phenylephrine-hydrochloride and Burns

The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing grotesque facial disfigurement. As this disfigurement is visible on frontal and profile views, the patient suffers both socially and psychologically. The nose is a three-dimensional organ. Reconstruction is therefore more difficult and needs to be more precise than in other parts of the face. Maintaining symmetry, contour and function are essential for successful nasal reconstruction. Multiple factors determine the optimal method of reconstruction, including the size of the defect, its depth and its site. Satisfactory social life is recovered only after multiple surgical procedures and long-term rehabilitation and physiotherapy.

Topics: Burns; Burns, Chemical; Facial Injuries; Humans; Nose; Nose Deformities, Acquired; Patient Satisfaction; Plastic Surgery Procedures; Reoperation; Rhinoplasty; Surgical Flaps; Treatment Outcome

The prominence of the nose renders it susceptible to soft tissue trauma of multiple etiologies. In this review, we present a framework for evaluation and treatment of nasal soft tissue injuries. Initial evaluation of nasal soft tissue injuries should include a complete trauma assessment, history, and physical examination. Mechanisms described include lacerations, abrasions, bites, and thermal injuries. Finally, we discuss wound care and surgical treatment options, including local flap and free tissue transfer. Though timing of repair remains somewhat controversial, most sources indicate that immediate reconstruction should be undertaken when possible.

Topics: Animals; Bites and Stings; Burns; Degloving Injuries; Dogs; Humans; Lacerations; Nose; Physical Examination; Rhinoplasty; Soft Tissue Injuries; Surgical Flaps; Time Factors

Patients who have survived thermal injuries to the face suffer from severe disfigurement. When the nose and ear are involved, the resulting deformities are immediately obvious to all who see the patient. This level of injury results in a self-imposed confinement; the patients never leave their homes. It is therefore important that we plastic surgeons know, understand, and use all options available to improve our patients' appearance and ultimately their mental and physical well being.

Topics: Burns; Ear; Humans; Nose; Plastic Surgery Procedures; Prosthesis Implantation

A 31-year-old man suffered burns to the forehead, alar grooves and forearms. Vascular island skin flaps, with the infraorbital vessels as the pedicle, were used to reconstruct the burned nasal alae. The case is reported here and the relevant literature is reviewed.

Topics: Adult; Burns; Forehead; Humans; Male; Nose; Skin Transplantation; Surgical Flaps

Topics: Air Pollution; Anti-Bacterial Agents; Burns; Humans; Humidity; Intubation, Intratracheal; Laryngoscopy; Nose; Oxygen Inhalation Therapy; Pneumonia; Positive-Pressure Respiration; Prognosis; Pulmonary Edema; Respiratory Insufficiency; Respiratory Tract Diseases; Sepsis; Steroids; Tracheotomy

Reliable securement of nasally inserted enteral tubes is a problem in patients with facial burns that make use of traditional adhesive tape ineffective.. To implement the nasal bridle as a way to decrease inadvertent removal of nasally inserted enteral tubes and improve subsequent patient outcomes.. The nasal bridle was implemented in the burn unit of the University of Kansas Hospital, Kansas City, Kansas, as a quality improvement project. Outcomes for the calendar year 2010 were measured in patients treated before use of the bridle (prebridle control group) and in patients for whom the bridle was used. The groups were compared on measures of tube insertions per tube day, abdominal radiographs per tube day, and a number of complications.. A total of 50 patients were studied: 33 in the control group and 17 in the bridle group. Baseline characteristics of age and sex did not differ between the groups. The bridle group had significantly fewer tube insertions and abdominal radiographs per tube day than the control group. Although complications were generally less common in the bridle group, the differences were not statistically significant.. In burn patients, use of a nasal bridle to secure nasally inserted tubes had clinical advantages over securement with traditional adhesive tape.

Topics: Burn Units; Burns; Enteral Nutrition; Facial Injuries; Female; Humans; Intubation, Gastrointestinal; Kansas; Length of Stay; Male; Middle Aged; Nose; Outcome Assessment, Health Care; Personnel, Hospital; Quality Improvement; Staff Development; Surgical Tape; Trauma Severity Indices

Complex nasal defects in the distal regions of the nose are cosmetically difficult to repair. In 70 patients over a period of 10 years, defects of the nasal ala and the soft triangle, nasal tip, columella, and columellar-lobular junction were reconstructed with modified auricular composite grafts. A randomized group of 40 of these patients was assessed after a mean of 55.5 months to evaluate the method's functional and cosmetic long-term results. The majority of the patients (60%, N = 48) had been treated primarily for basal cell carcinoma. Of all defects, 57% ( N = 46) measured 2 to 3 cm in width and 43% ( N = 34) 1 to 2 cm. Seventy-five percent ( N = 60) of all defects were composite lesions involving skin, cartilage, and vestibular mucosa, in contrast to 25% ( N = 20) involving skin and cartilage with intact vestibular skin. Two crucial technical modifications seemed to have improved survival for larger grafts: first, the use of hinge flaps from the margins of the defect to obtain a well-vascularized recipient bed and optimization of the raw contact surface; second, postoperative gentle scarification of the graft in combination with a constantly applied heparin solution decongests venous stasis normally seen in such grafts. This maneuver establishes a stable and early blood supply enhancing graft take. With this type of treatment, 67 (84%) grafts healed well without further complications, whereas 13 (16%) grafts developed complications, resulting in partial ( N = 9) and total ( N = 4) necrosis of the transplant. Six of these patients underwent a secondary reconstruction using another auricular composite graft. Long-term results of this method have turned out to be very satisfying in terms of functional and cosmetic outcome and patient acceptance.

Topics: Adolescent; Adult; Aged; Burns; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear Cartilage; Esthetics; Female; Follow-Up Studies; Graft Survival; Humans; Male; Melanoma; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Patient Satisfaction; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Skin Transplantation; Treatment Outcome; Young Adult

Topics: Adolescent; Adult; Burns; Clinical Trials as Topic; Ear; Facial Injuries; Hearing Disorders; Humans; Male; Nose; Pharynx

Acid burn injuries in the midfacial region cause contracture of the skin and nasal aperture, which can lead to nasal airway obstruction. Management of such complicated situations requires a multidisciplinary approach, including prosthetic intervention. This article describes a clinical treatment for fabricating a custom nasal conformer for a 28-year-old man who presented with a history of an acid burn injury leading to obstructed external nares and fusion of the tip and columella of the nose with the philtrum of the upper lip. The prosthesis served the dual function of maintaining the nasal airway passage and preventing the contracture of the graft placed over the upper lip during reconstructive surgery.

Topics: Adult; Burns; Cleft Lip; Contracture; Dental Implants; Humans; Male; Nose; Plastic Surgery Procedures; Stents

Postburn total nasal reconstruction associated with face burns is challenge to all reconstructive surgeons. The local tissue flaps for reconstruction is virtually out of options, forcing surgeons to opt for distant tissues for nasal reconstruction. Here in, we have described the use of distally based radial artery perforator flap for total postburn nasal reconstruction which has not been described for nasal reconstruction. The anatomy and technique of the flap and case series is presented in this report. Two cases of total nasal reconstruction using the distally based radial artery perforator flap are presented, one case post thermal burn and another post chemical burn. Radial artery distal perforator-based pedicled flap is a versatile option for nasal reconstruction especially when there is a paucity of unscarred skin in loco regional options.

