1/16. Kite-flying: a unique but dangerous mode of electrical injury in children.A retrospective study was conducted to evaluate the cause of a sudden rise in number of pediatric admissions with electrical injuries at our centre during the year 1998. In evaluating the cause, six out of twelve admissions were found to be related to kite-flying which is a popular sport during the months of June, July, August and September. In two out of six cases current travelled directly through the string of the kite. In two others, flame burns occured following ignition of clothing. Another patient had contact with wire through a metal rod. In the last case, arcing pulled the hand of the patient leading to direct contact with wire. The average burns size was approximately 31% body surface area (BSA), with all patients having burns over the palmar aspect of at least one hand. No patient required amputation for the injuries. In this article, attention has been focussed on the various modes of electrical injuries associated with kite-flying and some measures have been advised to avoid such accidents.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/16. Early decompression fasciotomy in the treatment of high-voltage electrical burns of the extremities.Based on a knowledge of electropathophysiology, a recommended treatment has been proposed for the management of extensive high-voltage electrical burns. Early, aggressive, surgical intervention consisting of adequate decompression fasciotomy and wound debridement has been emphasized as the first line of treatment. Frequent redebridements under general anesthesia are important to the preservation of viable tissue. Early coverage procedures or attempts at primary closure following decompression are contraindicated in high-voltage injuries. This method of treatment in eight cases of high-voltage, electrical injury has preserved viable tissue, decreased the incidence of fatal sepsis and renal shutdown, decreased patient morbidity, and generally facilitated patient rehabilitation.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
3/16. tetanus and the plastic surgeon.tetanus in the united states is decidedly rare, and most of us will not see a case of it during our careers. Given its lethality, it is a disease about which one must be aware. Be willing to consider it as a diagnosis, no matter the immunization status of the patient, if clinical signs and symptoms warrant. To emphasize this point, the authors present a case of an otherwise healthy 41-year-old man who sustained electrical burns when he fell from a ladder and struck a power line on his way to the ground. He developed a compartment syndrome of his left leg at the exit site and subsequently underwent fasciotomies. When he later began to exhibit signs and symptoms of sepsis, his wound was debrided, and most of his anterior compartment was resected. Despite this, his condition worsened, and his clinical picture was suggestive of tetanus, including the classic findings of trismus, risus sardonicus, and opisthotonus. Using mechanical ventilation, paralysis, narcotics, and muscle-relaxing sedatives, the authors supported him until his tetany subsided. He survived and was discharged to home when complete coverage of his burns and left leg anterior compartment was obtained. The authors discuss the presentation, diagnosis, and treatment of tetanus, as well as its incidence in the general population and in the previously immunized patient.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
4/16. Modified distally based peroneal artery perforator flap for reconstruction of foot and ankle.The distally based sural fasciocutaneous flap has been used widely for reconstruction of foot and ankle soft-tissue defects. Here we report on a series of cases of foot and ankle reconstruction with a modified distally based sural flap. The vascular pedicle of the flap includes an axial perforator branch of the peroneal artery and two concomitant veins. This modified distally based perforator flap, measuring around 17 x 6 cm to 30 x 10 cm in size, was transferred for coverage of foot and ankle soft-tissue defects in 7 cases. All flaps survived completely. Neither arterial ischemia nor venous congestion was noted. As compared to other distally based sural flaps with neuro-veno-adipo-fascial pedicles, this modified sural flap with a thin perforator pedicle is easily rotated. The flap can obtain abundant blood supply through both axial perforator and longitudinal chain-linked vascular plexuses, and does not have the venous reflow problem. In conclusion, the invention of this perforator fasciocutaneous flap provides a valuable tool for repair of foot and ankle soft-tissue defects.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
