfaced with a 6 x 12 cm free forearm flap. Release of the scar contracture in the second patient resulted in a long, narrow, tortuous defect that was difficult to cover, even with a forearm flap, and a jejunal segment was microsurgically transferred as a patch graft to reconstruct the defect. Patient #3 had dysphagia due to stricture of the cervical portion of the esophagus. The defect after resection of the cervical portion was reconstructed by free jejunal interposition. Appropriately selected free-flap transfer in each case provided a satisfactory restoration of function of the oropharyngeal and digestive passages.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
8/49. Upper aerodigestive tract burn: a case report of firework injury.The case of a 46 year-old German man with upper aerodigestive burn by firework was reported. He presented with the symptoms and signs of upper airway obstruction. tracheostomy was done and direct laryngoscopy with microscopic examination revealed swelling and denudation of the mucosa of the oral cavity and supraglottic area. Intravenous steroids and antibiotics were administrated for treatment. It is suggested that proper management needs an understanding of the mechanism and effect of the corrosive agent. Careful airway management resulted in a good outcome in this patient.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
9/49. Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures.Free thin anterolateral thigh flaps combined with cervicoplasty were used in a series of seven patients undergoing reconstruction for previous burn injury from September of 2000 to May of 2001 at Chang Gung Memorial Hospital. This method uses a suprafascial dissection technique to provide a thin flap to improve cervical contour. neck contractures had resulted from flame burns in six patients and from a chemical burn in one patient. The mean age was 32.7 years (range, 22 to 45 years). The size of excised scar ranged from 10 x 2 cm to 26 x 5 cm (mean, 19.7 x 3.3 cm). The size of flaps ranged from 11 x 5 cm to 26 x 8 cm (mean, 21.3 x 6.5 cm). Average operative time was 6 hours. Average hospital stay was 10 days. All flaps survived, with one flap sustaining partial marginal loss. The donor site was closed primarily in five cases and by using a split-thickness skin graft in two cases. At a mean follow-up time of 5 months, the functional improvement was measured as follows: a mean increase in extension of 30 degrees (preoperatively, 95 degrees; postoperatively, 125 degrees), a mean increase in rotation of 18 degrees (preoperatively, 59 degrees; postoperatively, 77 degrees), and a mean increase in lateral flexion of 12.5 degrees (preoperatively, 26.5 degrees; postoperatively, 39 degrees). The average cervicomandibular angle was improved by 25 degrees (preoperatively, 145 degrees; postoperatively, 120 degrees). This series demonstrates that the use of free thin anterolateral thigh flaps combined with cervicoplasty provides a one-stage reconstruction with a thin, pliable flap that achieves good cervical contour with low donor-site morbidity.- - - - - - - - - - ranking = 2.5keywords = tract (Clic here for more details about this article) |
10/49. Distraction of oral scars contractures following caustic ingestion. A form of conservative treatment.The chemical burns in the oral mucosa as consequence of accident of suicide attempt are relatively frequent. The evolution of the repairing process is conditioned by the quality and concentration of the caustic as by the location and time exposure of the affected region. At this report, we document a form of conservative treatment for the limitation of mouth opening, which the patient presented after swallowing a detergent acid. In order to obtain a minimal oral opening, a screwed cone, whose action mechanism was acting as a cradle between both jaws, was used. Once achieved a 10 mm opening, it was possible to use an external distractor to accomplish a continuous traction.- - - - - - - - - - ranking = 5keywords = tract (Clic here for more details about this article) |
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