Topics: Adolescent; Adult; Burns; Female; Humans; Male; Nose; Perforator Flap; Radial Artery; Rhinoplasty

Significant evolution has been made concerning resuscitation and emergency management of severely burned patients, and nowadays most patients will survive and deal with burns sequelae. They constitute a reconstructive challenge, mainly because options and donor areas are frequently compromised, results are often limited, and other options should then be considered. A 27-year-old male patient with 55% total burn surface area, presented with severe facial disfigurement including ectropion, upper/lower lip retraction, and partial loss of the nose. In order to improve the patient's condition, autologous reconstruction was considered. The only unburned area in the body was the left dorsal region, and a three-stage reconstruction was planned using a paraescapular flap. In a first stage, an elective surgery was performed to identify and tag the recipient vessels in the neck. After 3 months, the prelamination process was initiated with the drawing of a facial model, and a nose and lips were opened inside the flap. This was based on a three-dimensional latex model as a print of the patient's face, which allowed us to calculate distances and estimate the length of the vascular pedicles. After 3 months, the flap (18 × 8 cm) was transferred and microvascular anastomoses were performed. No major complications were seen after surgeries, and after 28 months, an extremely important functional gain was obtained. Despite the number of surgeries required and less than optimal aesthetic results, this method may offer a satisfactory solution for complex acquired facial burn sequelae when other local or distant flap options are not available.

Topics: Adult; Burns; Esthetics; Facial Injuries; Free Tissue Flaps; Humans; Male; Nose; Plastic Surgery Procedures

Initial examination and exploration of childhood injuries may not lead to an obvious explanation of abuse. Although abusive oronasal injuries have been described, ones including nasal destruction are rare. We describe 4 children abused using implements that ultimately were thought to have caused significant nasal tissue destruction. In 2 of the cases, a forced pacifier placement was implicated in causing pressure injuries. In the other 2 cases, gags were part of the children's injuries. All 4 children had other findings of abuse and neglect.

Topics: Burns; Child Abuse; Child, Preschool; Ear, External; Female; Humans; Infant; Lip; Nose; Pacifiers; Pressure Ulcer

Upper airway injuries can be fatal in burn patients if not recognized, a scenario that causes a significant amount of anxiety for physicians providing initial assessment of burn patients. Early elective intubation is often performed; sometimes unnecessarily. However, some providers employ nasolaryngoscopy for patients presenting with facial burns or signs/symptoms of upper airway injury in order to assess the need for intubation, but this practice is not considered standard of care and may also be unnecessary. Evidence is currently lacking about the utility of nasolaryngoscopy as an adjuvant assessment during evaluation of potential upper airway burn injuries. The objective of this study was to determine if nasolaryngoscopy provides additional information to the history and physical in making the decision to electively intubate patients with facial burns.. This study was a retrospective analysis of all patients who underwent fiberoptic nasolaryngoscopy after facial burn injury to evaluate for upper airway injury associated with burns over a 2 year period at a regional burn center. During this time period, all patients who presented with facial burns, soot, or carbonaceous sputum underwent nasolaryngoscopy to look for upper airway injury regardless of mechanism of injury. Patients intubated prior to arrival were excluded from the study. Patients were considered to have signs/symptoms of airway injury (symptomatic) if they presented with dyspnea, tachypnea, hypoxia, or significant burns to buccal mucosa. Procedure notes were used to determine if supraglottic/glottic injury (erythema or edema) was present on nasolaryngoscopy. Presence of pathologic changes and whether they led to intubation were evaluated in the asymptomatic and the symptomatic groups of patients. Select individual records were inspected further to help determine if the nasolaryngoscopy findings altered management plans and if intubation was ultimately necessary based upon the presence or absence of a cuff leak and the duration of intubation.. Twenty-two patients were symptomatic upon presentation, 14 of which had positive findings on laryngoscopy and 7 (50%) were intubated. One-hundred and eighty-eight patients were asymptomatic, 58 (31%) of which had either erythema or edema or carbonaceous debris on nasolaryngoscopy, and only 2 (1%) were intubated. These patients were both extubated within two days. None of the 130 asymptomatic patients with negative nasolaryngoscopy were intubated.. This study showed disparity between signs and symptoms of airway injury and nasolaryngoscopy findings. Asymptomatic patients showed pathologic changes in 30% of scopes, but this finding only changed management 1% of the time. Furthermore, the two patients in this group were extubated quickly, suggesting they may have been suitable for observation without intubation. These results indicate that the presence of erythema or edema is of questionable clinical significance in asymptomatic patients and nasolaryngoscopy is of limited benefit in this group. Only 50% of the symptomatic patients with airway injury evident on nasolaryngoscopy were actually intubated, also bringing into question the significance of the pathologic changes in this group. However, negative nasolaryngoscopy may have had some benefit in preventing intubation in a few, select symptomatic patients. This study suggests that a thorough history and physical is the best tool to identify patients at higher risk of upper airway injury who need intubation, but this should be further studied in prospective trials to determine the definitive role of nasolaryngoscopy.

Topics: Adult; Burn Units; Burns; Burns, Inhalation; Diagnostic Techniques, Respiratory System; Dyspnea; Facial Injuries; Female; Humans; Hypoxia; Laryngoscopy; Larynx; Logistic Models; Male; Nose; Pharynx; Retrospective Studies; Smoke Inhalation Injury; Tachypnea

Topics: Burns; Cannula; Humans; Infant, Newborn; Male; Nose; Respiration, Artificial; Steam; Treatment Outcome

Background Reconstruction of the central facial subunits is a complex and challenging task. In cases in which both the nasal and upper lip subunits are involved, a technique that can reconstruct both aesthetic units with tissue of similar color and texture from a single donor site will be ideal. In this article we present our experience with the bipedicled preexpanded forehead flap for simultaneous nasal and upper lip resurfacing. Patients and Methods Between January 2012 and January 2015 we used this technique in the simultaneous reconstruction of total nasal and upper lip subunits in five patients. All cases were for burns scar resurfacing. Results Good aesthetic results were achieved in each of our five cases to date and no complications were encountered. All donor sites closed primarily with aesthetically pleasing well-concealed linear scars. In all cases small modifications such as philtral shaping and further flap thinning were performed under local anesthesia between 6 and 12 months postoperatively Conclusion The preexpanded forehead flap provides an unparalleled color and texture match when it comes to facial resurfacing. When both total nasal and upper lip resurfacings are required, it is possible to achieve this in a single sitting from a single donor site by using a bipedicled preexpanded forehead flap.

Topics: Adolescent; Adult; Burns; Cicatrix; Esthetics; Facial Injuries; Female; Forehead; Humans; Lip; Male; Middle Aged; Nose; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome; Young Adult

The previous use of fresh porcine xenografts at the Prague Burn Centre had raised concerns over the transmission of zoonotic pathogens. This study examines the risk of zoonotic Staphylococcus aureus colonisation of burn patients from fresh porcine skin xenografts. Samples were collected from the nares, skin and perineum of commercial pigs (n=101) and were screened for methicillin sensitive S. aureus (MSSA) and resistant S. aureus (MRSA). The efficacy of the antibiotic wash used in decontamination of the pigskin was tested against planktonic- and biofilm-grown isolates. The spa type of each isolate was also confirmed. All pig swabs were negative for MRSA but 86% positive for MSSA. All planktonic-grown isolates of MSSA were sensitive to chloramphenicol and nitrofurantoin and 44% of isolates were resistant to streptomycin. Isolates grown as biofilm exhibited higher rates of antimicrobial resistance. Sequence analysis revealed three distinct spa types of the MRSA ST398 clonal type. This finding demonstrates the existence of a MSSA reservoir containing spa types resembling those of well-known MRSA strains. These MSSA exhibit resistance to antibiotics used for decontamination of the pigskin prior to xenograft. Amended use of procurement could allow the use of fresh pigskin xenografts to be reinstated.

