Burn injury: review of pathophysiology and therapeutic modalities in major burns.

Despite a considerable decrease in their incidence worldwide, burn injuries remain one of the commonest forms of trauma and account for a weighty proportion of trauma cases in health-care emergencies around the globe. Although the latest data reveal a substantial decline in burn-related mortality and hospital admissions in the US over the past three decades, severe thermal injuries continue to trigger devastating morbidity and significant mortality while their management remains a dynamic challenge for the entire medical and paramedical community. Concrete evidence continues to be established regarding burn-associated pathophysiologic responses, and their destructive sequelae and deleterious effects in survivors at cellular, systemic as well as socio-economic level.

Microsurgery in the burn population - a review of the literature.

The management of patients suffering from burn injury poses unique challenges for the reconstructive surgeon, both in the acute and delayed settings. Once resuscitative measures are optimized and hemodynamic stability is achieved, early burn debridement and coverage is performed. Traditionally, this consists of excision of devitalized tissue and subsequent coverage using split thickness skin grafts.

The cleft sternum: a possible role for pliable prosthetic reconstruction.

Background: Faced with our intraoperative inability to primarily close a very wide isolated cleft sternum of a pediatric patient without causing cardiovascular decompensation, we describe our use of a synthetic material for partial approximation allowing muscular coverage.

Method: We report an infant who was born with an isolated large complete sternal cleft where a trial of primary surgical repair had to be abandoned because of cardiovascular compromise. A similar difficulty was encountered in approximating the origins of both pectoralis major muscle flaps at the midline.

Numerous recurrent trichilemmal cysts of the scalp: differential diagnosis and surgical management.

Trichilemmal cysts are common benign soft tissue tumors that occur in hairy areas, especially the scalp, where they present themselves as solitary masses that could be easily treated by surgical excision followed by pathologic identification. It is unusual to find these benign masses in very large numbers in 1 scalp. In the current article, we describe a 43-year-old woman who presented with 51 scalp masses, some of which recurred after repetitive excisions somewhere else by different surgeons under local anesthesia.

Fibro-osseous pseudotumor of the thenar eminence: a rare aggressive but benign tumor.

Fibro-osseous pseudotumor is a rare benign lesion that is characterized by fibroblastic proliferation with foci of osseous differentiation. The tumor commonly involves the digits and is usually mistaken for malignancy because of its aggressive nature thus resulting in surgical over treatment. We report a patient with fibro-osseous pseudotumor that involved the thenar eminence and was managed successfully by local resection from the surrounding structures with no residual loss of function.

Dynamic thoracoplasty for asphyxiating thoracic dystrophy.

The life-saving procedures to expand the chests of infants born with Jeune asphyxiating thoracic dystrophy provide a static solution incapable of responding to the growth demands of thriving patients. We describe an instrument that provided a dynamic solution for an infant, where an initial methyl methacrylate midsternotomy spacer placed at 4 months of age was followed at 11 months with recurrence of his difficulties. At 8 months after the second operation the patient was stable and thriving with no recurrence of symptoms.

A rationale for adjuvant surgical intervention in pyoderma gangrenosum.

Medical specialists who care for patients with pyoderma gangrenosum have been reluctant traditionally to consult plastic surgeons. This is the result of previous negative experience with debridement and skin grafting. However, a new understanding of the pathophysiology of the disease process, and better therapeutic options for control have emerged.

Laparoscopic transverse rectus abdominus flap delay for autogenous breast reconstruction.

Laparoscopic ligation of the deep and superficial inferior epigastric vessels was done for ten mastectomized patients who elected to have autogenous reconstruction of their breast. All these patients had at least one indication for the delay which included obesity, smoking, or requirement of a large volume of tissue for their reconstruction. The procedure did not add any morbidity or mortality to our patients and was found to be comparable to the "open" delay in preventing partial tissue loss in all but two patients.

Abdominoplasty: the use of stapled prolene mesh in severe musculoaponeurotic laxity.

We have evaluated the role of stapled Prolene mesh for reinforcement of the midline abdominal wall plication in patients with advanced musculoaponeurotic laxity. Twenty-one multiparous women underwent a standard abdominoplasty with wide longitudinal rectus sheath plication, followed by stapling of the mesh to the external oblique fascia and anterior rectus sheath. All patients were followed up for at least 6 months and 10 of them for 1 year.

Intercostal thorascopic harvesting of the internal mammary artery for supercharging a pedicled rectus abdominis flap.

Thorascopic harvesting of the internal mammary artery for supercharging the rectus abdominis pedicled flap for breast reconstruction is presented. The procedure was carried on a woman who had previously undergone a mastectomy and who was obese and a diabetic. The patient underwent a "high" flap delay 2 weeks earlier.

Giant cell tumor (osteoclastoma) of the mandible: a diagnostic dilemma and a therapeutic challenge.

A recurrent giant cell lesion of bone 4.5 years after initial curettage from the mandibular body is described in a 40-year-old premenopausal female patient. Giant cell tumor is exceedingly rare in this location and histologically may be indistinguishable from giant cell reparative granuloma.

Bacille Calmette-Guérin (BCG)-itis of the hand: a potential hazard for health workers.

The bacille Calmette-Guérin vaccine has been used widely for several decades in tuberculosis prophylaxis. More recently, it has been used therapeutically in the management of neoplastic diseases such as malignant melanoma and urinary bladder tumors. Complications of the b.

Reconstruction of avulsed scalp after go-cart injury.

Scalp avulsion is a rare injury that has significant physical and psychological consequences. It may require emergency replantation or late, challenging surgical reconstruction, or both. The authors describe two patients who had scalp avulsion.

Effect of capsulectomy on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin in the pig.

Skin flaps constructed on expanded skin usually include the underlying capsular tissue. It has been hypothesized that capsulectomy may jeopardize the viability of the expanded skin flap. The experiments reported herein were designed to test this hypothesis.