Cases reported "Burns, Chemical"

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1/44. Limbal transplantation after chemical injuries of the eye.

    PURPOSE: To illustrate the benefit of limbal stem cell transplantation in three eyes with severe ocular surface failure due to chemical burns. methods: In two patients with monocular corneal scarring and vascularization after chronic chemical burns, a limbal tissue autograft was transferred from the unaffected fellow eye. A complete superficial keratectomy was performed on the host eye. One patient with bilateral ocular surface disorder received an eccentrically trephined corneolimbal allograft. To prevent immunologic rejection of the transplanted limbus, this patient was treated with systemic Ciclosporin A. RESULTS: Postoperatively the limbal autografts grew a normal epithelium on the recipient eye with less vascularization and scarring. Our two patients reported a significant reduction in symptoms (redness, pain, photophobia) and an improved visual acuity. The corneolimbal allograft has remained clear for five months postoperatively. CONCLUSION: In strictly unilateral conditions of limbal deficiency, transplantation of healthy limbal tissue from the normal fellow eye may result in a stable ocular surface and a quiet and comfortable eye. Transplantation of an eccentrically trephined corneolimbal allograft under systemic Ciclosporin A cover may be an option in the rehabilitation of patients with severe bilateral stem cell deficiencies.
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ranking = 1
keywords = operative
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2/44. Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review.

    OBJECTIVE: The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck. methods: A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily. RESULTS: Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results. CONCLUSION: The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.
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ranking = 0.5
keywords = operative
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3/44. Development of a newly designed double-fixed Seoul-type keratoprosthesis.

    OBJECTIVE: To develop a newly designed double-fixed keratoprosthesis (Seoul-type keratoprosthesis [S-KPro]) and to assess its mechanical stability and biocompatibility. methods: Twenty-five rabbits were divided into 4 groups by fixation technique, amniotic membrane (AM) implantation, and skirt material. The eyes were studied with the use of slitlamp, light, and electron microscopy. Stress testing was performed. In addition, 2 human subjects underwent S-KPro implantation. Best-corrected visual acuity was checked, and ophthalmic examination was performed. RESULTS: The average retention period of the group receiving double-fixated polyurethane-S-KPro with AM was longer (>24 weeks) than that of the others. Fibroblast invasions were found in polyurethane pores but not in polytetrafluoroethylene (Gore-Tex) pores on light microscopy. The minimal pressure that induced aqueous leakage was greater than 250 mm Hg in all of the tested eyes. Two human subjects have maintained a good postoperative condition for 18 and 8 months. CONCLUSIONS: The double-fixation technique of applied S-KPro and AM appears to be helpful in improving the stability of the keratoprosthesis. Polyurethane with relatively large pore size (40 microm) may be used successfully as a material for the keratoprosthesis skirt. CLINICAL RELEVANCE: Our results may be important for improving the clinical outcome of keratoprosthesis.
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ranking = 0.5
keywords = operative
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4/44. Onychocryptosis-phenol burn fiasco.

    Ingrowing toenails, onychocryptosis, are a common condition that can be treated conservatively or surgically. Conservative treatment often fails necessitating operative intervention. Surgical treatments include wedge resection, Zadik's procedure and nail removal with ablation of the germinal matrix by phenol. The following report describes a 15-year-old male footballer who sustained burns following phenol treatment, resulting in amputation of his left great toe, as well as suggestions to avoid any similar complications.
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ranking = 0.5
keywords = operative
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5/44. Thoracoscopic esophagectomy in children.

    Minimal access surgery is an alternative to open surgery in esophageal resections. Thoracoscopic surgery has been utilized for both benign and malignant esophageal lesions and is a complex and challenging surgical procedure that can provide some benefits in comparison with open thoracotomy. Many studies have described laparoscopic or thoracoscopic-assisted esophagectomy in adults. So far, to the best of our knowledge, there is no study about thoracoscopic esophagectomy in children. This report describes 2 pediatric cases of benign esophageal lesions: one stricture after accidental ingestion of caustic soda and one esophageal stenosis after thyroglossal duct complication. Both patients were submitted to thoracoscopic esophagectomy combined with laparotomy and open cervical exploration with success. This procedure presents some potential advantages when compared with open esophagectomy: shorter hospital stay, precise dissection of mediastinal structures, less postoperative pain, less blood loss during surgery and less long-term discomfort. In our cases, thoracoscopic surgery for children showed the same benefits as in adults. Although very feasible, it should not be attempted without sufficient training and should be carried out only in specialized medical centers and by surgeons with adequate experience with open esophagectomy.
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ranking = 0.5
keywords = operative
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6/44. Clinitest burns of the esophagus.

    Five children developed esophageal stricture from the ingestion of a Clinitest tablet. The sodium hydroxide contained in these tablets induced a short, dense stricture that was resistant to dilation and necessitated resection. In all patients primary esophageal resection with end-to-end anastomosis was technically possible. Four of the patients needed two or more dilations postoperatively and 1 still requires dilation. Prevention of accidental ingestion by use of a childproof container and parental education about the caustic nature of Clinitest are both essential to eliminate this child health hazard.
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ranking = 0.5
keywords = operative
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7/44. Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures.