Topics: Animals; Anti-Bacterial Agents; Biological Dressings; Burns; Chloramphenicol; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nitrofurantoin; Nose; Perineum; Skin; Staphylococcus aureus; Streptomycin; Swine

Heat generated at the tips of nasal endoscopes have been shown to reach temperatures high enough to cause thermal tissue injury. Endoscope sheaths have the potential to minimize the risk of thermal tissue injury. The purpose of this study was to assess the abilities of plastic and metal endoscope sheaths and sheath irrigation to insulate against dangerous scope tip temperatures.. A 4-mm 0-degree rigid nasal endoscope was used with light-emitting diode (LED) and xenon light sources (400-W LED, 300-W, and 175-W xenon) to assess scope tip temperature before and after endoscope sheath placement. Temperatures were assessed again after placement of each sheath, both before and after active saline irrigation. Scope tip temperature was measured using a noncontact infrared thermometer.. The unsheathed rigid scope tip reached a maximal temperature after 10 minutes at 100% light source intensity. The 400-W LED and 300-W xenon sources generated potentially dangerous scope tip temperatures exceeding 42°C, whereas the 175-W xenon source never generated a maximal temperature over 32.6°C. After placement of plastic and metal sheaths, mean scope tip temperatures were decreased by 2°C (4.8%) and 2.2°C (5.5%), respectively. After active saline irrigation, mean scope tip temperatures were decreased by 5.1°C (12.6%) and 5.2°C (12.8%), respectively.. With modern light sources, nasal endoscopes have the potential to reach temperatures that may cause thermal tissue injury. Endoscope sheaths lead to decreases in scope temperatures, and the effect is greater with active irrigation. In addition to improving visualization, endoscope sheaths may decrease the risk of thermal tissue injury.

Topics: Burns; Endoscopes; Endoscopy; Light; Nose; Temperature

Nasal reconstruction after severe panfacial burns can be challenging to correct because of scarring, loss of suitable donor sites, and variably limited blood supply of local flaps. We describe 2 cases of subtotal nasal reconstruction in which we overcame these difficulties. Both cases had alar subunit loss, which had left significant functional and esthetic deformities. However, both cases were managed very differently because of availability of donor sites.The first patient had 70% total body surface area burns with bilateral alar subunit loss: nasal reconstruction required a meticulous multistaged forehead flap. The second patient required nasal reconstruction using a turn-down flap to maximize take of a composite graft from previously burned ear donor sites.A number of surgical techniques have been described to manage subtotal burns nasal reconstruction, foremost of which are the nasolabial and paramedian forehead flaps. Cartilage grafts from the septum and the conchal bowl can be integrated into these flaps. Composite grafts can be unpredictable and are often used with caution.Such cases demonstrate that large composite grafts can be an extremely robust method of reconstruction even in a subset of patients with extensively scarred recipient and donor sites. In our second case, composite grafting avoided multistaged procedures such as the forehead flap and can be considered as a first-line procedure in large alar subunit loss.

Topics: Burns; Female; Humans; Male; Nose; Rhinoplasty; Surgical Flaps

Most nasal reconstructions previously repaired with regional flaps require a revision to improve appearance and function. Many local flaps also create significant landmark and contour distortions, such as alar crease obliteration or nostril margin malposition.. Over 400 nasal reconstructions with regional tissues, primarily forehead flaps, and 100 local flap repairs were evaluated to identify the causes of failure of the primary repair, to classify late deformities, and to develop an approach to the late revision of a nasal reconstruction. Surgical timing, staging, incisional approaches, and operative technique were defined with the goal of restoring normal dimension, volume, position, projection, symmetry, skin quality, border outline, and contour.. Deformities can be classified as "minor," when overall dimension, volume, and position are satisfactory but nasal landmarks are imperfect, nostril margins are asymmetric, or the nostrils are small; or "major," when there is a significant failure to restore the basic fundamental character of the nose. It is bulky, shapeless, malpositioned and without landmarks. These characteristics determine incision sites, the extent of required flap reelevation, soft tissue excision and cartilage grafting, the number of stages, the use of secondary local flaps, surgical delay, and the need for reoperation with a second regional flap.. Revision is accomplished through new direct incisions and old peripheral border scars. Soft tissue excision and secondary cartilage grafts can effectively reestablish contour. Lining deficiencies are addressed by transferring discardable local excess skin from the nostril margin, columella, cheek, or upper lip to open the airway. If local tissues are inadequate, a second regional flap must be transferred to resurface or line the nose.

Topics: Bone Transplantation; Burns; Cartilage; Constriction, Pathologic; Facial Injuries; Humans; Lip; Nasal Cavity; Nose; Plastic Surgery Procedures; Reoperation; Surgical Flaps; Time Factors; Treatment Failure

Topics: Attitude of Health Personnel; Burns; Cleft Lip; Cleft Palate; Decision Making; Humans; Nose; Patient Care Planning; Plastic Surgery Procedures; Surgery, Plastic

Surgical reconstruction of the nasal tip is a very delicate procedure, as it must rebuild three different anatomical planes: mucosa, cartilage and skin with functional and aesthetic requirements. This procedure is even more difficult in burns patients, due to more limited donor sites and poor skin quality. Numerous flap options are available to reconstruct defects of the tip of the nose. The authors report their experience of nasal alar reconstruction by a scar tissue remodelling technique using a rolled dermal flap with overlying full-thickness skin graft.. The medical charts of seven patients (five women and two men with a mean age of 30) treated between 1991 and 2006 were retrospectively reviewed. Six patients presented sequelae of a facial burn and one patient had congenital facial hemiagenesis.. Reconstruction was bilateral for all burns patients and unilateral for the patient with facial hemiagenesis. The skin graft was raised from the medial aspect of the forearm in four cases, the retroauricular region in two cases and the groin in one case. One patient required a second surgical procedure for necrosis of the nasal tip. No nasal obstruction was reported with a mean follow-up of five years (range: six months to 15 years).. The rolled dermal flap with overlying full-thickness skin graft is a simple and reliable procedure for reconstruction of the nasal alae. Filling of the nasal alae defect and reconstruction of all anatomical planes are achieved in a single surgical procedure. The aesthetic and functional results were satisfactory, with minimal scarring of the donor site. This technique is very suitable for the treatment of burn sequelae and can also be used to treat nasal hemiagenesis and nasal mutilation by biting or facial trauma.

Topics: Adolescent; Adult; Burns; Burns, Chemical; Child; Cicatrix; Face; Facial Injuries; Female; Humans; Male; Middle Aged; Nose; Postoperative Complications; Reoperation; Retrospective Studies; Rhinoplasty; Skin Transplantation; Surgical Flaps; Tissue and Organ Harvesting

Chondrocutaneous (ChC) grafts have been used for nasal alar reconstruction for years. One of the consequences for using these grafts is the restriction in dimensions. In this study, we presented our results in which ChC grafts bigger than 20 mm in length have been used in conjunction with a dermal turnover flap for full-thickness alar subunit defects. Technical details and results of 8 alar subunits reconstructions in 8 patients were evaluated. Follow-up period ranged from 10 to 27 months, with a mean of 18.3 months. We achieved satisfactory results without partial or total graft failure. Finally, surgeons can safely use outsized ChC composite grafts with this type of design, for successful alar subunit reconstruction.

