1/7. Distally-based neurofasciocutaneous flaps in electrical burns.Distally-based neurocutaneous flaps have been used successfully for reconstruction of the lower extremity for some decades. The reconstruction of deep wounds exposing tendons, bones and/or vessels in electrical burns requires flap coverage. It is known that there is often some sub-clinical vascular damage in electrical burn injury. Therefore, an important part of the procedure is modification to improve flap viability during the reconstruction of electrical burn wounds. In this paper, we report our experience with the use of distally-based sural and saphenous neurocutaneous flaps for coverage of defects in the lower leg and foot in 14 electrical burn patients. In 12 patients, the flaps survived completely, in two patients the flaps underwent partial necrosis. In these cases, the width of the pedicle of the neurocutaneous flap was increased from 3.5 to 5cm and the neurovenous pedicle was decreased to give a delay effect several days before the flap harvesting. We believe that these modifications positively effect the viability of the flap and should be used to improve neurocutaneous flap circulation in high risk patients.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/7. Dispersive pad site burns with modern radiofrequency ablation equipment.Pad burns during or after radiofrequency ablation (RFA) are a skin complication probably underreported in the literature. We report on 4 severe pad burns, deep second and third degree, in 3 patients undergoing radiofrequency ablation of liver malignancies, 1 percutaneously and the other 2 after laparotomy. All burns occurred at the leading edge or at the corner of the pads attached to the patients' thighs. Potential causes leading to the burns are discussed. Current dispersive pad designs do not prevent the leading edge phenomenon and subsequent burns. Further developmental work in the pad design with the possibility of skin temperature monitoring via temperature sensors under the leading pad edge is needed.- - - - - - - - - - ranking = 0.0024859466249022keywords = liver (Clic here for more details about this article) |
3/7. Successful transfer of two reverse forearm flaps despite disruption of both palmar arches.The advantages of the ipsilateral forearm flap in emergency post-traumatic hand reconstruction are now well-established. A prerequisite for such a transfer has always been the presence of at least one intact palmar arch. We report the successful transfer of two reverse forearm flaps despite disruption of both palmar arches. In both cases the flap was raised on the vascular axis which had ceased to contribute significantly to the hand circulation. The anatomical basis of this transfer is discussed.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
4/7. Early vascular grafting to prevent upper extremity necrosis after electrical burns: anastomotic false aneurysm, a severe complication.From May 1972 to January 1982, early vascular grafting was used to re-establish circulation across the electrically burned wrist. Thirty-three thrombosed arterial segments (radial and/or ulnar arteries) were removed in 18 limbs and autografts of the greater saphenous or omental veins were used for the revascularization. One vascular graft, which had been sutured to the ulnar artery on day 3 post-injury, contained an anastomotic false aneurysm at the proximal anastomosis. One month after vascular grafting, this aneurysm ruptured and bled. An emergency exploration of the wrist confirmed the diagnosis and surgery successfully restored the circulation, avoiding amputation of the injured limb. Histopathological examination of the specimen was consistent with the presence of anastomotic false aneurysm. The pathogenesis of this complication is reviewed. Our experience indicates that circulation to a limb following electrical injury can be successfully restored by early vascular grafting, but emphasizes the importance of close periodical follow-up after graft acceptance due to the possibility of late anastomotic complications.- - - - - - - - - - ranking = 3keywords = circulation (Clic here for more details about this article) |
5/7. Early vascular grafting to prevent upper extremity necrosis after electric burns: additional commentary on indications for surgery.Early vascular grafting has been used to reestablish circulation to the hand in the treatment of electric injuries of the wrist with arterial damage. Since 1972 this therapy has yielded good results by preventing necrosis of the injured hand and by helping to maintain function. However, the indications and timing for performing this operation still are poorly defined. The surgeon is faced with the difficult task of determining whether the injury is severe enough to affect distal circulation and thereby lead to necrosis. The lack of reliable clinical signs is chiefly responsible for this difficulty; however, the potential for delayed thrombosis of vessels complicates the problem. In this article, indications for early vascular grafting in an electrically injured wrist are discussed based on recent clinical experience, with emphasis on the use of arteriography. A case history involving electric burns of both upper extremities is presented as an illustration.- - - - - - - - - - ranking = 2keywords = circulation (Clic here for more details about this article) |
6/7. Electrical injury of the eye.A 17-year-old male suffered superficial and deep facial burns after coming into contact with a high tension electrical cable with his head and right side of the face. The right eye sustained severe thermal coagulative injuries and subsequently was enucleated. Histopathological examination showed that the retinal neuropile was relatively intact although the retinal and choroidal circulations were severely compromised. The left eye was less affected but a dense cataract developed and required lensectomy. visual acuity remained poor in the left eye due to retinal atrophy, retinal vascular attenuation and optic nerve degeneration. Electroretinographic tests and pseudo-random binary stimulus visually evoked responses were useful in predicting the visual outcome.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
7/7. Successful treatment of fulminating complications associated with extensive rhabdomyolysis by plasma exchange.The first successful treatment by plasma exchange of acute renal failure and disseminated intravascular coagulation, as well as liver and central nervous system damage, was achieved in two patients with severe multiorgan damage associated with extensive muscle tissue damage caused by heatstroke and/or electrical injury. Substances derived from damaged muscle tissue, such as myoglobin and enzymes, were efficiently removed by a cellulose acetate membrane filter. Improvement of consciousness, disturbance, coagulation disorder, and renal failure were observed. The disorders associated with extensive rhabdomyolysis seem to be a promising indication for this therapy. plasma exchange with a membrane filter is useful for treatment of patients with renal failure, being readily connected on-line with conventional dialysis.- - - - - - - - - - ranking = 0.0024859466249022keywords = liver (Clic here for more details about this article) |