1/47. Reliability of inferior pedicle reduction mammaplasty in burned oversized breasts.Heavy pendulous breasts cause physical and psychological trauma. Postburn deformity of breasts results in significant asymmetry, displacement of nipple-areola complex, due to burn scar contracture, and significant scarring; these factors add more psychological discomfort and subsequent behavioral changes. The use of the inferior pedicle procedure in burned breasts can solve many problems. The technique reduces the size of the large breast, eliminates the scar tissue by excising both medial and lateral flaps, and brings the mal-located nipple and areola to a normal position. This study stresses the possibility of harvesting the inferior dermal pedicle flap from within the postburn scar tissue without necrosis of the nipple and areola, because of the excellent flap circulation. Acceptable aesthetic appearance and retainment of nipple viability and sensitivity can be achieved with the inferior pedicle technique even with postburn deformity of the breast. The study was conducted on 11 women, all of whom had sustained deep thermal burns to the breasts and anterior torso and whose breasts were hypertrophied and pendulous.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/47. Child burn: accident, neglect or abuse. A case report.The authors report a case of a child who has suffered three episodes of burn injuries in a short period of time, probably provoked by neglect or abuse from the parents. This mode of injury is of great importance because of the high mortality, as well as the physical, psychological and social sequelae that it causes. The absence of care and attention from the parents or caretakers contribute to the high frequency of this kind of trauma. In these cases, the admission of the child to the hospital is justifiable, regardless of the size or depth of the burn wound. Aspects concerning the epidemiology are discussed in this article, as are comments based on the literature about infant abuse and neglect.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/47. Microsurgical reconstruction of the thermally injured upper extremity.The use of free flaps for coverage of the deeply burned hand has advantages that include the salvage of the exposed vessels, nerves, tendons, joints, and bone; a single operation to obtain wound closure, minimizing the risk of infection; and earlier physical therapy. This article focuses on the choice of suitable free flaps for the coverage of the deeply burned hand; and it also presents some case reports.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/47. Bizarre paediatric facial burns.child abuse and neglect account for a significant number of paediatric burn injuries. It is of great importance because of the high mortality, high frequency of repeated abuse, as well as the physical, psychological and social sequelae that it causes. Burn abuse is often under-recognized and under-reported because it is difficult to define non-accidental injury. On the other hand, false accusation of burn abuse is extremely damaging to the family. Bizarre and unusual burn injuries can be caused by accident and should not automatically be assumed to be deliberate injury. Three boys of age 1-7 years with bizarre facial burns were admitted to the burns Unit at the Prince of wales Hospital between February 1995 and July 1999. One was burned by his baby-sitter with hot water steam and the other two were burned by their mothers with hot boiled eggs. The unusual causes of their burns raised the suspicion of child abuse and formal investigations were carried out by the Social Services Department. Detail assessment including a developmental history of the child and the psychosocial assessment of the family revealed that these three boys were burned because of poor medical advice and innocent cultural belief.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/47. Physical injury as a provoking factor in three patients with scleroderma.A 51-year-old female developed linear-like scleroderma in the left thigh following a linear wound caused by a car accident. 27 years later she also developed a typical diffuse cutaneous systemic sclerosis with extensive skin involvement and bibasilar pulmonary fibrosis. The second case is a 39-year-old female who had a history of Raynaud's phenomenon since early childhood. She developed a morphea following a burning injury of the left thigh. 17 years later she also developed a typical limited cutaneous systemic sclerosis with sclerodactyly, skin ulcers and subcutaneous calcinosis. The third case is a 43-year-old female who developed a typical morphea of the right elbow around the site of a previous local corticosteroid injection. The two remarkable points of these 3 cases are the possible role of physical injury in the provocation of localized scleroderma and in the first 2 cases the unusual later development of a systemic form of scleroderma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/47. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/47. Cryopreserved cultured epidermal allografts achieved early closure of wounds and reduced scar formation in deep partial-thickness burn wounds (DDB) and split-thickness skin donor sites of pediatric patients.Burn treatment in children is associated with several difficulties, e.g. available skin replacement is small, donor area could expand, and subsequent hypertrophic scar and contracture could become larger along with their physical growth. In order to have better clinical results, the authors prepared cryopreserved cultured epidermal allografts from excess epidermal cells of other patients, and applied the epidermal allografts to 55 children, i.e. 43 cases of deep partial-thickness burn wounds (DDB) due to scald burn and 12 cases with split-thickness skin donor sites. In the 43 DDB patients, epithelialization was confirmed 9.1 /-3.6 days (mean /-S.D.) after treatment. In 10 of the 43 patients, epithelialization was comparable between the area which received the epidermal allografts (grafted area) and the area which did not receive the epidermal allografts but was covered with usual wound dressing (non-grafted area). As a result, epithelialization day was 7.9 /-1.7 in grafted areas and 20.5 /-2.3 in non-grafted areas. In the 12 patients with split-thickness skin donor sites, epithelialization was confirmed 6.3 /-0.9 days after treatment. Epithelialization of the grafted and non-grafted areas was comparable in 8 of the 12 patients, and it was 6.5 /-1.1 days and 14.1 /-1.6 days, respectively. In these 10 DDB patients and 8 split-thickness skin donor site patients, redness and scar formation were also milder in the grafted area. The 55 patients have been followed up for 1-8 years (mean, 4.75 years), and scar formation was suppressed in both DDB and split-thickness skin donor sites. These findings showed that cryopreserved cultured epidermal allografts achieve early closure of the wounds and good functional outcomes.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/47. Injuries experienced by infant children: a population-based epidemiological analysis.OBJECTIVE: Injuries to infant children are an important health concern, yet there are few population-based analyses from which to develop prevention initiatives. This study describes the external causes, natures, and disposition from an emergency department of infants with injuries for a geographically distinct population in Eastern ontario. methods: Epidemiologic analysis of emergency-based surveillance data (1994-2000) for infants (<12 months old) from the Kingston sites of the Canadian hospitals Injury Reporting and Prevention Program. RESULTS: A total of 990 cases of injury to infants were identified, of which 217 (21.9%) required significant medical intervention. Leading causes of injury were falls (605/990; 61.1%), ingestion injuries (65/990; 6.6%), and burns (56/990; 5.7%). Common types of falls experienced were: from furniture (229/605; 37.9%), being dropped (92/605; 15.2%), in car seats (73/605; 12.1%), down stairs (63/605; 10.4%), or in a child walker (42/605; 6.9%). The observed patterns of injury changed according to the ages of the children. Vignettes are used to illustrate recurrent injury patterns (falls, physical vulnerability, burns and ingestions, equipment injuries). CONCLUSION: The results indicate the relative importance of several external causes of injury and how these vary by age group. This population-based information is also useful in establishing rational priorities for prevention, and the targeting of interventions toward responsible authorities.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/47. Pelvic injuries in child abuse.Three cases of child abuse are described in which pelvic injuries were prominent findings on radiologic examination: Two patients had pelvic fractures, and one was found to have heterotopic ossification of the soft tissues of the pelvis and thighs corresponding to extensive bruising in the pubic, genital, buttock, and thigh areas, resulting from physical and sexual abuse. These represent uncommon radiographic findings. Skeletal survey in cases of suspected child abuse should include the entire pelvis, and special attention should be paid to the ischiopubic rami the most common site of these rare pelvic injuries.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/47. Four-year review of burns as an etiologic factor in the development of long bone fractures in pediatric patients.Reduced bone density has been documented in children after burns. This loss of bone may place children at heightened risk for fractures. The medical records of all acutely injured patients with burns in excess of 40% TBSA burn admitted to our institution between January 1, 1997, through December 31, 2000, were reviewed for fracture incidence. patients with fractures sustained during the course of initial trauma were not included in the review. One hundred four records were reviewed. These patients had a mean age of 6.7 /- 0.51 years, (range, 0.2 to 18.0) and a mean %TBSA burn of 59.9 /- 1.60 (range, 40 to 98) with a mean full-thickness %burn of 51.7 /- 2.16 (range, 0 to 95). Fifteen long bone fractures were documented in six patients during the review time frame. All fractures were initially suspected by physical therapy personnel upon regularly scheduled therapy sessions and subsequently verified by x-ray. All fractures identified by this review occurred in children less than 3 years of age. Most fractures were noted during the rehabilitation phase of injury (range, 73 to 283 days after burn) once wounds were more than 95% healed, except for one child, who sustained multiple fractures during the acute recovery phase at a referring hospital. A 5.8% incidence of fractures was noted in patients with burns in excess of 40% (6 of 104 admissions). The etiology of the fractures is unknown, although the hormonal milieu postburn, depressed vitamin d status, inadequate protein intake, and decreased weight-bearing activity are potential contributory factors. In addition, infants and toddlers tend to provide more resistance to therapy because of an inherent lack of cognition. This may account for the increased breaks in this population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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