Chronic Leg Ulcers in Werner's Syndrome

We report two siblings suffered from Werner's syndrome, which is a rare premature aging disorder caused by genetic mutations. They developed premature aging during adolescence with Loss and graying of hair, short stature, baldness, atrophic skin, thin extremities, flat feet, 'bird' face and cataracts. Multiple chronic ulcers were noted over the feet in both patients. Heating was prolonged because of atrophic subcutaneous tissue, poor perfusion, impaired fibroblast activity and the loss of normal foot architecture. Treatment of the ulcers was challenging, as flap options were limited over the lower third of the leg and skin grafting was not easy as there was a lack of healthy granulations. However, we have successfully closed the ulcers with Integra artificial skin and ultra-thin split thickness skin grafting with the scalp as donor site. The main purpose of this paper is to alert physicians to this syndrome when treatments are being planned for patients with chronic leg ulcers. (C) 2003 The British Association of Plastic Surgeons . Published by Elsevier Ltd. All rights reserved

The Treatment of Bone Exposure in Burns by Using Artificial Dermis

Background: The treatment of bone-exposed wounds with artificial dermis is not widely accepted in burn patients because of uncertain clinical results. This article aimed to review our clinical experience with this technique. Methods: We implanted artificial dermis in 11 bone-exposed burns. Implantation was directly performed on bones with periosteum, whereas bones without periosteum were trephinated or burred before implantation. All wounds were closed by secondary skin grafting. Results: The mean patient age was 49 years. Lower extremity is the most common site of bone exposure. The mean bone exposed area was 55.6 cm(2), whereas the mean Integra-implanted area was 86.7 cm(2). The overall implant take rate was 91%, and the skin grafting success rate was 80%. No secondary breakdown was noted after a 2-year follow-up. Conclusions: This study confirms that artificial dermis can be an alternative treatment tool for burns with exposed bones, especially in patients with limited donor sites

Intralesional Corticosteroid Therapy in Proliferating Head and Neck Hemangiomas: A Review of 155 Cases

Purpose: The purpose of this paper is to review the effect of intralesional corticosteroid therapy in the treatment of 155 head and neck hemangiomas. Methods: In the past 10 years , we have treated 155 proliferating head and neck hemangiomas with intralesional corticosteroid injections. Three to 6 injections of triamcinolone acetonide (10 mg/mL) in monthly intervals were given. Using slides and chart review, the results were assessed 1 month after completion of the treatment. Results: Eighty- five percent of the lesions showed greater than 50% reduction in volume. Varied treatment response was noted in different classes of hemangioma. Eighty per cent of the superficial, 75% of the deep, and 60% of the combined hemangiomas show more than 50% reduction in volume. Further growth was not found after treatment. The postinjection complication rate was 6.4% in this series. There were 2 patients with cushingoid appearance, 5 with cutaneous atrophy, and 3 suffered from anaphylactic shock. We found that lesions showing less than 50% reduction in volume were located mostly in the perioral area. Conclusions: Intralesional corticosteroid injections are safe and effective in arresting hemangioma proliferation . Superficial hemangiomas yield the best results. Copyright( C) 2000 by W.B. Saunders Company

Traumatic Asphyxia

　　Four patients showing classic physical stigmata of traumaticc asphyxia were studied. Cervicofacial cyanosis and edema, subconjunctival hemorrhage, and multiple ecchymotic hemorrhage of the face, neck, and upper part of the chest were documented. Admission Glasgow comascale scores ranged from 8 to 15. All but one had no associatedinjury. Skin discoloration resolved within 3 weeks. Complete resolution of subconjunctival hemorrhage occurred 1 month later. In our series, sore throat, hoarseness, dizziness, numbness, and headaches were common. Profound lower leg pitting edema, hemoptysis, hemotympanum, and transient visual loss were noted. Chest radiographic findings were normal in all patients. Microscopic hematuria was noted in one patient. Diagnosis is made from the history and characteristic appearance of the patient. Treatment is directed to the associated injury. Oxygen supplement with head elevation to 30 degrees is the mainstay of treatment. If the patients survives the initial insult, the prognosis is excellent.# 159415

Prediction of burn healing time using artificial neural networks and reflectance spectrometer