    Free thin anterolateral thigh flaps combined with cervicoplasty were used in a series of seven patients undergoing reconstruction for previous burn injury from September of 2000 to May of 2001 at Chang Gung Memorial Hospital. This method uses a suprafascial dissection technique to provide a thin flap to improve cervical contour. neck contractures had resulted from flame burns in six patients and from a chemical burn in one patient. The mean age was 32.7 years (range, 22 to 45 years). The size of excised scar ranged from 10 x 2 cm to 26 x 5 cm (mean, 19.7 x 3.3 cm). The size of flaps ranged from 11 x 5 cm to 26 x 8 cm (mean, 21.3 x 6.5 cm). Average operative time was 6 hours. Average hospital stay was 10 days. All flaps survived, with one flap sustaining partial marginal loss. The donor site was closed primarily in five cases and by using a split-thickness skin graft in two cases. At a mean follow-up time of 5 months, the functional improvement was measured as follows: a mean increase in extension of 30 degrees (preoperatively, 95 degrees; postoperatively, 125 degrees), a mean increase in rotation of 18 degrees (preoperatively, 59 degrees; postoperatively, 77 degrees), and a mean increase in lateral flexion of 12.5 degrees (preoperatively, 26.5 degrees; postoperatively, 39 degrees). The average cervicomandibular angle was improved by 25 degrees (preoperatively, 145 degrees; postoperatively, 120 degrees). This series demonstrates that the use of free thin anterolateral thigh flaps combined with cervicoplasty provides a one-stage reconstruction with a thin, pliable flap that achieves good cervical contour with low donor-site morbidity.
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ranking = 4.5
keywords = operative
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8/44. Use of autologous cultured limbal and conjunctival epithelium in a patient with severe bilateral ocular surface disease induced by acid injury: a case report of unique application.

    PURPOSE: Reconstruction of the ocular surface in a case of severe bilateral partial limbal stem cell deficiency (LSCD) with extensive symblephara using autologous cultured conjunctival and limbal epithelium. CASE REPORT: A 31-year-old woman presented with severe bilateral ocular surface disease with partial limbal stem cell deficiency, symblephara, lid and facial scarring, with a vision of 20/400 and counting fingers at 1 m in both eyes. Limbal and conjunctival tissue was harvested from the healthy-appearing left eye and used to generate two sheets of composite epithelium consisting of central limbal and peripheral conjunctival cells. The limbal tissues were explanted in the central region while the conjunctival tissues were explanted on the periphery of the deepithelialized human amniotic membrane (HAM) and nurtured using human corneal epithelial cell medium. After successful generation of a monolayer from both tissues had been confirmed, the composite of cultivated limbal and conjunctival epithelium with HAM was transplanted in each eye after excision of fibrous tissue and release of symblephara. One year postoperatively, the patient had a best spectacle-corrected visual acuity of 20/40 in the right eye (preoperative acuity 20/400) and counting fingers at 1 m in the left eye (same as preoperative) with a stable ocular surface. CONCLUSIONS: Autologous cultured epithelial transplantation is as an excellent option in selected patients with bilateral partial LSCD with small area(s) of healthy limbus in either eye and avoids the attendant risk of rejection and cost and potential toxicity of immunosuppression in allogeneic tissue transplantation. This case also highlights the feasibility of generating a composite culture of limbal and conjunctival epithelium using a single amniotic membrane.
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ranking = 1.5
keywords = operative
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9/44. A new technique for esophagoplasty in relatively long esophageal strictures.

    A 3-year-old girl with severe dysphagia secondary to caustic stricture of the cervical esophagus (about 4 cm in length) underwent esophagoplasty by a new technique following failed attempts at esophagoscopy and dilatation. This procedure results in a neoesophagus in the region with a lumen approximately twice its previous diameter, which will further increase in size gradually after a number of dilatations. The postoperative course was uneventful. She had almost no dysphagia following four successive dilatations 1, 2, 3 and 5 months after surgery. barium swallow revealed an acceptable lumen. She was asymptomatic 2 years after surgery.
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ranking = 0.5
keywords = operative
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10/44. Chemical burn injury secondary to intraoperative transesophageal echocardiography.

    We describe a case of a 72-yr-old male who suffered aerodigestive tract chemical injury resulting from a probable post-processing residual of the high-level disinfectant solution Cidex OPA (ortho-phthalaldehyde) used to disinfect the transesophageal echocardiogram probe used for cardiac monitoring during general anesthesia. This case highlights the need for strict adherence to manufacturers' instructions when using chemical disinfectants for transesophageal echocardiogram probe reprocessing. IMPLICATIONS: We describe a case of aerodigestive tract chemical injury resulting from a probable post-processing residual of the high level disinfectant solution Cidex OPA (ortho-phthalaldehyde) used to disinfect the transesophageal echocardiogram probe used during general anesthesia.
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ranking = 2
keywords = operative
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