Seasonal flu-vaccination in the immunocompromised burns patient.

Background And Aims: Influenza is a serious disease which can be life threatening. Patients with significant burns have reduced physiological reserve and are at risk both of incurring dangerous respiratory complications. In other susceptible patient groups the flu vaccine is used to reduce the risk of flu and lessen its effects.

Universal decontamination of hospital surfaces in an occupied inpatient room with a continuous 405 nm light source.

Background: Previous work has shown that a ceiling-mounted, 405 nm high-intensity narrow-spectrum light environmental decontamination system (HINS-light EDS) reduces bacterial contamination of environmental surfaces in a burns unit by between 27% and 75%. Examination of the efficacy of the light over extended exposure times and its probable mode of action was performed.

Aim: To ascertain the correlation between bacterial kill achieved on sampled surface sites around the burns unit and both irradiance levels of the 405 nm light, and exposure time.

Airborne bacterial dispersal during and after dressing and bed changes on burns patients.

Background: It is acknowledged that activities such as dressing changes and bed sheet changes are high-risk events; creating surges in levels of airborne bacteria. Burns patients are particularly high dispersers of pathogens; due to their large, often contaminated, wound areas. Prevention of nosocomial cross-contamination is therefore one of the major challenges faced by the burns team.

A systematic review of emergency department interventions for college drinkers.

Background: Alcohol use in college-age individuals is associated with increased injury risk. Many college drinkers end up in the emergency department (ED) as a result of their drinking, providing a unique opportunity to intervene.

Objective: This systematic review evaluates the existing evidence for the use of brief ED interventions for alcohol use in the college-age population.

Quantifying bacterial transfer from patients to staff during burns dressing and bed changes: implications for infection control.

Routine nursing activities such as dressing/bed changes increase bacterial dispersal from burns patients, potentially contaminating healthcare workers (HCW) carrying out these tasks. HCW thus become vectors for transmission of nosocomial infection between patients. The suspected relationship between %total body surface area (%TBSA) of burn and levels of bacterial release has never been fully established.

Minimally invasive harvesting of adipofascial scapular flaps.

Introduction: Scapular flaps are a reliable system for reconstruction. Disadvantages of reconstruction with these flaps include unsightly scars at the donor site due to wound healing under excessive tension and the use of skin grafts. Minimally invasive harvesting techniques may reduce potential donor-site morbidity.

Clinical studies of the High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS), for continuous disinfection in the burn unit inpatient and outpatient settings.

Infections are the leading cause of morbidity and mortality in burn patients and prevention of contamination from exogenous sources including the hospital environment is becoming increasingly emphasised. The High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS) is bactericidal yet safe for humans, allowing continuous disinfection of the environment surrounding burn patients. Environmental samples were collected from inpatient isolation rooms and the outpatient clinic in the burn unit, and comparisons were then made between the bacterial contamination levels observed with and without use of the HINS-light EDS.

ED point-of-care ultrasound in the diagnosis of ankle fractures in children.

In pediatric ankle injury, radiography is the current standard used to differentiate fracture from ligamentous injury; however, the associated cost, increased time, and radiation exposure pose a significant downside to this imaging modality. Point-of-care ultrasound may be an attractive alternative in this setting, as illustrated by this patient case. A 14-year-old boy presented to the emergency department with a left ankle inversion injury sustained while playing soccer.

Late-onset rhabdomyolysis in burn patients in the intensive care unit.

Rhabdomyolysis (RML), defined as creatine phosphokinase (CPK) >1000 U/L, is relatively common immediately after a significant burn. Late-onset RML, occurring a week or more after a burn, is less well understood and recognised. All patients admitted to the Intensive Care Unit (ICU) following an acute burn between May 2006 and December 2009 were retrospectively identified.

Environmental decontamination of a hospital isolation room using high-intensity narrow-spectrum light.

The performance of a new decontamination technology, referred to as 'high-intensity narrow-spectrum light environmental decontamination system' (HINS-light EDS) was evaluated by a series of three studies carried out in a hospital isolation room used to treat burns patients. The ceiling-mounted HINS-light EDS emits high-intensity 405nm light which, although bactericidal, is harmless to patients and staff thereby permitting continuous environmental disinfection throughout the day. Performance efficacy was assessed by contact agar plate sampling and enumeration of staphylococcal bacteria on environmental surfaces within the room before, during and after HINS-light EDS treatment.

Tertiary resurfacing after one of the first free flaps in Europe, a reflection on 30 years of microsurgical progress.

