Late complications of high-voltage electrical injury might involve multiple systems and be related to current path.

Delayed complications of electrical burns are mostly unexpected, and the link between the injury and the symptoms often goes unrecognized. A possible relation between source-ground sites and late clinical manifestations was recently emphasized. We report a unique case of combined intestinal-spinal delayed complications following a high-voltage electrical injury, a possible explanation being a greater current flow through the right hemisoma. The potential for late complications is an additional feature that physicians must consider in managing electrical injuries. Manifestations are variable and presentation is confounding, but current flow path can constitute a precious source of information to predict complications in the late phase of management.

Les complications tardives des électrisations par haut voltage sont le plus souvent inattendues et le lien avec l'accident initial est fréquemment non reconnu. Une relation possible entre le trajet source-terre et les complications tardives a récemment été mise en évidence. Nous rapportons le cas de complication tardive touchant à la fois l'intestin et la moëlle épinière, pouvant être expliqué par le passage préférentiel du courant dans l'hémicorps droit. La possibilité de complications tardives doit être prise en compte des électrisations par haut voltage. Ces manifestations sont variables et la clinique peut être peu claire, mais le trajet supposé du courant peut être un argument permettant de relier l'atteinte initiale et les complications tardives.

Multidisciplinary care in severe pediatric electrical oral burn.

Oral burns in pediatric patient are commonly due to electrical injuries, representing an important reconstructive issue even for functional than esthetic reason. Different classification, surgical management and even oral device were described to allow the best long-term result. In most case a multidisciplinary approach is necessary to achieve a satisfactory outcome. A severe case of pediatric oral burn with germinative teeth damage is presented, describing a multispecialist team approach that guarantee a satisfactory outcome by reconstructive surgery, careful progressive evaluation of dental and soft tissue healing and speech recovery. The use of acellular dermal substitute template within traditional reconstructive surgery had provided a good functional and esthetic result joint to valid preservation of germinative dental element as shown at long-term X-ray evaluation. Intensive rehabilitation speech program has also avoided phonetic impairment in an important speech develop period. It was so evident that the necessity of a multispecialist care in such difficult injury to achieve the best long-term result.

The contribution of a dermal substitute in the three-layers reconstruction of a nose tip avulsion.

Through and through defects of the nasal ala still remains debated challenge in plastic reconstructive surgery. We present a 36 y.o. woman who suffered by a through and through nose tip avulsion subsequently a dog bite. She refused the use of traditional auricular composite graft or the multiple stages midline forehead flap due to the secondary visible scars. We treated her with the combined use of mucoperichondrial septal flap, cartilage graft and dermal substitute Integra graft, followed by a secondary, full-thickness skin graft. We consider the Integra(®) as a useful option for the treatment of a complex trauma of the nose with through and through tip and alar avulsion when, due to scar or consent problem, it's not possible the use of other techniques.

Burn care in relation to burn epidemiology in Italy.

AIM: Burn centres are 'hubs' of referral for large areas and should be organised in a network optimised for the needs of their area. Burn centres' organisation and activity in Italy are analysed with reference to burn epidemiology in the country. METHODS: A questionnaire was submitted to Italian burn centres concerning organisation, activity and epidemiology of burns treated in 2008. RESULTS: A total of 2067 patients were admitted to a burn centre in 2008; 50% of burns were due to flames (21% alcohol); and 25% of patients were <14 years old. Overall mortality was 5.3%. 144 beds in 15 burn centres were available (seven reserved for children; bed/inhabitants ratio, 1/414, .023). However, distribution is not uniform in the country. Bed rotation was 14.4 patients/bed, and hospital stay varied from 11.7 days for <20% total body surface area (TBSA) burns to >120 days for burns >70%. About half (57%) of patients admitted had less than 20% TBSA burns, 32% had 20-50% TBSA burns, 7% from 50% to 70% and 4% over 70% TBSA. A national network coordinating burn centre activity is lacking. CONCLUSIONS: Italy seems to have less availability of beds for burn care than other countries, and distribution and organisation of the network may be improved. The high prevalence of child burns should be noticed and this makes prevention campaigns advisable.

Knee Region Coverage with Reversed Gracilis Pedicle Flap (GReSP Flap).

INTRODUCTION: To treat severe soft-tissue complications of total knee arthroplasty, we used an extended reversed gracilis flap based on secondary pedicles (the GReSP flap). STEP 1 PREPARE WOUND BED: Locate the gracilis and pedicles, then debride the wound bed. STEP 2 EXPOSE GRACILIS MUSCLE: Expose the superficial aspect of the muscle, while protecting the saphenous vein and nerve. STEP 3 CHECK MUSCLE PERFUSION: Temporarily clamp the main vascular pedicle to ensure blood supply when perfused only by the secondary pedicles. STEP 4 MOBILIZE MUSCLE FLAP: Transect the proximal tendon of the gracilis muscle to provide maximal length for the muscle flap and ligate the main vascular and nerve pedicles. STEP 5 COVER WITH SKIN GRAFT: Suture the flap in place and cover with skin graft. STEP 6 POSTOPERATIVE CARE: Immobilize the knee for two weeks; follow with rehabilitation to restore range of motion. RESULTS & PREOP/POSTOP IMAGES: We treated three patients who had an infection at the site of a total knee arthroplasty and exposure of the implant. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.

Use of acellular dermal regeneration template in a complete finger degloving injury: case report.

