Cases reported "Burns"

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1/19. Contact burn by charcoal in an attempted suicide.

    A 23-yr-old lady was inadvertently burned during an attempted suicide. After quarrelling with her boyfriend, she attempted to commit suicide by using alcohol, benzodiazepine and burning charcoal within her sealed bedroom. Her left leg fell over the edge of the bed while she was half-conscious, that resulted in direct contact with the hot pot causing 1% full thickness burn and burn of her left tibialis anterior and extensor digitorum longus. She was initially resuscitated with 100% oxygen and gastric lavage and subsequently was managed in the burns Unit for wound care, surgical debridement of the burn wound and skin graft, and psychological support. Burning charcoal in a sealed room is an emerging form of suicide in hong kong and this is the first case complicated by a burn wound in our locality. A holistic approach to tackle the bio-psycho-social aspects of individual's problem is advocated.
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ranking = 1
keywords = tibia
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2/19. Sensate sole-to-sole reconstruction using the combined medial plantar and medialis pedis free flap.

    The coverage of soft-tissue defects of the sole needs special consideration because of the forces of weight bearing on the reconstruction. A variety of free tissue transfers have been advocated for soft-tissue replacement of the weight-bearing portions. However, there is no doubt that the ideal tissue for resurfacing the sole is the plantar tissue itself. The authors present a case of reconstructing the sole with the combined medial plantar and medialis pedis free flap that involves approximately 70% of the weight-bearing portion. This contralateral, combined fasciocutaneous free flap based on the posterior tibial-medial plantar vascular system is a good alternative in covering extensive sole injuries.
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ranking = 1
keywords = tibia
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3/19. Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury.

    Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.
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ranking = 1
keywords = tibia
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4/19. Use of the medial adipofascial flap of the leg for coverage of full-thickness burns exposing the tibial crest.

    Bone exposure constitutes a frequent and difficult problem in burn patients. Where free flaps remain indicated in tibial osteomyelitis, a pedicled fascial or adipofascial flap provides an excellent alternative for coverage of simple tibial crest exposure. In fact, the adipofascial tissue of the anteromedial aspect of the leg can be mobilized over the whole length of the tibia. It is vascularized by the saphenous artery and the posterior tibial artery perforators. This pattern of blood supply allows a wide range of use for any size of burn defect in this area. Therefore, this local pedicled flap provides an excellent solution for coverage of the exposed tibia after severe burns.
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ranking = 9
keywords = tibia
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5/19. A patellar-tendon-bearing orthosis used in pediatric burn rehabilitation.

    Burn rehabilitation in children presents a difficult challenge. Hypertrophic scar formation is accelerated in this population due primarily to the growth of normal surrounding tissue. Many patients who develop burn wound contractures of the foot and ankle are rendered nonambulatory. We describe a pediatric patients who developed fixed bilateral equinovarus deformities secondary to thermal injury. A patellar-tendon-bearing orthosis was fabricated for this patient to unload the foot-ankle complex with major weight bearing forces at the patellar tendon and tibial condyles. Through the incorporation of this orthosis with a full therapeutic rehabilitation program, the patient was able to ambulate independently using a rolling walker. We recommend the use of the patellar-tendon-bearing orthosis for those pediatric burn victims who develop foot-ankle contractures to allow for ambulation until such time as additional, more aggressive treatment is tolerated, or on a more permanent basis, if necessary.
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ranking = 1
keywords = tibia
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6/19. Heterotopic ossification in children with burns: two case reports.

    Heterotopic ossification is the formation of ectopic bone in soft tissue, and has been reported as a rare complication in pediatric burn patients. At our hospital, two 86% body surface area burn patients developed heterotopic ossification in the shoulder, elbows, distal femur, proximal tibia, fibula, and ribs approximately four months after the burn injury. These two rare and unusual cases are presented documenting the clinical involvement, radiological studies, laboratory data, as well as treatment of their heterotopic ossification. Discussion will focus on the incidence, diagnosis, pathophysiology, and treatment of heterotopic ossification in burn patients and how this information relates to the specific diagnosis and management of the complication of heterotopic ossification in the burn child.
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ranking = 1
keywords = tibia
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7/19. The tibialis anterior muscle flap for full-thickness tibial burns.

    Full-thickness burn wounds to the tibia present a challenging coverage problem. If skin grafting fails, few local options exist, and free tissue transfer may be required for coverage. We report on the use of the tibialis anterior muscle flap to cover longitudinal tibial defects in five extremities in four patients. These patients sustained 80, 55, 40, and 11% total body surface area burns. Postoperatively, all five extremity wounds healed with full coverage of the tibia. Minimal deficits in ankle inversion and eversion resulted, but all patients are fully capable of walking and able to bear weight. We feel that the tibialis anterior muscle flap is a safe, reliable, technically simple alternative for coverage of the burned tibia.
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ranking = 14
keywords = tibia
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8/19. Cross-leg free anterolateral thigh perforator flap: a case report.

    The purpose of this report is to introduce the cross-leg anterolateral thigh perforator flap for closure of a defect on the dorsum of the foot, and to show that the anterolateral thigh perforator flap is a safe option for a cross-bridge microvascular anastomosis in defects of the extremity. The free anterolateral thigh perforator flap was used for a patient with an unhealed wound on the dorsum of the foot. The flap was revascularized by end-to-side anastomosis between the flap's artery and the posterior tibial artery of the other leg, since there was no available recipient artery on the same leg. After a 4-week neovascularization period, the pedicle was cut. To the best of our knowledge, this is the first report of the use of a free anterolateral thigh perforator flap for a cross-bridge microvascular anastomosis.
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ranking = 1
keywords = tibia
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9/19. role of acellular dermal matrix allograft in minimal invasive coverage of deep burn wound with bone exposed--case report and histological evaluation.

    A sandwich graft was applied to the debrided cortical bone layer of the tibia in the case of a 72-year-old male patient with full-thickness necrotic burn injury. The combined graft consisted of a dermal template material and autologous split thickness skin graft. After application, the graft was found totally accepted and provided good functionality with acceptable appearance. Histopathologic evaluation revealed a complete take with revascularisation of the implant. Supporting lamellar bony trabecules were also seen in the deep dermal dermis representing a connection to the underlying bone. The use of the dermal matrix in deep burn exposing the bone provides a satisfactory functional result and good cosmetic appearance.
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ranking = 1
keywords = tibia
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10/19. The very long posterior tibial artery island flap.

    limb salvage procedures utilising tissue which would otherwise be discarded have become a well established practice in the management of trauma. These principles may also be utilised in the treatment of the burn injury. Two patients are presented with severe burns to the lower limbs involving muscle and bone where above knee amputation seemed inevitable. Salvage of the knee joint and conversion to a below knee amputation has been made possible by utilising the remaining skin of the sole of the foot based on a very long posterior tibial neurovascular pedicle ("Fillet of Sole" flap). This has provided full thickness sensate skin over the knee joint and below knee stump and has led to improved functional performance of the patient.
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ranking = 5
keywords = tibia
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