Novel use of a supraclavicular transverse cervical artery customised perforator flap: a paediatric emergency.

Perforation of the piriform fossa is a rare, potentially life-threatening paediatric emergency. Prompt diagnosis and early operative intervention is key to patient survival, yet restoring aerodigestive continuity can pose a significant reconstructive challenge. A seven-month old baby girl presented to an emergency department acutely unwell with a twenty-four-hour history of haemoptysis, cough and worsening respiratory distress. A contrast swallow demonstrated extension of contrast into the retropharyngeal region necessitating immediate surgical intervention. A 3.0 cm×1.0 cm perforation within the left posterolateral piriform fossa was identified. The defect was repaired with a supraclavicular transverse cervical artery customised perforator flap. This was inset into the piriform fossa luminal defect as a life-saving procedure. Following a stormy post-operative course, the child was discharged home on day 28 of admission and admitted electively 6 weeks later for division of flap pedicle. This case highlights the novel use of this fasciocutaneous island flap to reconstruct an extensive, potentially fatal, piriform fossa defect in an acute paediatric setting. This simple flap design offers timely mobilisation, reliable blood supply, adequate tenuity and surface area, to reconstruct this extensive defect as a life-saving intervention in a profoundly septic child.

Self-inflicted burns in the Irish National Burns Unit.

We carried out a review of self-inflicted burns presenting to the National Burns Unit in the Republic of Ireland. 87 self-inflicted burns were identified over a 12-year period accounting for 4.2% of total Burns Unit admissions. Patient demographics were identified. The majority of patients had a history of mental illness and deliberate self harm. We also examined the motivation behind the self-immolation, the total body surface area involved and the mortality rates.

Hospital-based needlestick use and injuries by Dublin interns in 2010.

BACKGROUND: Needlestick injuries (NSI) remain an occupational hazard for doctors. Previous reports suggested that needlestick practice among interns could be improved. AIMS: We aimed to report the current occupational sharp practice and experience amongst a modern cohort of Irish interns. METHODS: A self-designed questionnaire was distributed among interns at two Dublin-based teaching hospitals. RESULTS: Thirty-one interns completed a self-designed questionnaire. Notably, only 26% routinely wore gloves when performing phlebotomy like tasks; 35% considered their training adequate; 26% had suffered a NSI within the first 8 months of work--over half occurred between 0000 and 0800 hours. There was a higher rate of reporting NSI than in historical reports. CONCLUSION: Improvements have been made in occupational health management of NSI. However, practical preparation for internship continues to remain a concern. Efforts are needed to reduce unnecessary risk of suffering a NSI among our junior doctors.

Factitious disorder as a differential diagnosis for recurrent skin graft failure.

This case report presents the history of a 43-year-old man who sustained a relatively minor burn to his face but who subsequently suffered significant morbidity. Although the wound was grafted on a number of occasions, it failed to heal. Multiple investigations were carried out to determine the cause of recurrent wound breakdown. It had been suspected that the patient was interfering with the wound but this could not be proven initially. He was eventually diagnosed with factitious disorder and it was only when this was managed in the multi-disciplinary setting that his wound finally healed.

The use of lasers in the treatment of cutaneous lesions.

INTRODUCTION: Laser has progressed significantly over the last three decades. Light amplification by stimulated emission of radiation (lasers) are currently employed by a number of medical and surgical specialties and used to treat a wide range of conditions. AIM: This article aims to provide an insight into laser science and describe its current usage in the treatment of cutaneous lesions and its potential for future developments. CONCLUSION: There are many types of lasers, each having unique properties that enable them to fulfil their task and achieve the desired result. Their applications will no doubt continue to expand with the parallel advancement in laser technology.

Surgical trainees neuropraxia? An unusual case of compression of the lateral cutaneous nerve of the forearm.

Compression of the lateral cutaneous nerve of the forearm is an uncommon diagnosis but has been associated with strenuous upper limb activity. We report the unique case of a 32-year-old male orthopaedic trainee who suffered this nerve palsy as a result of prolonged elbow extension and forearm pronation while the single assistant during a hip resurfacing procedure. Conservative measures were sufficient for sensory recovery to be clinically detectable after 12 weeks.