5/16. Surgical treatment of electrical burns by local flap plastic surgery.Electrical burns are a serious problem within burn medicine even though they are relatively uncommon. The size of the burn is small, but the wound is often deep, and frequently the patient has systemic complications as well. In the majority of patients with such injuries immediate surgical intervention is essential, consisting of escharotomy, fasciotomy, and debridement of the devitalized tissues, necrectomy of the burn area, and closure of the defect by a direct suture, a dermo-epidermal graft, or local flap. Our report consists of three case studies. The patients underwent local flap plastic surgery after a full thickness soft tissue loss. All three patients healed primarily and did not require further correction of flaps. Final functional and aesthetic results are very good if the local flap is used appropriately.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/16. Penile resurfacing with vascularized fascia lata.penis resurfacing is a challenging procedure, and should simultaneously ensure erectile function, tactile sensibility, sexual satisfaction, and aesthetic integrity. This article presents three cases with penile skin defects treated by means of a pedicled fascia lata attached either to the tensor fascia lata (one case) or an anterolateral thigh flap (two cases). The cause of the wounds included electrical burn, Fournier's gangrene, and self-mutilation. The size of flaps ranged from 10-13 cm in width and 15-30 cm in length. All flaps included vascularized fascia lata, which covered part or the circumference of the penis. All flaps survived completely. The lateral cutaneous nerve of the thigh was included in the designed flaps in all instances, and normal protective sensation was recorded postoperatively. The patients reported normal erectile function and ability to perform intercourse. The flaps, though relatively bulky and hairy, had a good color and texture match with the penis and suprapubic region. Based on our limited experience, we believe that the anterolateral thigh flap has greater dimensions with a longer pedicle, and allows for greater flexibility in flap design compared to the tensor fascia lata flap. An anterolateral thigh flap can be safely thinned in a second stage, and it is our flap of choice for penis resurfacing.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
7/16. Use of the lateral intercostal perforator-based pedicled abdominal flap for upper-limb wounds from severe electrical injury.BACKGROUND: Upper-extremity wounds can be covered with a variety of flaps. However, pedicled distant flaps still have a place in treatment, especially in the early stages of wound restoration after a severe electrical injury. The purpose of this clinical study was to present the use of the pedicled abdominal flap, using the blood supply of the lateral intercostal perforator vessel, to cover defects caused by severe electrical injury. methods: Between 2003 and 2005, 6 cases of deep burn wounds were treated with a lateral intercostal perforator-based pedicled abdominal cutaneous flap, with the blood supply originating from the lateral perforator branches of the seventh to 10th intercostal arteries. This flap was used to repair deep burn wounds on the elbow, forearms, and hands that were the result of severe electrical injuries. RESULTS: Flaps were harvested in sizes ranging from 16 cm x 12 cm to 9 cm x 7 cm. The pedicle was separated from 18 to 21 days after the operation. Five flaps survived entirely. The sixth underwent marginal necrosis (1.5 cm x 3 cm) at the distal portion of the flap because flap cutting exceeded the paraumbilical line. Results were cosmetically satisfactory for all patients. CONCLUSIONS: This flap is suitable for covering defects in hands, forearms, and elbows. The procedure was performed easily, safely, and reliably, and the flap has several advantages over other commonly used techniques for upper-limb wounds from severe electrical injury. We recommend this flap as the treatment of choice.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/16. Use of a cross-leg free muscle flap to reconstruct an extensive burn wound involving a lower extremity.A young patient sustained a high-voltage burn with extensive destruction of the soft tissue in his left lower extremity. Occlusion of the anterior and posterior tibial arteries, loss of toe extensors and the superficial and deep peroneal nerves were noted, besides the exposure of the lower end of the tibia and metatarsal bones. In the absence of proper recipient vessels, a cross-leg free latissimus dorsi muscle flap with overlying skin and depending on the vessels of the contralateral foot was used successfully for reconstruction of the defect. The pedicle was divided 3 weeks after microvascular anastomosis and the flap survived completely. This technique permits transfer of free flaps to compromised wounds without available recipient vessels, and the latissimus dorsi muscle flap, with its characteristics of large size and copious vascularity, could be split to cover exposed bones in different areas simultaneously.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/16. The bipedicled lip flap for reconstruction of the vermilion border in the patient with a severe perioral burn.Reconstruction of the severely burned lip may require both reconstitution of the tissue bulk and an increase in size of the vermilion. We present two patients in whom a bipedicled lip flap was used to transpose both bulk and vermilion from the relatively normal donor lip to the atrophic burned lip.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/16. 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 = 1keywords = size (Clic here for more details about this article) |
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