Topics: Adolescent; Adult; Aged; Burns; Cartilage; Child, Preschool; Craniofacial Abnormalities; Female; Humans; Male; Nose; Rhinoplasty; Skin Transplantation; Surgical Flaps; Suture Techniques; Treatment Outcome

The occurrence of neoplasms in injury scars--as consequence of occupational accidents--may lead to compensation according to the statutory accident insurance regulations. According to newer regulatory attempts in occupational dermatology, certain criteria have to be met before the diagnosis of a neoplasm induced by a scar is accepted and compensation is due.. Based on a retrospective analysis of 217 dermatological claim files between 2007 and 2009 of the IPA (including 22 follow-ups), medical opinions on neoplasms developing in possible occupational scars were re-evaluated using criteria of the German social accident insurance and the Bamberg medical bulletin, part II (Bamberger Merkblatt, BM II) to see how well they qualified for recognition as an occupational or accident-related disorder.. Three cases were identified where a neoplasm was suspected of having developed in an occupationally-related scar. One of the insured events entitled for compensation. Following the guidelines of the BM II, this case was approved as an occupational disease secondary to injuries with resultant reduction in earning capacity, whereas the others did not meet the requirements.. Two problems in evaluating malignant tumors in occupational scars are the long latency period and the documentation of a scar. The tumor excision specimen should be histologically re-examined to document the presence of an associated scar.

Topics: Accidents, Occupational; Arm Injuries; Burns; Carcinoma in Situ; Carcinoma, Basal Cell; Cell Transformation, Neoplastic; Cicatrix; Expert Testimony; Germany; Head and Neck Neoplasms; Humans; Insurance, Accident; Melanoma; Nose; Nose Neoplasms; Retrospective Studies; Skin; Skin Neoplasms; Workers' Compensation

Forehead skin is often insufficient to use for nasal reconstruction because of a low hairline. In addition, skin graft used to repair donor-site defects results in obvious mismatched patches, whereas healing by secondary intention of donor-site defects causes conspicuous scars. To make up for the shortage of forehead skin used for nasal reconstruction and primary donor-site defect closure, the authors challenged the conventional idea of late shrinkage of expanded forehead flaps for nasal construction, and suggest a technique combining extended forehead skin expansion with single-stage nasal subunit plasty.. This technique was applied to 43 patients for nasal reconstruction over a 9-year period. The technique consists of three stages: extended forehead skin expansion, single-stage nasal contouring and subunit plasty, and pedicle restoration. All cases were followed for at least 12 months. Outcomes were evaluated in terms of aesthetics, function, and donor-site aesthetics.. No secondary shrinkage occurred in any of the cases. Eighty-one percent of the patients assessed themselves as satisfactory for aesthetics, 70 percent assessed themselves as satisfactory for function, and 77 percent assessed themselves as satisfactory for donor-site aesthetics. The complications included minor brow elevation (five cases), L-strut distortion (four cases), stuffiness of the nostrils (four cases), flap hyperpigmentation (one case), flap skin paleness (one case), and alar graft extrusion (one case).. The combination of extended forehead skin expansion with single-stage nasal subunit plasty overcomes the defect of late shrinkage of an expanded flap for nasal reconstruction and achieved satisfactory results in aesthetics (nose and donor site) and function.

Topics: Adolescent; Adult; Bites and Stings; Burns; Child; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Patient Satisfaction; Plastic Surgery Procedures; Postoperative Complications; Rhinoplasty; Skin; Skin Pigmentation; Surgical Flaps; Tissue Expansion; Young Adult

Nasal reconstruction following severe burn injury remains a challenge in plastic surgery. In burn patients, the external nares and the soft triangle are commonly affected subunits of the nose where local tissue deficit and scar contraction during the recovery period contribute to soft triangle deformity and alar stenosis. These patients usually have associated facial burns with varying severity, which significantly limit the availability of local flaps. Reconstruction with skin grafts often yields unsatisfactory results because of the mismatch in colour and texture in addition to the primary and secondary contraction phenomena. The use of superiorly based columellar flap, which has yielded satisfactory results on a female patient, would be a new and reliable option for reconstruction of the soft triangle deficit with alar stenosis.

Topics: Adolescent; Burns; Female; Humans; Nose; Rhinoplasty; Surgical Flaps

The authors present a case of ice pick scars forming in the nasal alar grooves of a patient who was treated with a 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for facial telangiectasias. Treatment options for these types of scars are reviewed and specifically we report the success of an ablative fractionated 2940-nm erbium:yttrium-aluminum-garnet (Er:YAG) laser.

Topics: Aluminum; Burns; Cicatrix; Cosmetic Techniques; Erbium; Female; Humans; Laser Therapy; Lasers; Middle Aged; Neodymium; Nose; Yttrium

Topics: Burns; Humans; Lip; Male; Middle Aged; Nose; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive; Risk Factors; Smoking

There are two important routes for the transmission of Staphylococcus aureus to the burn wound. In the endogenous route, patients naturally carrying S. aureus colonize their own wounds, whereas in the exogenous route burn wounds are cross-infected from other sources. In this study we evaluated the effect of blocking the endogenous route on S. aureus burn wound colonization by mupirocin application in the nose of patients at the time of admission.. From September 2000 to January 2002 all patients with burns admitted to a single dedicated Burn Centre received nasal mupirocin upon admission. This period was compared to two control periods (C1: July 1999 to July 2000 and C2: January 2002 to January 2003) for S. aureus burn wound colonization. The colonization risk was analysed, adjusting for confounding, with Cox proportional hazard regression.. A total of 98 patients did not have S. aureus burn wound colonization at the time of admission and were, thus, considered at risk for S. aureus acquisition during their stay. As compared to C1, the relative risk of acquiring S. aureus in their wound was 0.48 (95% CI: 0.24-0.97) in the mupirocin period and 0.55 (95% CI: 0.28-1.1) during the C2 period. S. aureus nasal/pharyngeal colonization was a significant independent risk factor for wound colonization (RR: 2.3; 95% CI: 1.2-4.2).. Nasal mupirocin may contribute to risk reduction of S. aureus wound colonization in patients with burns.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Burns; Cross Infection; Drug Administration Routes; Female; Humans; Male; Mupirocin; Nasal Mucosa; Nose; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Child abuse by burning comprises 6-20% of all child abuse cases, but misdiagnosis may arise in cases of some medical conditions. We present two cases of suspected inflicted burns, later diagnosed as staphylococcal scalded skin syndrome (SSSS). In case 1, a 6-month-old girl was referred to hospital for small round ulcerations on the face and abdomen, resembling cigarette burns. Because of the inconsistency of the mother's report (insect bites) with the injury pattern and an unstable family history, hospitalization was decided. The following day, new bullous lesions were visible on the neck and nose, indicating the natural origin of the findings, finally diagnosed as SSSS. In case 2, a 2-month-old boy was hospitalized for erythema, with bullous lesions on the abdomen. He was transferred to another hospital, with suspected congenital or autoimmune skin disorder but negative searches led to a diagnosis of inflicted scalds: a report was sent to the judicial authorities, and the child was entrusted to his grandparents. In fact, a review of the clinical documentation showed that, in the second hospitalization, new erythematous and bullous lesions had been described, which could not be ascribed to inflicted injuries. Child abuse was finally ruled out, and SSSS was diagnosed. In cases of suspected inflicted child burns, observation during hospitalization may reveal changes in lesions, ascribed to the evolution of medical conditions. SSSS diagnosis is mainly based on clinical grounds but, if the suspicion of abuse remains, isolation and phage typing of Staphylococcus aureus from nasal, pharyngeal or cutaneous swabs may confirm the diagnosis.

