Epidemiology And Outcomes Of Radiator Burns At A High Throughput Burns Centre.

Indoor radiator burns can cause significant morbidity and mortality, especially in vulnerable patients. However, the epidemiology and clinical outcomes are poorly characterized. A retrospective study of all radiator burns referred to a tertiary regional burns centre between 2013-2019 was conducted. Four hundred and forty-seven patients (median age 25.6 years, male:female ratio 1.4:1) were referred; 109 (24%) admitted, 201 (45%) managed in outpatients and 137 (31%) managed locally. The incidence of burns leading to referral was 0.65/100,000/year, but increased annually. Contact burns consisted of 99.6%. Age distribution was bimodal: <5 years (43%), >65 years (27%), although all ages were affected. Median TBSA was 0.75% (0.1-11.5%), but 79% had injuries <2%. Childhood burns were predominantly superficial dermal grab injuries, usually manageable as outpatients. Elderly patients had larger burns usually secondary to falls or impaired sensorium, and were more likely to die (p<0.05). Burns due to impaired sensorium were deeper and more likely to require surgery (p<0.05). Sixty-three (14%) patients required surgery. Thirty-day mortality was 1.1%. Age was the only significant predictor of mortality. This study quantifies the epidemiology and outcomes of a growing problem. It identifies at risk populations (extremes of age), and important features of the clinical assessment.

Les brûlures en milieu clos liées à un radiateur peuvent être responsables de morbidités et de mortalité non négligeables, particulièrement chez les patients fragiles. Toutefois, l'épidémiologie et l'évolution en sont mal connues. Nous avons étudié rétrospectivement les 447 brûlures (âge médian des patients 25,6 ans ; 1,4 hommes pour 1 femme) liées à ces appareils adressées dans un CTB de référence entre 2013 et 2019. Parmi celles- ci, 109 (24%) ont été hospitalisées, 201 suivies par nous en externe et 137 (31%) pris en charge dans une structure non spécialisée. L'incidence annuelle est de 0,65/100 000/an, en augmentation régulière. Quasiment toutes (99,6%) sont dues à un contact. Bien que tous les âges puissent être affectés, on observe 2 pics d'incidence, avant 5 ans (43% des patients) et après 65 ans (27%). La surface atteinte s'étendait de 0,1 à 11,5% (médiane 0,75%), 79% des brûlures touchant moins de 2% SCT. Les enfants souffraient le plus souvent de brûlures superficielles, suivies en externe, après avoir empoigné le matériel. Chez les sujets âgés, les brûlures, consécutives à une chute ou à contact prolongé en raison de troubles sensoriels (ces dernières plus souvent profondes et nécessitant un traitement chirurgical ­ p< 0,05), sont plus étendues et plus souvent mortelles (p< 0,05). Soixante- trois (14%) patients ont eu besoin de chirurgie, la mortalité à 30 jours était de 1,1% ; l'âge étant le seul facteur prédictif de mortalité. Cette étude précise l'épidémiologie et l'évolution d'un problème émergeant, la population à risque (âges extrêmes) et met en avant certaines particularités cliniques.

A systematic review of outcomes following hand reconstruction using flaps from the superficial palmar branch of the radial artery (SUPBRA) system.

BACKGROUND: Flaps based on the superficial branch of the radial artery (SUPBRA) are indicated when homo- or heterodigital flaps are inappropriate, but glabrous or like-for-like reconstruction is required. AIM: To systematically review the outcomes of hand reconstruction using SUPBRA flaps. METHODS: PubMed was searched for English-language articles studying SUPBRA flaps in November 2019. Data collected included flap vascular supply, dimensions, complications, donor site closure, and two-point discrimination. RESULTS: Twenty-six papers were eligible (410 flaps). Flaps were classified as glabrous, nonglabrous or combined. Nonglabrous flaps were either free- (52%) or reverse-flow pedicled (1.7%) wrist flaps. Glabrous flaps were either free palmar (36.3%), reverse-flow pedicled palmar (2%), antegrade-flow pedicled palmar (0.2%) or perforator-based island palmar flaps (3.7%). Combined glabrous/nonglabrous flaps formed 4.1% of flaps. Maximal flap dimensions allowing direct closure were: 3.1 × 6 cm for wrist flaps and <3 × 10 cm for glabrous palmar flaps. Combined flaps can be 10 × 16 cm. Overall, complete and partial flap failure rates were 3.17% and 0.98%, respectively. Most complete failures were due to venous thrombosis. All 220 wrist donor sites were closed directly. Two out of 173 palmar donor sites (≥3.1) could not be primarily closed. Wound complications were rare, but 53.4% of free palmar flaps required debulking. The results of neurorrhaphy were inconsistent. CONCLUSIONS: Flaps based on the SUPBRA are robust, provide like-for-like reconstruction of glabrous skin defects in one-stage, offer versatility due to diverse skin paddle orientation patterns and are in the same operative field as the defect.

