Faciocervical Group B Streptococcal Necrotising Fasciitis: a Multidisciplinary Approach Management.

Neonatal necrotising fasciitis secondary to Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a rare, life-threatening entity with approximately 40 cases reported in the literature.1 GBS soft tissue infection in infancy most commonly affects the face, likely originating from the colonised oral cavity.2 In cases unresponsive to medical management alone, early surgical debridement can be life-saving. We present a case of faciocervical GBS necrotising fasciitis in a male neonate requiring multiple surgical debridements. The resultant soft tissue defect healed with topical negative pressure therapy and eventual placement of a double-layer dermal substitute. Due to his prematurity, the patient was not skin grafted to limit donor site morbidity. After recovering from his life-threatening infection, the patient had intensive scar therapy leading to a favourable cosmetic result with no evidence of function-limiting contracture. Our report draws focus to the need for a multidisciplinary approach incorporating therapy-led scar management early in the postsurgical recovery plan.

Is Routine Imaging Necessary for the Management of Pediatric Hand Fractures Postoperatively?

BACKGROUND: Pediatric hand fractures heal remarkedly well, and clinically significant displacement after operative fixation is rare. Radiation exposure in medical practice is regulated by the Ionizing Radiation Medical Exposure Regulations 2017, and unnecessary radiation should be avoided. In the literature, there is paucity of information regarding the number of radiographs required in the postoperative period and guidelines are lacking. METHODS: This study aims to examine whether routine imaging or the lack of it influences functional outcome and time to discharge from the clinic. A retrospective data of pediatric hand fractures requiring intervention between 2014 and 2018 at our institution were conducted before and after elimination of routine postoperative imaging. A total of 230 patients were included in the study. RESULTS: Two cohorts of patients were identified. The first had routine postoperative radiographs, whereas the second did not have routine radiographs. There was no change in management and difference in the range of motion at discharge between the 2 groups (P = 0.74). Patients without routine imaging were discharged earlier from clinic (74.4 vs 108.2 days, P = 0.012). CONCLUSIONS: This study shows that clinically significant fracture displacement is rare after operative reduction and fixation in pediatric age group. It demonstrates our experience in refraining from routine postoperative radiographs. The overall benefit is to avoid unnecessary radiation and subsequent costs implicated.

A pilot study of a hand-held camera in a busy burn centre: Prediction of patient length of recuperation with wound temperature.

AIM: The aim of our study was to evaluate temperature differences of burns looking at their prognostic ability to predict healing at the 21 day mark. MATERIALS AND METHOD: Thirty two burns in 26 patients aged 1-71 years old were photographed with a FLIR T650 camera. Environment, reflected, and body core temperature of the patients were measured. Skin emissivity was constant 0.98. Pictures were analyzed with R&D FLIR Software. Minimal and average burn temperatures and skin temperature in 255 pixel squares were measured. Patients were divided into healed and not healed groups. Statistical analysis was performed with SPSS 20 (IBM Armonk, USA) and p<0.05 was significant. RESULTS: There were 25 healed and 7 non-healed burns at 21 days. Healed burns were significantly warmer than non-healed burns (p<0.05). There was a statistically significant strong, negative correlation between the difference of minimal burns temperatures and healthy skin temperatures with days needed to heal the burns (p=0.001; rho=-0.564). CONCLUSION: Infrared camera seems to be useful equipment in predicting burns' healing time. However further clinical studies need to be done.

Custom-made standardised over-dressings for torso burns; economical and efficient.

INTRODUCTION: Torso burns following debridement and skin grafting usually require fairly complex dressings. The dressing consists of an interface layer, an absorbent layer and a retaining layer. Although numerous inner dressings are now available from multiple manufacturers, Gamgee dressing (pad of cotton and gauze) is often used as an outer absorbent dressing. Dressing the torso is usually a challenge, and the purpose of this paper is to present a custom-made over-dressing for torso burns, which reflects the current practice at our centre. MATERIALS AND METHODS: A U-shape cut is made at one end of the Gamgee to design the shoulder straps. This custom-made dressing is held in place by a custom-designed netted vest. RESULTS: This custom-made over-dressing for the torso was found to be comfortable for patients, easily made from locally available materials, easy to apply, absorbent and not restrictive of movement. The shoulder straps prevent sliding of the Gamgee, and in a nonrestrictive way. The netted vest provides the required compression to keep the Gamgee in firm contact with the inner layers of the dressing without compromising respiration. CONCLUSION: In this report, we present our practice of a custom-made dressing that is very efficient and economical. We hope that this information will be of practical use to other centres managing burns.

Toe-to-hand transfer in a severely burned upper limb: a surgical dilemma.

Reconstruction of the burned thumb is a challenge to the plastic surgeon and the goal of the surgery is to achieve a functionally and aesthetically acceptable hand. We report a case of a patient who presented with extensive scarring of the upper limb and atrophic thumb due to severe burns and multiple surgical procedures. The patient had limited reconstructive options, and had a free toe-to-thumb transfer with successful outcome in a technically challenging situation 37 years after the injury.