Topics: Burns; Child Abuse; Diagnosis, Differential; Female; Forensic Medicine; Humans; Infant; Male; Nose; Skin; Staphylococcal Scalded Skin Syndrome; Staphylococcus aureus

Topics: Aged; Burns; Facial Injuries; Humans; Male; Nose; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome

Patients who have survived thermal injuries to the face suffer severe disfigurement from the devastating deformities of full-thickness facial burns. The nose is the prominent central organ of the face, which has crucial effect on Aesthetic appearance. The plastic surgeon's role to deal with such cases is to undertake procedures to produce a more pleasant look although the target organ could be the non-burned areas of the face. It is a common belief that surgical intervention under the scarred or grafted nose is risky and may result in skin or covering graft necrosis. For this reason, plastic surgeons are cautious and hesitate to perform Aesthetic surgery on burn scarred tissue. We present 13 cases, 10 women and three men with complete or subtotal nasal burn. Classic Aesthetic Rhinoplasty operations were performed to create a better appearance and correct any internal or external deviations. These procedures are carried out under severely burned skins, or previously grafted and reconstructed noses. Cases were followed for about a one-year period. There was no necrosis in any part of skin after surgery. We believe that Aesthetic rhinoplasty can be done safely in these victims with pleasing outcome. The problems that we encountered in these cases were irregularities of burned alar margins, multiple operations and intractable nasal deviation in severe cases.

Topics: Adolescent; Adult; Burns; Cicatrix; Facial Injuries; Female; Humans; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Treatment Outcome

Topics: Airway Obstruction; Burns; Humans; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Surgical Flaps

Deformities of a totally burned face present a profound challenge to the reconstructive plastic surgeon. Skin grafting has been used traditionally for resurfacing with limited success, especially when the burns were so severe the deeper structures were destroyed. Total face reconstruction, using bilateral extended scapular free flap, has been reported previously for severe deformities following an extensive facial burn. Although this method obtained better aesthetic and functional results than skin grafting, the donor-site morbidity was relatively high, with a large scar that extended across the entire back. In addition, the nose needed to be reconstructed separately with a forehead flap or free radial forearm flap. The authors experienced a case in which a totally burned face was reconstructed successfully with a single free-expanded flap. A 54-year-old man sustained a severe facial burn with gasoline that involved the face, anterior neck, anterior chest, and bilateral upper extremities. Sequential debridement and skin grafting were required to close the burn wound. A tissue expander was inserted in his left back before the facial reconstruction. Six months after insertion of the tissue expander, the left dorsal skin was transferred to the face as one large flap, size 28x27 cm, with three sets of vascular anastomoses. The flap totally survived with abundant tissue at the central area to reconstruct the nose. With five complementary procedures, including a costal cartridge graft, the shape of the nose was restored, and acceptable functional and aesthetic results were obtained. This method did not require a separate tissue transfer for nasal reconstruction. To our knowledge, this is the first case of successful reconstruction with one flap for total face reconstruction that included the nose.

Topics: Burns; Cicatrix; Facial Injuries; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Surgical Flaps; Tissue Expansion

Topics: Adolescent; Burns; Cicatrix; Constriction, Pathologic; Female; Humans; Laser Therapy; Nose; Skin Transplantation

Malignancies in scars are generally known as Marjolin's ulcer. The majority of these arise from burn injuries. Although Marjolin's ulcer consists of all kinds of skin cancer, squamous cell carcinoma is the main cancer type reported in the literature. The pathogenesis of this tumor is due to chronic irritation of the effected area and mostly involves the extremities and scalp area. This report presents an unusually located and rare type of Marjolin's ulcer: on the nose and baso-squamotic in type. A 54-year-old man, 33 years after burn, presented with an unhealed ulcer on his nose which had been present for 2 years. The case was managed by tumor excision and a naso-labial transposition flap. To our knowledge, this is the first report of Marjolin's ulcer developing on post-burned skin of the nose.

Topics: Burns; Carcinoma, Basosquamous; Humans; Male; Middle Aged; Neoplasms, Post-Traumatic; Nose; Nose Neoplasms; Skin Neoplasms; Ulcer

We report the use of a traditional technique of rhinoplasty in the immediate assumption of responsibility of deep burn of the nasal edge which cannot be grafted. The limit of the realization of this gesture lies in the fact that it must exist nasal morphological characteristics at the patient. The two cases presented had an hypertrophic nose with osseous and/or cartilaginous bump. The reduction height of the osseo-cartilaginous frame allows closing the defect without cutaneous tension. One carries out a true excision-joining of the burn of the nasal dorsum. We note at one year of retreat, the discretion of the scar located on the centre line of the nose, the absence of after-effects as well as the cosmetic satisfaction of the patients with respect to the modifications morphological their noses.

Topics: Adult; Burns; Humans; Male; Middle Aged; Nose; Rhinoplasty

Topics: Burns; Child, Preschool; Dioctyl Sulfosuccinic Acid; Emergencies; Emergency Medicine; Female; Foreign Bodies; Humans; Infant; Male; Nose; Surface-Active Agents

Group A beta haemolytic Streptococcus has been one of the most serious infections in the burn patients resulting in severe cellulitis and sepsis. Penicillin has been used ever since its introduction as prophylaxis against these conditions. Penicillin prophylaxis was used in our burn unit as well without any serious evaluation until December 1992. This prospective study was therefore, undertaken to evaluate the incidence of beta haemolytic Streptococcus infection in burn patients, and its clinical outcome over a period of 5 years in the absence of prophylaxis with penicillin. 14 of the 1213 burn patients admitted to the Al-Babtain Centre for Plastic Surgery and Burns from January 1993 to December 1997 had either colonization or infection with Streptococcus spp. Their mean age was 15 years (range 1 month to 52 years) and the mean burn surface area was 20% (range 5 to 90%). Streptococci were isolated from burn wounds in 10 patients, throat in 3 and blood culture in 1. Group A Streptococcus was found in 5, group C in 3 and group D in 6 patients. In all patients except one the organisms were isolated > or =72 h post burn. The infections were successfully controlled by antibiotic and no detrimental effect was observed either on wound healing or skin graft take. There was no mortality amongst these 14 patients. The study showed that only 1.1% of the burn patients in our unit acquired Streptococcus of which only one third comprised of group A. This study thus demonstrates that the practice of penicillin prophylaxis during the first five post burn days may not be of any value and therefore, deserves discontinuation in units where the incidence of this organism is minuscule.

Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Burns; Comorbidity; Data Collection; Female; Humans; Incidence; Infant; Infant, Newborn; Injury Severity Score; Kuwait; Male; Middle Aged; Nose; Pharynx; Prospective Studies; Risk Factors; Sex Distribution; Streptococcal Infections; Streptococcus pyogenes; Survival Rate

Topics: Burns; Eye Injuries; Eyelids; Female; Follow-Up Studies; Forearm; Humans; Middle Aged; Multiple Trauma; Nose; Surgical Flaps

Topics: Burns; Humans; Necrosis; Nose; Rhinoplasty; Splints

We employed a forearm flap that had been thinned through primary defatting for nasal covering in three cases to reduce the need for secondary revision. Partial flap loss did occur in one case due to subcutaneous vascular plexus injury, but acceptable results were obtained in the remaining two cases. Donor site concave deformities were substantially reduced by removal of fat from around the flap margin. Great care must be taken during surgery to avoid damage to the small vascular network around the pedicle to prevent flap necrosis.

Topics: Burns; Female; Humans; Middle Aged; Nose; Nose Deformities, Acquired; Surgical Flaps

A 21-year-old man is reported in whom flap tissue was required to reconstruct the face and nose following burns. The whole of both forearms were used as radial forearm flaps for both cheeks, both lower eyelids, the right upper eyelid, upper and lower lips and chin. A Tagliacozzi arm flap and a dorsalis pedis flap were used for the nose. The ears were resurfaced using grafted skin along the line of the superficial temporal arteries. No thinning of the flaps was required and some facial muscle attachments to the forearm deep fascia led to more recovery of facial movement than might be expected with a flap reconstruction.

Topics: Accidents, Traffic; Adult; Burns; Facial Injuries; Forearm; Hand Injuries; Humans; Male; Multiple Trauma; Nose; Surgical Flaps; Treatment Outcome

The nose is in the medial portion of the face and is frequently injured in trauma of this area. Due to its situation its structure and shape, and its essential function, this organ is particularly exposed in the case of facial burns. These injuries, are usually associated with larger injuries, and frequently with systemic problems, such as respiratory problems. The authors describe nasal burns in the larger context of facial burns, and summarize recent data on this topic. They then recall the fascinating story of rhinopoiesis through the ages. The third part is devoted to their personal approach to reconstruction of the nose in severe panfacial burns, using a forehead flap with one or several tissue expanders.

Topics: Burns; Europe; Facial Injuries; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; History, Medieval; Humans; Nose; Rhinoplasty; Surgery, Plastic; Surgical Flaps; Tissue Expansion

In facially burned patients, a simple and effective technique is described for reconstruction of deformities of the lower third of the nose. The first stage consists of replacing the dorsal scarred skin with a skin graft from the buttocks or other area. The second stage is a vertical columella-based prefabricated flap that is outlined beginning near the tip of the nose and extending superiorly to the glabellar region. This flap is raised with the underlying muscle as a composite tissue, transposed to the defect, and sutured to the vestibular mucous membrane or the integument of the remaining portions of the nose at the alar rim. This very well vascularized vertical prefabricated myocutaneous flap can cover a cartilage graft taken from the ear to reconstruct an alar rim. The donor site is closed by undermining the nasal skin laterally on each side and suturing the edges at the dorsum to leave an acceptable midline scar. In patients for whom a nasolabial flap or other technique is not suitable or is impossible, this new and simple technique may be used successfully.

Topics: Adult; Burns; Cicatrix; Facial Injuries; Female; Humans; Male; Nose; Surgical Flaps

Two cases of patient fires are presented. Components necessary for this complication to occur are outlined, in addition to recommendations for prevention.

Topics: Adult; Aged; Burns; Carcinoma, Basal Cell; Electrocoagulation; Eyelid Neoplasms; Facial Injuries; Fires; Humans; Lip; Male; Mouth; Nose; Nose Neoplasms; Operating Rooms; Safety; Skin

Topics: Burns; Constriction, Pathologic; Follow-Up Studies; Humans; Intubation; Nose; Nose Diseases; Stents; Suction; Surgical Flaps

A simple method using ice-water and aluminium foil for enhancing composite graft survival is reported. Cooling the entire recipient site retards cellular degeneration in the graft until neovascularisation occurs. The success of this technique in nasal reconstruction using auricular chondrocutaneous tissue and nonmicrosurgical fingertip reattachment is presented. The potential application to thicker skin grafts is also discussed.

Topics: Adult; Amputation, Traumatic; Burns; Cartilage; Cryotherapy; Female; Finger Injuries; Graft Survival; Humans; Male; Nose; Postoperative Care; Skin Transplantation

Free flaps are usually needed for the reconstruction of extensive facial burns, but the final result is often a poor texture and color match. The authors report a burn case managed with a radial forearm free flap. The aesthetic result was improved by surgical tattooing of the flap, including the appearance of a beard.

Topics: Adult; Burns; Cicatrix; Facial Injuries; Humans; Male; Mouth; Nose; Surgical Flaps; Tattooing

In acute facial burns, it is sometimes necessary to insert tubes down one or both nostrils. We describe a simple secure method of fixation.

Topics: Burns; Equipment Design; Facial Injuries; Humans; Intubation; Nose

The authors present some clinical applications of the concept of flap prefabrication. Three cases are described where reconstructions around the head and neck were accomplished. The radial vascular territory of the forearm was selected for prefabrication of structures which were then transferred by microsurgical techniques. In two cases, a sensate flap was used, with nerve repair in the neck.

Topics: Adolescent; Aged; Amputation, Surgical; Burns; Ear, External; Facial Injuries; Forearm; Humans; Lip; Male; Microsurgery; Middle Aged; Nose; Nose Neoplasms; Surgical Flaps

Paranasal sinusitis is a complication of nasotracheal intubation. Of 99 nasally intubated adult patients who survived 48 hours after being burned, 22 who were intubated for more than 7 days underwent a computed tomographic scan of all paranasal sinuses, with timing dictated by the patient's clinical condition. Eight patients had computed tomographic and clinical findings consistent with sinusitis. Treatment consisted of removal of all nasal tubes, oral and topical nasal decongestants, and, when appropriate, culture-specific antibiotics. A subgroup of patients with preexisting sinus disease made up 50% of the patients with sinusitis; early conversion to an oral airway or a tracheostomy should be considered in such patients. Only one patient required surgical drainage of the sinuses. The frequency and morbidity of sinusitis in nasotracheally intubated burn patients does not justify the risk of routine conversion to an oral airway.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Nose; Sinusitis; Tomography, X-Ray Computed

Topics: Adult; Burns; Constriction, Pathologic; Humans; Malaysia; Male; Medicine, East Asian Traditional; Nose; Nose Deformities, Acquired

Eight cases of reconstruction of nose by using skin expander are reported in detail in this article. In which, 6 cases were total nose reconstruction, 2 were upper partial reconstruction. The results were good in all cases. It is considered that the forehead flap is the place of choice in nasal reconstruction. It gives good shape contour and best color match. After application of tissue expander it could provide more skin for reconstruction, and prove more advantages in repairing the donor site. It has been observed that the reconstructed nose contour was satisfactory, with no obvious constriction after more than a year follow up. The methods and advantages of operation and some typical cases are presented.

Topics: Adult; Burns; Cicatrix; Female; Forehead; Humans; Nose; Nose Deformities, Acquired; Surgical Flaps; Tissue Expansion

Burn reconstruction of the head and neck must first start with special care to this anatomic area in the early acute phase, with appropriate early débridement and coverage with sheet grafts of medium thickness into unit facial orientation. Postoperative garment and mask splinting, will help lessen the hypertrophic scar formation that frequently follows facial burns and skin coverage. Carefully planned reconstruction of these areas is indicated, with priority given first to the neck, then to the periorbital area, and then to perioral areas. Principles of scalp, ear, nasal, and cheek reconstruction following burns of the face are carefully outlined. The unit concept of burn scar resurfacing of the face has been the mainstay of our treatment. We have emphasized skin coverage of the face from similar donor site areas. The emotional and psychological effects of facial scarring secondary to severe burns are crippling to patients. Although numerous reconstructive surgical procedures may lessen the deformity, ultimately burn patients realize that their burn scars are permanent and no surgeon can give them back their original facial appearance. These patients need strong and continued support and reassurance from their physicians and nursing professional staff to maintain their self-identity and confidence.

