Follow-up study of three cases of congenital microgastria.

Current knowledge on congenital microgastria is limited due to its extreme rarity, and the paucity of nutritional and quality of life follow-ups. Patients affected by congenital microgastria cases followed at out center were screened, and general and nutritional status were evaluated at follow-up visits through validated questionnaires. Three cases were included: one patient died because of a complex syndromic picture where microgastria was imperatively approached conservatively. The remaining cases underwent Hunt-Lawrence at 2 and 17 months. After 2 years and 27 years postoperatively, both patients are on full oral intake. The 28-yearold patient did not reach a BMI higher than 18. She rated her quality of life as unimpacted, with a Gastrointestinal Quality of Life Index of 111. In the other case, parents reported about their 2-yearold child an Infant Gastrointestinal Symptom Questionnaire of 13, corresponding to "no distress". Our findings confirm the literature trend supporting the role of early surgery in microgastria to improve outcomes. We presented the nutritional status and quality of life in two cases of congenital microgastria operated according to Hunt-Lawrence at a 2-year and 27-year distance, which is the longest follow-up reported to date.

Estimation of wound surface area: an evaluation of medical professionals' assessment in a plastic surgery unit.

The percentage of skin graft take following the resurfacing of burn injuries is routinely calculated in a subjective fashion, in order to make management decisions. Given the gravity of decisions made based on this clinical assessment of graft check, it is notable that limited research has been carried out on this subject. No standardised subjective assessment tools exist to measure surface area of graft take in a manner similar to that of Wallace's Rule of Nines or Lund and Browder. This study set out to examine the accuracy of visual assessments of graft take within the multidisciplinary team regularly making assessments of newly grafted burn wounds. A total of 15 digitally drawn images were used to assess 36 staff members' estimations of percentage of surface area. The results showed a wide variation in estimation in all staff types, including senior burns surgeons, who were found to underestimate surface area by as much as 30%. The British Burns Association has removed 'healing time' as an outcome measurement from its guidance, as it recognises how hard it is to make a standardised assessment of wound healing. This study demonstrates the difficulty in subjectively assessing surface area and makes some suggestions for further research and clinical applications of technology to aid assessment.

Management of chemical burns.

Chemical burns represent a small number of burn injuries in the UK. They have the potential to be life-threatening with serious aesthetic and functional consequences, accounting for 30% of all deaths from burns. Chemical burns are caused by corrosive agents (acids and alkali) leading to extensive tissue damage. Understanding the pathophysiology of a chemical burn injury and identifying the nature of the offending agent is important for effective management. Prompt assessment and management of chemical injuries is vital to reduce the deleterious effect of the compound involved. This article reviews the pathophysiology of a chemical injury and the management of these burns.

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.

Pretibial lacerations.

Patients with pretibial lacerations are commonly referred to plastic surgery services for operative intervention. However, the vast majority of cases can be managed conservatively. Through understanding the epidemiology and pathophysiology underlying these injuries to appropriately assessing and managing these patients, this review demonstrates how best to facilitate wound healing and undertake conservative management. A multidisciplinary approach to managing patients with pretibial lacerations is discussed so that clinicians can provide a better quality of life for patients through optimisation and preventing further decline.

Bone-Penetrating TASER Bolt: A Rare Case of Penetrating Injury to the Middle Phalanx of the Little Finger.

TASER© (Axon Enterprise, Scottsdale, Arizona) is a type of electric gun that delivers a sudden shock to temporarily disable a human subject. It is used by law enforcement, as well as civilians, worldwide. Despite its wide use as a "non-lethal" form of self-defence, it can lead to serious injuries. We are presenting a rare case report of a 28-year-old man who presented to our Plastic Surgery Trauma Service following a penetrating TASER bolt injury to the middle phalanx of his left little finger.

Adrenaline Auto-injector injuries to digits; a systematic review and recommendations for emergency management.

AIMS: Accidental injury to digits with Adrenaline Auto-injectors (AAIs) is becoming increasingly common. Digital AAI injury causes painful ischaemia that can lead to necrosis and patient anxiety. There is a lack of understanding amongst surgeons regarding how to manage these injuries. We aimed to determine an optimal treatment algorithm for their management. METHODS: We conducted a systematic review using the search engines MEDLINE, PubMed, EMBASE, CINAHL, BNI, AMED, Google Scholar. Search items included ("epinephrine OR adrenaline") AND ("Digit" OR "Finger" OR "Thumb") AND ("Injury" OR "Accidental"). RESULTS: A total of 49 articles were identified describing 111 cases. In 58 cases; 52% of cases were managed with phentolamine, 24% were managed with nitroglycerine and 7% were treated with warm soaks. The remaining 17% of cases were managed with a variety of alternative treatments. Mean recovery time following treatment with phentolamine infiltration was 33 min, whilst symptoms persisted for several hours in some cases with observation/warm soaks and nitroglycerine. Phentolamine was more effective when injected into the AAI puncture site (mean resolution time: 17 min) in comparison to injection as a digital block (74 min). CONCLUSION: Phentolamine is the most effective method of reversing symptoms and treating ischaemic digits when compared to alternative therapies. Symptoms resolved much quicker when phentolamine was infiltrated into the site of injury compared to being infiltrated as a digital block. We propose a treatment algorithm for management of these injuries. Hand surgeons should be aware of AAI injuries and be able to advise on their management.

Acute Acalculous Cholecystitis in Burns: A Review.

Acute acalculous cholecystitis (AAC) is an acute inflammatory disorder of the gallbladder, which can complicate the recovery of burn patients. No formal literature review has been performed about this uncommon but potentially fatal complication in burn care. A Pubmed search from 1950 to 2015 was performed using MESH terms: "acalculous cholecystitis," "burns or thermal injuries or thermal damage," and "cholecystitis or gallbladder inflammation." The articles were analyzed and data collected individually on the incidence, presenting symptoms or signs, risk factors, investigations, and treatment modalities used. An International Burns Injury Database (IBID) search was additionally performed to identify the incidence of AAC in burn patients between 2005 and 2015 in the United Kingdom. Nineteen articles were identified which described 90 cases of AAC and thermal injuries. The incidence of AAC in burns ranges between 0.4 and 3.5%, typically affecting males (82.4%) with a mean age of 35 (range 13-89), and 97.8% of burns were >30% total body surface area (range: 22-80%). The majority of patients had established known risk factors for acquiring AAC, including blood transfusion (56.6% of patients), sepsis (52.2%), mechanical ventilation (45.5%), prolonged fasting or total parenteral nutrition administration (44.4%), and use of narcotic medication (10%). The IBID search identified one case of AAC among 145,227 burn injuries during 2005 to 2015 in the United Kingdom. AAC is a rare life-threatening condition that is associated with large thermal burns. Improvements in burns critical care have probably improved the management of known risk factors and reduced the incidence of this condition over recent decades.