Vacuum cleaner friction injuries in paediatrics: A 10 year review of national trends.

Our regional burns service has gained experience in managing paediatric hand friction burns due to vacuum cleaners (VC). We aimed to evaluate our 10 year experience managing these injuries as well as reviewing national data trends in order to identify those at risk of injury. MATERIALS AND METHODS: A International Burns Injury Database (IBID) request was made to review the number of burn injuries recorded due to Vacuum cleaner injuries (VCIs). In addition, a local IBID request was made to identify the number of burn injuries managed within our regional burns service. RESULTS: We identified 288 VCIs which have increasingly occurred in England and Wales between 1996-2020 and 32 children who sustained these injuries within our regional burns service. A general theme from both national and local data highlighted that these injuries occurred in males (78%, n=25) with a mean age of 20 months (9 months-4.5 years) affecting children's hands (94%). In 25 cases (78%) these injuries involved an interphalangeal joint. 85% (n = 27) of injuries were deep dermal/full thickness with eleven children (34%) undergoing surgical excision and skin grafts. DISCUSSION: Significant paediatric burn injuries can be sustained from VCs. Greater awareness is indicated for these injuries and legislation should be considered in order to improve the safety of vacuum cleaners. International burn societies are urged to collect data of these injuries in order to co-ordinate improved prevention strategies and change within the VC industry.

Perioperative management of patients on anti-platelets and anti-coagulants presenting for dermatological surgical procedures. A UK survey.

There are an increasing number of our patients on antiplatelet and anticoagulant medications. In the absence of clear guidelines for the perioperative management of these patients presenting for operative dermatological procedures, we undertook a pilot survey of the current practices of dermatologists in the United Kingdom. The aims of our study were to determine whether there was uniformity of practice and whether the modes of practice differed from those outlined in the literature for other related specialities, and to debate whether there is a need for national guidelines with this regard. A postal survey of 185 dermatologists was conducted. The response rate was 50%. Overall, most respondents (61%) stated that their practice was primarily based on personal preference and only 30% stated that it was based on the local Unit policy. Only 34% of the Consultants based their practice on evidence-based medicine. There appeared to be significant variations in current practice amongst dermatologists. Some aspects of practice were found to vary from those recommended in the literature. The findings of this study emphasise the importance of national guidelines for the use of anti-platelet and anti-coagulant medications in cutaneous surgery specifically and in surgery in general.

Ethyl chloride as a cryoanalgesic in pediatrics for venipuncture.

INTRODUCTION: Ethyl chloride can be used as a cryoanalgesic, but with the availability of alternative and relatively safer topical analgesics, its use has decreased. However, it still has the advantage of being quicker to apply compared with other topical analgesics, making it ideal for use in the outpatient departments. We wanted to compare the effectiveness of ethyl chloride as an analgesic during venipuncture in children. METHODS: Venipuncture was carried out using either no analgesia (NO), ethyl chloride spray (EC), or application of the topical anesthetic Ametop (TA) on children attending the phlebotomy outpatient service by experienced pediatric phlebotomists. A pain score was recorded using either the Faces scoring system or the Faces, Legs, Activity, Cry Consolability scoring system. RESULTS: A total of 55 patients were included in the study, 18 from group EC, 18 from group TA, and 19 from group NO. Thirteen patients from both groups EC and TA and 17 from group NO scored 2 or less on the pain scores. DISCUSSION: The use of ethyl chloride was as effective as topical anesthetics in preventing distress to children in venipuncture. However, in the appropriate situations, the use of NO could also be comfortable to the child if venipuncture was done by specialist pediatric phlebotomists.

Randomized clinical trial on the effects of the use of diluted adrenaline solution in reduction mammaplasty: same patient, same technique, same surgeon.

BACKGROUND: Reduction mammaplasty is a very common operation in plastic surgery. Efforts have been made to reduce blood loss and to lower morbidity by infiltrating the breast with vasoconstrictor agents before resection. This is the first randomized clinical trial conducted on the same patient, by the same surgeon, and using the same operative technique to compare the effects of dilute adrenaline solution infiltration. METHODS: Fifty patients (100 breasts) who underwent bilateral simultaneous reduction mammaplasty had 0.9% saline and bupivacaine with adrenaline (1:500,000) infiltrated in one breast and 0.9% saline and bupivacaine infiltrated in the other breast. RESULTS: There was a significant decrease in intraoperative blood loss in breasts infiltrated with adrenaline solution (p < 0.0001), with no increase in operating time or complication rate compared with breasts that had no adrenaline infiltration. CONCLUSION: The use of diluted adrenaline is a safe method of reducing the amount of intraoperative bleeding, with no increase in adverse effects.

Paediatric burns caused by other children.

OBJECTIVE: Children with burns inflicted by other children represent a small proportion of referrals to our paediatric burns unit. The aim of this paper is to investigate any differences between them. DESIGN: Prospective observational audit. PARTICIPANTS: Children admitted between January 1998 and December 2003. RESULTS: Forty-seven patients were admitted to our paediatric burns unit with burns inflicted by other children, of which 38 were male. Scalds were the cause of 53% of all the injuries. Two distinct groups were identified; one group had their burns inflicted by other children accidentally (Group A) and another reported their burns as inflicted by other children intentionally (Group B). The majority had less than 10% total body surface area (TBSA) burns sustained at home. Thirteen patients (27.7%) were reported as deliberate (Group B). The majority in Group B were males (90.9%, P>0.0001) with a median age of 12 years (P>0.0001) who sustained flame burns (P>0.0001) outdoors with a greater %TBSA (mean 12.1% versus 3.8% for Group A) and higher percentage of full thickness burns (38.5% versus 20.6% of group A). More children from Group B had separated parents (53.9% versus 5.9%) and came from poorer socioeconomic backgrounds (69.2% versus 8.8%). All the cases that required ITU admission came from this category. These patients required more surgery as compared to the accidental group (61.5% versus 26.4%). Children from Group B required prolonged periods of outpatient follow up (53.8% versus 14.7% from Group A) and a greater proportion of these children failed to keep outpatient follow-up appointments as compared to the accidental group (38.5% versus 23.5% of Group A, P=0.0007). CONCLUSION: Older male children sustained significant burns outside their homes. They reported them as being deliberate assaults, although on closer inspection of the circumstances it was difficult to support their account of the events.

Re-emergence of port wine stains following treatment with flashlamp-pumped dye laser 585 nm.

Despite the advances in laser treatment of port wine stains (PWS), re-emergence of these lesions still occurs. We carried out a retrospective audit of all children that received laser treatment of PWS between 1997 and 2000 using the flashlamp-pumped dye laser with a 585-nm wavelength. Out of 110 patients treated, 15 re-emerged. The age ranged between 7 months and 15 years. Fourteen had lesions in the head and neck. Before re-emergence, a child had, on average, 6.2 sessions every 4.8 months. Lesions re-emerged on average 31.1 months following discontinuation of treatment. The natural history of an untreated PWS is to darken as the vessels become more ectatic. Therefore, it is not surprising that any residual vessels not affected by laser will continue to progress in this way, causing re-emergence of the lesion. Perhaps we should expect most or all of treated PWS to eventually re-emerge.