Topics: Adolescent; Adult; Burns; Child; Child, Preschool; Chin; Ear, External; Eyebrows; Eyelids; Facial Injuries; Female; Humans; Infant; Male; Neck Injuries; Nose; Scalp; Skin Transplantation; Surgery, Plastic

The prevalence of nasal colonization and infection with methicillin-resistant Staphylococcus aureus (MRSA) among patients and staff was studied in a section of a Paediatric Surgical Unit in Lisbon between February and July 1985. Nasal colonization was demonstrated in 41% of burned patients, 5% of non-burned patients and 35% of the nurses. Infection by MRSA occurred in 30% of the burns. The isolates had identical serological patterns, slight differences on phage typing and were resistant to methicillin, cephalosporins, tetracycline, erythromycin and aminoglycosides. A chloramphenicol resistance plasmid of 3 Md was present in those isolates which were chloramphenicol resistant and a small plasmid of 1.7 Md which coded for constitutive erythromycin resistance was present in many isolates. Gentamicin, tetracycline and inducible erythromycin resistance were chromosomal. Several reasons for the apparent low virulence of the isolates are discussed. Attempts to control the outbreak by the discharge of colonized or infected patients, improvement of nursing practices and treatment with temporary removal from work of the colonized nurses did not eliminate the organism from the unit.

Topics: Burns; Cross Infection; Humans; Methicillin; Nose; Penicillin Resistance; Plasmids; Portugal; Staphylococcal Infections; Staphylococcus aureus

Topics: Adolescent; Adult; Burns; Burns, Inhalation; Ear; Hospitals, Military; Hospitals, Public; Humans; Middle Aged; Nose; Pharynx; Respiratory System; USSR

A gentamicin-resistant isolate of Staphylococcus aureus producing staphylococcal enterotoxin F (SEF) was isolated from a burn unit nurse during three episodes of toxic-shock syndrome (TSS). The nurse's reciprocal titer of antibodies to SEF was less than or equal to 5 during the three episodes, and when the titer rose to 1,000 no further relapses occurred despite continued colonization. The unusual antibiotic susceptibility pattern of the organism enabled demonstration of its spread. During four months, 12 (41%) of 29 burn unit patients, three other burn unit nurses, and a household contact of the nurse with TSS became colonized. None, including two patients whose initial reciprocal titers were less than or equal to 5, developed TSS. This experience illustrates significant cross-transmission of a TSS-associated strain and a temporal association of antibodies to SEF with cessation of recurrences of TSS. Additional factors must explain why other individuals lacking antibodies to SEF did not develop TSS.

Topics: Adult; Antibodies, Bacterial; Bacterial Toxins; Burn Units; Burns; Drug Resistance, Microbial; Enterotoxins; Female; Gentamicins; Humans; Male; Nose; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens

Topics: Burns; Child; Ear, External; Ectropion; Eyelids; Facial Injuries; Humans; Nose; Scalp; Surgery, Plastic; Surgical Flaps

A reversed-dermis Tagliacotian type of flap was used to resurface and reconstruct the nose in a boy with very extensive burns in whom there was very little "normal" skin available. It was possible to divide the flap and inset it on the sixth day. The result, after 1 year follow-up, was gratifying to both the patient and the surgeon.

Topics: Adolescent; Burns; Elbow; Humans; Male; Nose; Surgical Flaps

Topics: Adult; Burns; Female; Hemangioma; Humans; Infant; Male; Nose; Nose Neoplasms; Surgical Flaps

Facial burns cause deformities through the permanent effects of wound contracture and scar hypertrophy; they are related to the depth of the burn. The depth of an acute burn can be accurately ascertained only by observation over a period of time. Facial skin burns that do not heal by three weeks are subject to increasingly permanent deformity with the passage of time. The best defense against wound contraction and hypertrophic scar is early and complete wound closure. Early and late grafting must be completely successful in "take" to avoid unsightly irregular scarring; therefore, the receptor bed must be meticulously prepared for optimal take. Both early and late grafts are patches that flatten normal contour. However, if the skin graft conforms to a position in the facial mosaic (aesthetic unit of the face), or some subunit that is harmonious with normal facial lines, the patch of proper color can give a more aesthetic result. Nonreproducible anatomical structures such as the margins of the lids, lips, and nostrils should be preserved whenever found to be normal or only partially destroyed. To minimize the distorting effects of wound contracture, pressure therapy of the face and neck, as well as the positional splinting of the neck, must be maintained for many months following grafting and epithelialization until the deleterious wound forces abate. Burns of mobile structures, such as lids and lips, do not lend themselves to control by pressure, and frequently must be managed secondarily by first totally removing scarred tissues and then applying thick skin grafts of the best color match.

Topics: Burns; Cheek; Ear; Esthetics; Eyebrows; Eyelids; Facial Injuries; Forehead; Humans; Mouth; Neck; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Nasal reconstruction is one of the most important elements in rehabilitation of the patient suffering from the devastating deformities of full-thickness facial burns. When possible we use a single pedicle for complete nasal reconstruction. The forehead furnishes the best donor area. More distant donor sites are used if the forehead is not available. In lesser deformities, resurfacing with composite grafts or full-thickness skin grafts gives satisfactory results.

Topics: Aged; Burns; Child; Child, Preschool; Humans; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Skin Transplantation; Surgical Flaps; Transplantation, Autologous

Topics: Adult; Burns; Dermabrasion; Female; Humans; Middle Aged; Nose; Nose Deformities, Acquired; Radiation Injuries; Rhinoplasty; Skin Transplantation; Surgical Flaps; Transplantation, Autologous

Management of patients with severe postburn facial deformities is elaborated. On the basis of over 400 patients, the planning and value of numerous surgical methods are discussed with--special regard to rarely adopted but effective solutions.

Topics: Burns; Cicatrix; Ear; Eyebrows; Eyelids; Face; Facial Injuries; Humans; Lip; Nose; Rhinoplasty; Skin Transplantation; Surgery, Plastic; Surgical Flaps; Transplantation, Autologous

Topics: Burns; History, Ancient; History, Medieval; History, Modern 1601-; Humans; Nose; Rhinoplasty; Skin Transplantation; Surgery, Plastic; Transplantation; Transplantation, Autologous

Topics: Adolescent; Adult; Burns; Child; Child, Preschool; Facial Injuries; Female; Humans; Infant; Lip; Male; Nose; Skin Transplantation; Transplantation, Autologous

We present a method for reconstruction of the everted nostrils of the burned nose. Through a "ram's horn" incision, the everted vestibular lining and lower lateral cartilages are mobilized and repositioned, and the resultant defect is covered with a full-thickness skin graft. The linear scar is created as part of a circle, so that the postoperative contracture will improve the alar contour.