The mini-temporalis turnover flap for midface reanimation: Photogrammetric and patient-rated outcomes.

BACKGROUND: Mini-temporalis transposition (MTT) flaps, modified from Gillies' technique, have become less popular than temporalis tendon transfers for midface reanimation. MTT involves raising the middle third of the temporalis, transposition over the zygomatic arch and lengthening with deep temporalis fascia which is sutured to the orbicularis oris. AIM: This retrospective study assessed subjective and objective outcomes following MTTs by a single surgeon from 2009 to 2019. METHODS: Operative and surgical details were recorded. Four blinded consultants rated pre- and postoperative videos according to Terzis' scale. Pre- and postoperative resting, Mona Lisa and canine smile photographs were analysed using Emotrics, the software that automatically computes differences in inter-landmark distances. Patients also completed the Glasgow Benefit Inventory (GBI) patient-rated outcome measure. RESULTS: Forty-one patients (mean age 65.8 ±â€¯15.5) underwent MTT, median 3 (0.4-57) years post-paralysis and were followed up for median of 2.2 (0.4-8.8) years. Higher mean postoperative Terzis score demonstrates symmetric and aesthetic improvements (3 ±â€¯1.3 vs. 2 ±â€¯1; p<0.05). Emotrics analysis showed postoperative improvements in resting and dynamic symmetry of all indices, with the majority statistically significant (p<0.003). The mean GBI was 35.19 with 17 (94.4%) patients reporting improvement, whereas one (5.6%) patient reported detriment after surgery. Two (5.4%) patients suffered complications: one haematoma and one infection. Four patients (9.8%) required revisional flap tightening. No patients requested revisional surgery for temporal hollowing or zygomatic fullness. CONCLUSIONS: MTT effectively improves both subjective and objective resting and dynamic midface symmetry in a single stage. These results suggest this technique is a good alternative to temporalis tendon transfer techniques.

Minimal important changes and differences in elective hand surgery.

UNLABELLED: Minimal important changes and differences describe the smallest changes and differences between individuals that are relevant to patients following treatment. Minimal important differences may vary between conditions, treatments and lengths of follow-up, and can be calculated in different ways. Minimal important differences for elective hand surgery were reviewed. A total of 99 minimal important differences were identified in 29 articles. The conditions, treatments, outcome measures used and follow-up periods are discussed. The Disabilities of the Arm, Shoulder and Hand had the most estimates of minimal important differences, but these varied. The methods used in the included studies were reviewed and appraised. Most minimal important differences were calculated using retrospective anchors. Future research directions in this area are suggested. LEVEL OF EVIDENCE: II.

Validation of a new photogrammetric technique to monitor the treatment effect of Botulinum toxin in synkinesis.

AIMS: To validate a new photogrammetric technique for quantifying eye surface area and using this to quantify the degree of improvement in symmetry in patients with oral-ocular synkinesis following Botulinum toxin injection. STUDY DESIGN: Feasibility study and retrospective outcomes analysis METHODS: Ten patients' photographs were chosen from a photographic database. Their eye surface areas were measured independently by two raters using a graphics tablet. One rater repeated the procedure after 15 days. Bland-Altman plots were computed, ascertaining inter-rater and intra-rater variability. The eye surface areas of 19 patients were then derived from photographs taken before and after Botulinum toxin injections. Paired t-tests were used to analyse the significance of the difference in pre- and post-treatment symmetry. RESULTS: Ninety per cent of eye surface areas derived from the two raters were within a coefficient of variation of 0.1 (95% CI: 0.05-0.15). Similarly, 90% of eye surface areas derived from one rater had a coefficient of variation of 0.08 (95% CI: 0.04-0.12). Botulinum toxin significantly reduced synkinesis resulting from lip puckering, Mona Lisa smiling and Hollywood smiling (P<0.05). CONCLUSIONS: We have proposed a clinically valid tool for quantifying the effects of Botulinum toxin treatment for oral-ocular synkinesis. We recommend this method be used to monitor the response of such patients when receiving Botulinum toxin treatment.