The effect of a known object in a static image of a burn to improve the burn size estimation.

INTRODUCTION: Currently information regarding burn size from referring departments to burn centres varies in accuracy. Inaccurate assessment of burn size can lead to over or under treatment. Photographs of injuries may improve accuracy of assessment. We aimed to assess the accuracy of measuring burn size on a static image by including a standard object in the image. METHODS: Simulated burn areas were drawn on different body parts of the model. Using an iPhone® model 5 s with an 8 megapixel camera we took photos of the marked area, and repeated them with the palm, a standard bank card and a penny in the picture. First the Du Bois formula, was used to calculate body surface area. Members of the Burns team were asked to view the photos (n = 30) and estimate the percentage of the simulated burn. RESULTS: We found an overall overestimation of burn size. Small areas of the forearm were better estimated and within 1.1% of the calculated surface area, however we found no improvement when using a standard object in these images. The back areas were most overestimated ranging from 0.9%-8.9% despite all being the same sized area. CONCLUSIONS: Static images tend to overestimate burn size despite the use of a standard object in the image.

Kinesiology taping reduces the pain of finger osteoarthritis: a pilot single-blinded two-group parallel randomized trial.

OBJECTIVES: Osteoarthritis (OA) is the most common arthropathy of the hand, and current treatments carry risks of adverse events. Supportive (kinesiology) tape may be analgesic and provide functional improvement, with a low risk of adverse outcomes. We experimented with supportive tape for OA of the proximal interphalangeal joint (PIPJ) of the finger in this pilot randomized trial. METHODS: This two-group parallel randomized trial recruited adults with OA of the PIPJ of the finger. We excluded patients lacking capacity or the ability to safely apply the tape. Participants were randomized to receive kinesiology tape on the dorsum of the finger, blind to grouping. Pain was the primary outcome, which was recorded on a visual analog scale (VAS). Secondary outcomes were hand function and adverse reactions. Bootstrapped between-group analyses are reported. RESULTS: Ten patients were included and randomized and provided complete data. There was no significant difference in pain between the groups (mean difference of 0.4 VAS units [95% confidence interval {CI} -1.6, 0.7], p=0.4). Overall, the application of kinesiology tape reduced reported pain by 6% (mean reduction of 0.6 VAS units [95% CI 0, 1.2], p=0.04). Taping did not affect hand function or digital range of motion. There were difficulties in recruiting individuals owing to the lack of dedicated research staff. CONCLUSION: Kinesiology taping may reduce the pain of OA in the finger; however, whether this is a true effect, placebo effect, Hawthorne phenomenon, or due to a statistical error (ie, type 1 error due to underpowering) is unclear. Hence, further trials are required.

Endoscopic anatomy of the ulnar nerve: a useful adjunct to teaching anatomy.

INTRODUCTION: There has been a shift away from gross anatomy teaching and hands-on cadaveric dissection. This has been replaced by a variety of teaching modalities including problem-based learning, models and prosections, and computer-assisted learning. We aim to pilot a technique of endoscopic visualisation of upper limb anatomy, to produce a video that can be incorporated into anatomy teaching and to assess the video qualitatively as an adjunct to anatomy teaching. MATERIALS AND METHODS: A single, previously undissected, formalin preserved cadaver was used and views were obtained of the left arm. The video was shown to 10 surgical trainees who were then asked to complete appraisal forms anonymously. RESULTS: The endoscopic views were thought to be useful and helped the trainees to appreciate the in situ anatomy and potential sites of nerve compression. 70% of respondents would recommend the system to others. CONCLUSIONS: We feel this represents another method to help in the understanding of a complex area of anatomy in a way that is unique to endoscopy.

Soft tissue injuries: Chapter 8 Forearm, hand and wrist.

Hand, wrist and forearm injuries are common presentations to the emergency department. There is a huge variation of severity from small lacerations involving only skin to extensive upper limb composite loss. There is no minor injury in upper limb trauma. Even the most trivial of wounds may be associated with major tendon or nerve damage which, if missed, may have life-long functional implications for the patient. Although this review concentrates on soft tissue injury and not bony injury, it is not possible to separate the two completely. It is important to realise that all fractures have a soft tissue injury component that needs to be assessed and correctly treated. In some instances the soft tissue component is much more important than the fracture, and failure to recognise it will result in a poor outcome.

Treatment of compulsive cybersex behavior.

Compulsive cybersex has become a significant problem for many men and women who have fallen prey to the accessibility, affordability, and anonymity of online sexual behaviors. Some patients develop problems with compulsive cybersex due to predisposition or accidental conditioning experiences. Other compulsive users of cybersex present with underlying trauma, depression, or addiction. Three case studies highlighted obsession, compulsion, and consequence in the pathogenesis of compulsive cybersex. While men and women differ somewhat in their use of cybersex, both genders exhibit maladaptive coping, conditioned behavior, dissociative reenactment of life trauma, courtship disorder, intimacy dysfunction, and addictive behavior. Comprehensive treatment of compulsive cybersex would include the following components: relapse prevention, intimacy enhancement, lovemap reconstruction, dissociative states therapy, arousal reconditioning, and coping skills training. Thanks to recent treatment advances in several fields, help is available for those caught in the dark side of the net.

Review of community-referred hand infections.

PURPOSE: A retrospective review is presented of 76 patients with infections of the hand, referred from the community and admitted to our plastic surgery unit for treatment over a 30 month period. METHODS: Retrospective chart review and review of the pertinent English-language literature. RESULTS: The majority of the patients (82%) were male. Most incidents leading to infection happened at home (47%). All except two patients presented with cellulitis, and 55% had abscess formation. The most common site of infection was the digits followed by the dorsum of the hand. The average time to operative drainage was 6 h. Only seven patients (9%) were managed non-operatively. The mean duration of follow up was 51 days. Age and positive cultures were good predictors of the hospital stay and the number of operative procedures, respectively. CONCLUSIONS: Hand infections are surgical emergencies; correct and prompt management thus is essential. A quick and effective regimen for treatment yielded good results.

Validation of microsurgical models in microsurgery training and competence: a review.

Microsurgery has expanded the scope of many surgical specialties and is evolving into an integral part of training programmes. The complexity of microsurgery requires considerable time and resources for adequate training and practice. This article reviews the validation of microsurgical models for microsurgery training and competence.

Hand aging: patients' opinions.

BACKGROUND: The purpose of this article is to identify factors that make hands look youthful or old and to assess whether altering any of these factors could influence the perceived age of the patient. METHODS: A questionnaire showing digital images of female hands of different ages was administered. Some images were altered digitally to remove veins, blemishes, or wrinkles. Makeup and jewelry were added to others. A total of 93 questionnaires were completed. Statistical analysis of results with chi-square test was performed. RESULTS: Wrinkles, veins, prominent joints, thin skin, deformity, and spots characterized old hands. Fullness, lack of veins, and lack of wrinkles characterized young hands. Images with veins removed looked younger than the originals, and this was statistically significant in all cases. Images with added makeup and jewelry were also felt to look younger, but this was not statistically significant. Alterations to images of very elderly hands did not make them look younger. CONCLUSIONS: The authors have established factors that characterize the age of hands and established that hands with less visible veins, in general, look younger. Previous articles have claimed that fat grafting reduces the visibility of veins.