Background:Burn depth assessment is important as early excision and grafting is the treatment of choice for deep dermal burn. Inaccurate assessment causes prolonged hospital stay, increased medical expenses and morbidity. Based on reflected burn spectra, we have developed an artificial neural network to predict the burn healing time. Purpose:Our study is to develop a non-invasive objective method to predict burn-healing time.Methods and materials: Burns less than 20% TBSA was included. Burn spectra taken on the third postburn day using reflectance spectrometer were analyzed by an artificial neural network system. Results:Forty-one spectra were collected. With the newly developed method, the predictive accuracy of burns healed in less than 14 days was 96%, and that in more than 14 days was 75%.Conclusions: Using reflectance spectrometer, we have developed an artificial neural network to etermine the burn healing time with 86% overall predictive accuracy

Persistent Vegetative State in Electrical Injuries: A 10-Year Review

We reviewed 148 cases of electrical injury admitted to our burn centre. The incidence of persistent vegetative state was 3% (n = 5), higher in the low-voltage (6.7%) than in highvoltage group (1.2%). At the time of trauma, 44% (n = 65 ) lost consciousness and 50% of these (n = 32) received cardiopulmonary resuscitation on arrival at hospital. Of these, 50% recovered (n = 16), 22% became comatose (n = 7) and 28% (n = 9) died. Of the seven comatose patients, five did not show brain oedema but remained in a persistent vegetative state; this state was more common with low- voltage electrical injuries. The public should be warned of this effect of low-voltage trauma

Risk factors of tissue-expansion failure in burn-scar reconstruction

Background: Tissue expansion has become invaluable for burn-scar reconstruction. However, its use is hindered by the complications that often result in expansion failure. This study attempts to identify the risk factors of expansion failure in burn patients, as such factors have not been clearly defined. Methods: This study included 62 tissue expansions in 37 burn patients from January 2001 to June 2009. Factors including patient's age, sex, co-morbidities, expander size, implantation site, volume injected at implantation, preinflation volume ratio (PVR = volume injected at implantation/expander size), final inflation volume ratio (FIVR = cumulative volume injected at completion of expansion/expander size) and expansion duration were analysed. Cases were allocated into success (n = 53) and failure (n = 9) groups. Logistic regression was used in multivariate analysis for identifying predictors of expansion failure. Results: The mean age of the patients was 29.6 years. The male to female ratio was 1:1.4. Expansion complication and failure rates were 53% (n = 33) and 14.5% (n = 9), respectively. The risk factors statistically correlated to expansion failure (p < 0.05) were age, expander size, PVR and implantation at lower limb. Expansion of lower limbs carried a risk of failure 43 times greater than other sites. Conclusion: We conclude that tissue expansion should be avoided in older patients and in lower limbs. The largest possible expander size and inflation at time of implantation should be used to lower the risk of expansion failure

An unusual electrical burn caused by alkaline batteries

Electrical burns caused by low-voltage batteries are rarely reported. We recently encountered a male patient who suffered from a superficial second-degree burn over his left elbow and back. The total body surface area of the burn was estimated to be 6%. After interviewing the patient, the cause was suspected to be related to the explosion of a music player on the left-side of his waist, carried on his belt while he was painting a bathroom wall. Elevated creatine kinase levels and hematuria indicated rhabdomyolysis and suggested an electrical burn. Initial treatment was done in the burn intensive care unit with fluid challenge and wound care. The creatine kinase level decreased gradually and the hematuria was gone after 4 days in the intensive care unit. He was then transferred to the general ward for further wound management and discharged from our burn center after a total of 11 days without surgical intervention

Is artificial dermis an effective tool in the treatment of tendon-exposed wounds?

As flap surgery remains the main technique to close wounds with tendon exposure, the application of artificial dermis in these complex soft tissue wounds is seldom reported. The purpose of this article is to review our experiences in the treatment of tendon-exposed wounds with artificial dermis. This retrospective study included 23 patients with 33 tendon-exposed wounds treated with artificial dermis from 2004 to 2009. Data including patient demographics, wound type, duration from artificial dermis implantation to split thickness skin grafting, surgical complications, and clinical outcome were obtained by chart review. Successful treatment was defined as the formation of golden-yellow neodermis followed by successful split thickness skin grafting. Among the 33 tendon-exposed wounds, 11 were secondary to chronic ulcers, 16 to acute wounds, and 6 to surgical wounds after hypertrophic scar excision. The mean patient age was 49 years. The overall success rate with the artificial dermis technique was 82%, including 63% in the chronic ulcer group, 88% in the acute wounds, and 100% in the surgical wounds. In the success group, 11% of the wounds required repeated artificial dermis implantations. Within the failure group, two wounds were closed by below knee amputation, two by local flap surgery, and two were allowed spontaneous healing as a result of graft failure. We have demonstrated an overall success rate of 82% for tendon-exposed wound closure by using artificial dermis. The outcome was better in surgical and acute wounds than in chronic wounds