Finger degloving injury remains one of the most difficult challenges in hand reconstructive surgery. We report the use of an acellular dermal regeneration template to create a neodermis, followed by a secondary, full-thickness skin graft on a complete finger degloving injury, achieving a satisfactory recovery of range of motion and a cosmetically acceptable result.

Reversed gracilis pedicle flap for coverage of a total knee prosthesis.

BACKGROUND: Poor wound-healing and skin necrosis are potentially devastating complications after total knee arthroplasty. Primary soft-tissue coverage with a medial or lateral gastrocnemius transposition flap is typically the first choice for reconstruction. The aim of this study was to evaluate the use of a distally based secondary-pedicle flap of the gracilis muscle for reconstruction of a soft-tissue defect. METHODS: The characteristics of the distally based (secondary) pedicles of the gracilis muscle were studied with use of dissection (ten cadavers) and computed tomographic angiograms (fifty patients). On the basis of the anatomical features, an extended reversed gracilis flap based on the secondary pedicles was used in three patients with severe soft-tissue complications of total knee arthroplasty. RESULTS: The mean number of secondary pedicles was 1.8 (range, one to four). The pedicles originated from the superficial femoral or popliteal artery. The most proximal pedicle was often the largest (mean caliber, 2.0 mm), and its point of entry into the gracilis muscle was an average (and standard deviation) of 21 +/- 3.6 cm (range, 16 to 28 cm) from the ischiopubic branch. A significant positive association (p = 0.001; r(2) = 0.49) was found between the caliber of the proximal secondary pedicle and the number of other secondary pedicles. In all three patients, the adequate caliber of the secondary pedicles (as shown on preoperative computed tomographic angiograms) and good muscle vascularization confirmed the utility of the gracilis as a distally based pedicle flap. CONCLUSIONS: For the treatment of large soft-tissue defects of the patella or the proximal part of the knee, or for soft-tissue reconstruction over an exposed total knee prosthesis, the reversed gracilis pedicle flap may be an alternative to, or may be integrated with, a lateral or medial gastrocnemius flap.

A case of toxic epidermal necrolysis (ten) with severe chronic ocular complications in a healthy 46-year-old woman.

Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a severe drug reaction characterized by extensive destruction of the epidermis and mucosal epithelia. The eyes are typically involved in TEN. The precise pathomechanisms involved remain unknown. We present a case of toxic epidermal necrolysis in a healthy 46-yr-old female patient who had inhaled glycophosphate (herbicide) and was treated with paracetamol, aspirin, and chlorpheniramine. Thirty-five per cent of the skin area was affected by the syndrome, with involvement of conjunctival, gastrointestinal, and respiratory mucous membranes. Topical treatment was performed every day and the patient did not undergo surgery. Complete wound healing was achieved in 47 days. There were acute complications, consisting of infection of the skin areas ( Candida), gastrointestinal bleeding, pleural effusion, and severe ocular mucous membrane damage. The most serious chronic complication was the presence of significant opacity of the corneal epithelium, causing almost complete loss of vision. According to the data in the literature, ocular complications in TEN are frequent and are present in the majority of the patients studied, but are not often severe. Risk factors for the development of ocular complications are not known. Ocular sequelae may appear after the acute period and they can be extremely disabling, even causing almost complete loss of vision. Treatment includes corticosteroids and topical antibiotic therapy in the acute phase and if necessary corneal transplantation in the event of chronic damage to the corneal epithelium.

[Postmastectomy breast reconstruction--outcome on 33 consecutive cases]. / Reconstructia mamara postmastectomie rezultate pe 33 cazuri consecutive.

UNLABELLED: Nowadays postmastectomy breast reconstruction for breast cancer, seems to receive greater acceptance than in the past due to three important reasons: the improvement of the methods and techniques of plastic surgery; the new improved materials used as breast prosthesis; the better informed patients. The aim of this study is to review the outcomes of breast reconstruction performed for patients with mastectomy for breast cancer. MATERIAL AND METHOD: The medical records of 33 consecutive patients who underwent breast reconstruction, during a one year period, at a large municipal hospital were reviewed retrospectively. The main parameters studied were type of reconstruction, morbidity rate and type and number of reoperations. RESULTS: Among 33 patients , a number of 30 patient (90.9%) had theirs breasts reconstructed using a prostesis material and for 3 patients (9.1%) a flap type reconstruction was used. Immediate breast reconstruction was the preferred method of reconstruction. No major complications were noted. Minor complications were present in 4 patients (12.5%): infection (1 case), haematoma (1 case), skin necrosis (1 case), device extrusion due to local infection (1 case). CONCLUSIONS: Immediate breast reconstruction using expander and implant technique offers very good outcomes with low morbidity rate, excellent cosmetic results and consists in small, reliable and perfect reproductible operations.

Laparoscopy in the abdominal staging of melanoma.

A retrospective study on laparoscopic results in the abdominal staging of 297 patients with melanoma, is reported. In 195 (99.3%) of patients, laparoscopy was technically feasible, and in 10% the clinical stage was changed on the basis of the findings. In 34% of patients with metastasis of the liver and peritoneum, the tumor had a diameter of under 1 cm and therefore was not detectable with non-invasive techniques. In the light of these results laparoscopy is advisable in patients with Stage I melanoma at a high risk of metastatization (Clark IV-V; Breslow greater than 0.76 mm) and in Stage II patients. In Stage III patients, laparoscopy seems indicated for an evaluation of the efficacy of systemic treatment.