IntroductionDespite the heightened interest in the management and prevention of burn scars, only a few articles have been published that assess the risk factors for the development of burn scars. The relationship between admission to the burn unit and the need for reconstructive surgery, the effect of the burn area on the number of further surgeries needed, and the adverse event of the technique used in the reconstructive surgery is not widely explored in the literature. These unmet challenges are crucial for a standardized consensus about burn scar management. MethodsA retrospective study of patients admitted for burn reconstructive surgeries was conducted. A total of 100 patients (mean age: 29 years old) were included in this study. Data were retrospectively collected by reviewing the patients' charts. Data were analyzed using the SPSS software, version 25.00 (SPSS Inc., Chicago, IL). ResultsThe most common surgery performed was a release contracture with skin grafting (n = 93.93%). No significant difference was reported between the patient's age and the total number of surgeries. A significant difference was noted between the different techniques used and the total number of surgeries. Patients with release contracture surgery had higher scores of satisfaction and better functional outcome. ConclusionThe most common surgery performed for scar treatment was contracture release coupled with skin grafting. The most common cause of burn in Lebanon was flame, and the most commonly affected anatomical area was the upper limb. Further studies recruiting patients from all over Lebanon and assessing their characteristics are now warranted.
Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can result in fast tissue loss, necrosis, and potentially fatal acute sepsis. Diabetes, cancer, alcohol abuse, and chronic liver and renal disease are all risk factors for NF. In this case report, a 19-year-old man with a negative past medical and surgical history was diagnosed with aggressive rapidly progressive necrotizing fasciitis of the left lower extremity after a recent history of falling down from a skateboard. A successful treatment with long-term debridement surgeries followed by reconstructive surgery with skin grafting was made. Although the severity of this condition, the patient was able to resume a normal range of motion of the concerned extremity. NF has been described in the literature, but early diagnosis, which is crucial for successful management, rests a challenge.
Although animal bites account for a fair number of emergency department visits, donkey bites account for a very limited proportion. A 12-year-old boy presented to our department with a severe donkey bite involving his face. The injury included his left cheek with a laceration of the left ear cartilage. The examination revealed no serious morbidity (no vascular or nerve involvement). The patient received prophylactic antibiotics and anti-rabies/anti-tetanus vaccination. The wound was cleaned thoroughly with copious irrigation. Afterward, the patient underwent surgery to correct the defect in the cheek using a rotational advancement cervicofacial flap, while the penetrated ear cartilage was repaired and the skin margins were approximated and sutured. During the follow-up period, no complications were observed and the functional and cosmetic outcomes were satisfactory. Donkey bites are rarely encountered and they can result in different presentations and morbidities/outcomes. It is suggested that the timing from the bite injury to presentation, the stage/extent of the bite, the use of anti-tetanus and anti-rabies vaccines, and the prophylactic use of antibiotics may play a role in determining the outcomes and/or complications of donkey bites.
Mucormycosis is a rare but aggressive and fatal infection that is prevalent in immunocompromised patients. The variation in its clinical presentation and the lack of specificity are misleading and lead to a delay in the diagnosis and management. However, the era of coronavirus disease 2019 (COVID-19) is marked by the increasing emergence of Mucor infections, now identified as coronavirus-associated mucormycosis (CAM). Although many clinical forms exist, the most encountered in CAM is rhino-orbito-cerebral, as already reported in India.We present a case of a 56-year-old male patient with uncontrolled diabetes mellitus and a history of recent SARS-CoV-2 infection treated with IV steroids, presenting for maxillary teeth pain and instability on day 16 of COVID-19 infection. Early diagnosis of CAM is crucial and will help decrease mortality in COVID-19 patients, especially those with comorbidities such as diabetes mellitus. Increasing cases of CAM should prompt clinicians to have a high index of suspicion for rhinocerebral mucormycosis, especially in patients with risk factors receiving steroid therapy.In such patients, baseline glycosylated hemoglobin level and strict glycemic control by frequently measuring blood glucose levels and strictly adhering to insulin protocols would be rational but its efficacy in limiting the numbers of CAM in developing countries still needs to be confirmed.
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