Free flaps have been used for over 30 years. During this period, improved anatomical understanding has increased donor options and available pedicle lengths, permitting safer, single-stage reconstructions with simpler anastomoses. Refinements, such as perforator flaps in particular, have greatly improved donor morbidity, recipient site cosmesis, and the ability to replace 'like with like' while retaining options for innervation.

The size of the Y: the multiple Y-V plasty revisited.

Background: The multiple Y-V plasty is often used in the release of burn scar contracture bands. Although there are established views regarding its design, no attempts have yet been made to describe the mathematical principles upon which it is based. An understanding of the mathematics, however, should incur a greater ability to "fine tune" or "tailor" the outcome.

Assessment of burn depth: a prospective, blinded comparison of laser Doppler imaging and videomicroscopy.

Introduction And Aims: There is a need, both in clinical and research settings, for an affordable, objective method of assessing burn depth. This study compares burn depth assessment by videomicroscopy with laser Doppler imaging (LDI) in patients with dermal burns. The videomicroscope is inexpensive compared to LDI, and can visualise the dermal capillary structure, therefore potentially allowing objective assessment of dermal burn injuries.

Are burns photographs useful?

Unlabelled: Routine photography of all patients admitted to the West of Scotland Regional Burns Unit was introduced in 2003. To date, there are few burns units to evaluate the usefulness of photographs taken.

Aim: To assess the usefulness of photographs of patients admitted to the burns unit to various members of the multidisciplinary team.

The influence of crosslinking agents and diamines on the pore size, morphology and the biological stability of collagen sponges and their effect on cell penetration through the sponge matrix.

Artificial skin substitutes based on autologous keratinocytes cultured on collagen substrata are being developed for treating patients with severe burns. The properties of the collagen substrate can be manipulated, for example, by crosslinking, to optimize desirable properties such as cell growth and penetration into the substrate, biological stability and mechanical strength. Collagen sponges crosslinked with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDAC) and the diamine, diaminohexane, were used to determine the effect of crosslinking on pore size and morphology, on the stability of the crosslinked sponges both in cell culture media and during incubation with collagenase, and on the penetration of keratinocytes and fibroblasts through the sponge matrix.

A preliminary evaluation of the functional significance of alpha-1-acid glycoprotein glycosylation on wound healing.

The laying down of collagen and fibrous tissue is a key process in wound healing, however excessive collagen (and glycoprotein) deposition causes hypertrophic and keloid scars, eg after burns. Collagen synthesis is increased in these scars compared with normal healing, as is collagenase activity, which controls the degradation pathway of collagen. The processes of wound healing are inextricably linked to those of the acute-phase response (APR): alpha-1-acid glycoprotein (AGP), a plasma glycoprotein that undergoes both an increase in concentration and an alteration in its glycosylation pattern during the APR.

Successful free flap transfer following venous thrombectomy in recipient vessel.

We report the case of a 53-year-old male patient who suffered a high velocity multiple trauma with bilateral open tibial fractures. At definitive orthopaedic and plastic surgical reconstruction 5 days post initial trauma, he was found peroperatively to have an existing deep venous thrombosis in his popliteal vein on one side. He underwent venous thrombectomy and had subsequent successful latissimus dorsi flap transfer using the unblocked popliteal vein as a recipient vessel.

Endoscopic transaxillary subglandular breast augmentation using silicone gel textured implants.

We present our experience with endoscopic transaxillary subglandular breast augmentation using textured silicon gel implants. Fourteen implants were placed in seven patients through a 4 cm axillary incision, in a subglandular pocket, with the help of a 10 mm, 30 degrees endoscope with a subcutaneous retractor and endoscopic diathermy. The implant was inserted with the help of a plastic bag.

Use of tissue glue in field situations.

Tissue glues are in widespread use in Accident & Emergency departments, and are simple to use. Results of closure of uncomplicated wounds using glue are comparable to traditional methods such as suture, 'sterile strips'. There are certain times in the field situation where evacuation of a casualty with a simple laceration could be impossible.

A pigmented lesion clinic: analysis of the first year's 1055 patients.

The Pigmented Lesion Clinic (PLC) at Frenchay Hospital was started in January 1993 to deal rapidly and effectively with a growing number of referrals of suspicious pigmented lesions. Its objectives were to offer expert assessment and either reassurance or excision at the first PLC following referral by the patient's general practitioner. During 1993, 1055 patients were seen in 37 PLCs and 357 excision biopsies were performed.

Magnetic resonance imaging of acute tendon injury in the finger.

Accurate assessment of flexor tendon function in a digit with an acute, non-penetrating injury is difficult. MR imaging can negate the need for surgical exploration and the associated morbidity.