Topics: Burns; Cicatrix; Female; Humans; Male; Nose; Rhinoplasty; Skin Transplantation; Transplantation, Autologous

Topics: Burns; Humans; Neck Injuries; Nose; Radiation Injuries; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Birth Injuries; Burns; Diaphragm; Embolism, Amniotic Fluid; Female; Fractures, Bone; Humans; Infant, Newborn; Infant, Newborn, Diseases; Nose; Obstetrical Forceps; Pelvic Bones; Pregnancy; Pregnancy Complications; Scalp; Snake Bites; Uterine Rupture; Uterus; Wounds and Injuries

A strain of Staphylococcus aureus resistant to as many as nine distinct antibiotics has shown unusally high virulence as indicated by its ability to cause an epidemic of furunculosis amongst hospital nurses.

Topics: Bacteriophage Typing; Burns; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Female; Furunculosis; Humans; Nose; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus; Virulence

Topics: Adult; Burns; Cicatrix; Evaluation Studies as Topic; Face; Female; Humans; Italy; Methods; Nose; Nose Deformities, Acquired; Postoperative Complications; Rhinoplasty; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

The dispersal of Staphylococcus aureus from burned patients, the relation between nasal carriage by the staff and exposure to airborne Staph. aureus, and the transfer of Staph. aureus-carrying particles within the ward have been studied. The dispersal of Staph. aureus from burned patients was correlated to the size of the burn wound. The median values varied from 21 c.f.u./m.(2)/hr. for patients with small burns to 453 c.f.u./m.(2)/hr. for extensively burned patients. The size of the dispersed particles appeared to be smaller than that usually found in hospital wards. Carriage of nasal strains by the staff was correlated to the air counts; the number of patient sources did not seem to be of great importance. The transfer of Staph. aureus within the ward was at least 6 to 20 times that which would have been expected if transfer was due to air movement only.

Topics: Air Microbiology; Air Movements; Burns; Carrier State; Cross Infection; Hospital Design and Construction; Hospital Units; Humans; Nose; Patient Isolators; Perineum; Pharynx; Skin; Staphylococcal Infections; Staphylococcus

Topics: Adolescent; Adult; Aged; Airway Obstruction; Burns; Child; Child, Preschool; Ear; Eye Burns; Facial Injuries; Female; Humans; Infant; Lung Injury; Male; Middle Aged; Neck Injuries; Nose; Scalp; Skin Transplantation; Surgery, Plastic; Transplantation, Heterologous; Transplantation, Homologous; Wounds and Injuries

Topics: Burns; Face; Humans; Lip; Methods; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Adolescent; Adult; Burns; Child; Cicatrix; Female; Humans; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Skin Transplantation; Transplantation, Homologous

Topics: Bites and Stings; Burns; Face; Facial Injuries; Facial Neoplasms; Humans; Methods; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Aerosols; Air Conditioning; Air Microbiology; Bacteriophage Typing; Burns; Cell Count; Cross Infection; Disease Outbreaks; Hospital Units; Humans; Models, Biological; Nose; Perineum; Pharynx; Potassium Iodide; Skin; Staphylococcal Infections; Staphylococcus

Topics: Bacteriological Techniques; Bacteriophage Typing; Burns; Chloramphenicol; Coagulase; Erythromycin; Humans; Hyperbaric Oxygenation; Methicillin; Microbial Sensitivity Tests; Nose; Penicillin G; Skin; Staphylococcal Infections; Staphylococcus; Streptomycin; Tetracycline; Wound Infection

The use of plastic isolators and of an ;air curtain' isolator for protection of patients against infection was studied in a burns unit.Preliminary bacteriological tests showed that very few airborne bacteria gained access to a plastic ventilated isolator; even when the filter and pre-filter were removed from the air inflow, settle-plate counts inside the isolator were much lower than those in the open ward, but the difference was smaller in tests made with an Anderson air sampler, which showed also that fewer large bacteria-carrying particles appeared inside the isolator than outside it. An open-topped isolator allowed virtually free access of bacteria from ambient air. The numbers of airborne bacteria inside an air curtain were appreciably lower than the counts of airborne bacteria in the open ward, but not as low as those in the plastic ventilated isolator.Controlled trials of isolators were made on patients with fresh burns of 4-30% of the body surface; the patients were given no topical chemoprophylaxis against Staphylococcus aureus or Gram-negative bacilli. Patients treated in plastic isolators showed a significantly lower incidence of infection with Pseudomonas aeruginosa than those treated in the open ward; this protective effect was shown by isolators with or without filters or with an open top. Ventilated isolators, which protected patients against personal contact and airborne infection, gave a limited protection against multi-resistant ;hospital' strains of Staph. aureus, but no such protection was given by an open-topped isolator, which protected only against personal contact infection, or by air curtains, which protected only against airborne infection; the air curtain gave no protection against Ps. aeruginosa, and there was no evidence of protection by any isolator against Proteus spp. and coliform bacilli.Both the controlled trials and evidence from the bacteriology of air, hands, fomites and rectal and nasal swabs taken on admission and later, supported the view that Ps. aeruginosa is transferred mainly by personal contact, Staph. aureus probably by air as well as by contact and coliform bacilli mainly by self infection with faecal flora, many of which are first acquired from the hospital environment in food or on fomites.The use of plastic isolators is cumbersome, and of limited value except in the control of infection with Ps. aeruginosa. For this reason and because of the effectiveness of topical chemoprophylaxis such isolators are unli

Topics: Air Microbiology; Burns; Child; Cross Infection; Drug Resistance, Microbial; Feces; Hand; Hospital Departments; Humans; Nose; Patient Isolators; Plastics; Proteus; Pseudomonas aeruginosa; Pseudomonas Infections; Rectum; Staphylococcal Infections

Topics: Bacitracin; Burns; Chloramphenicol; Cross Infection; Erythromycin; Fusidic Acid; Humans; Methicillin; Microbial Sensitivity Tests; Neomycin; Nose; Novobiocin; Penicillin Resistance; Penicillins; Staphylococcal Infections; Staphylococcus; Streptomycin; Tetracycline

Topics: Bites and Stings; Bronchi; Burns; Foreign Bodies; Humans; Inflammation; Laryngeal Diseases; Laryngeal Neoplasms; Larynx; Nose; Otorhinolaryngologic Diseases; Pharyngeal Neoplasms; Respiratory Insufficiency

Topics: Burns; Contracture; Ear; Extremities; Eyelids; Hand Injuries; Humans; Melanoma; Nose; Pressure Ulcer; Radiation Injuries; Surgery, Plastic; Wounds and Injuries

Topics: Burns; Congenital Abnormalities; Contracture; Ear, External; Face; Humans; Lip; Male; Nose; Surgery, Plastic; Wounds and Injuries

Topics: Burns; Facial Bones; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Mandible; Nose

Topics: Burns; Edema; Humans; Inflammation; Neoplasms; Nose; Oxyphenbutazone; Postoperative Complications; Skin Transplantation; Surgery, Plastic; Wounds and Injuries

Topics: Armenia; Aspergillosis; Burns; Burns, Chemical; Chemical Industry; Citrates; Facial Dermatoses; Humans; Nose; Occupational Diseases

Topics: Burns; Dermabrasion; Ear Deformities, Acquired; Ear, External; Humans; Nose; Nose Deformities, Acquired; Rosacea; Surgery, Plastic

Topics: Burns; Cheek; Cicatrix; Craniocerebral Trauma; Eyelids; Facial Injuries; Hand Injuries; Humans; Neck; Nose; Plastics; Surgery, Plastic; Tendon Injuries; Thoracic Injuries

Topics: Burns; Humans; Nose