Adult burn injuries due to domestic barbeques in New South Wales.

PURPOSE: Burn injuries associated with domestic barbeques were responsible for 80 admissions to Concord Hospital Burns Unit during the period from January 1998 until December 2007. In our series the number of burn injuries associated with domestic barbeques is increasing and we have reviewed the records of these patients to document their injuries and identify possible causes. METHODS: The database of the unit was reviewed for all admissions resulting from domestic barbeques from January 1998 until December 2007. Patients whose injuries resulted from bonfires, camping or other domestic fires were excluded from the study. RESULTS: The number of barbeque related burn injuries has increased as has the incidence of burns associated with gas fired barbeques. Young adult males predominate. Injuries ranged from 2 to 65% TBSA and 34% required intubation. There were 10 major complications with one death and 20% of patients required grafting. Length of stay varied from 1 to 51 days. CONCLUSIONS: In this series the number of admissions resulting from both wood fired and gas barbeques has increased. The cause of injury in open fires is associated with misuse of accelerants, whilst the cause of injury in gas barbeques is mainly due to delayed ignition of gas or incorrect use of the appliance. Distribution and severity of injuries are similar.

Initial experience of Integra in the treatment of post-burn anterior cervical neck contracture.

Bilaminate bioartificial skin substitutes such as Integra have been described as a temporary substitute for autograft in acute burns. The aim of this study was to assess their role in the treatment of hypertrophic scarring and anterior neck contracture in the reconstructive phase of burns surgery. Five patients underwent Integra grafting over a 12-month period, with one patient having the procedure performed on two separate occasions. One patient had a combination of hypertrophic scarring of the face and neck contracture, and two patients suffered from recurrent folliculitis in hypertrophic scars in the bearded area of the neck. Mean hospital stay was 24 days (range, 19-30 days). Mean follow-up was 48 months (range, 43-54 months). In all cases of neck contracture a superior cosmetic result was achieved. Recurrence of contracture of greater than 50% occurred within the follow-up period in all cases. Ineffective immobilisation of the graft and overgranulation were identified as contributing to contracture recurrence. Based on our initial experience bilaminate artificial skin substitutes offer an improved cosmetic result in cases of neck contracture and hypertrophic scarring, particularly in the bearded area of the neck. Recurrence of neck contracture remains a problem despite improved techniques of immobilisation. Long-term follow-up will be necessary to assess the applications of this technique fully.

An unusual cause of thigh pain after total hip arthroplasty.

The aim of total hip arthroplasty surgery is to relieve pain. There are many postulated causes of thigh pain following total hip arthroplasty, some of which are not easily corrected. Muscle hernia as a result of hip surgery is a cause of thigh pain that is disabling, relatively easy to diagnose, and may be preventable.

Local recurrence and intracerebral spread of squamous cell carcinoma of the scalp.

This case of squamous cell carcinoma of the scalp and malar region highlights the possibilities of therapeutic failure at the excisional, reconstructive, or histopathologic stage despite the performance of the appropriate, clinically indicated procedures and customary close examination of carcinoma patients and specimens. The extent of local recurrence and rapid intracerebral spread emphasize the occasionally aggressive nature of squamous cell carcinoma of the scalp and the need for early excision.

The blood supply to the skin of the leg: a post-mortem investigation.

A detailed investigation of the blood supply to the skin of the leg in 22 cadavers using intra-arterial dye and lipiodol confirmed the increased vascularity of the skin of the upper leg and showed that surgically successful flaps are more safely raised on the medial and posterior aspect of the leg. There was a generally uniform distribution of the vascularity with the significant exception of the lower leg where the supply to the skin from perforating vessels was strikingly deficient. Some observations are made on the feasibility of using innervated free flaps and a free vascularised nerve graft.