A prospective randomized trial of absorbable versus metal skin staples for securing skin grafts to excised burn wounds was performed in 20 patients. The absorbable staples were easy to use and efficacious in securing the skin grafts, except to edematous fatty tissue. Aesthetically, the absorbable staples yielded as good or better results when compared with metal staples resulting from a lack of tissue distortion. A decrease of 61.4 minutes of the most significantly painful portion of the postoperative dressing change (i.e., staple removal) would have been avoided by using absorbable staples. The overall cost of using the absorbable staples for small burns was comparable with metal staples; however, the cost difference was significantly greater for large burns.

No abstract

The authors describe a case of dermatofibrosarcoma protruberans of the frontal region in a young girl. The condition was treated by radical excision of the scalp, frontal bone, and sinuses, and immediate reconstruction with an acrylic cranioplasty and microsurgical transfer of a free groin flap. Pathological examination revealed the margins of the excised specimen were clear of tumor. The initial flap failed, but a second graft was immediately transferred successfully, with a good cosmetic result.

No abstract

A recent increase in the number of patients with severe group a streptococcal soft tissue infections and the streptococcal toxic shock like syndrome (stsls) in Edmonton sparked the interest to review eight cases that occurred between March 1991 and December 1993, including two patients after cosmetic surgery. These cases were felt to be sporadic and not linked. Four of the eight patients (age range 25 to 64 years), including one patient following upper blepharoplasties, developed invasive infection without shock. These patients presented one to seven days after the initiating event with only mild fever, but severe pain and localized erythema and swelling in the affected area which progressed quickly with the formation of bullae. Two streptococcal specimens were serotyped as M1 and contained streptococcal pyrogenic exotoxins (spe) a and B. Management included surgical debridement, penicillin, and clindamycin (interferes with M-protein and toxin production). All four patients recovered. The other four patients, including one patient following rhytidectomy, (age range 45 to 83 years) were much more ill and developed stsls. They rapidly developed septic shock within 12 to 24 h and progressed to multiorgan involvement despite surgical debridement. One streptococcal specimen was serotyped as M1 and positive for spe a and B, another specimen as M12 and positive for spe B, and another specimen as M-nontypable and positive for spe B. Two patients died within five days of presentation. The other two patients recovered following lengthy hospitalization, reconstructive surgery and rehabilitation.

G roup A strep to coc cus is found around the world; its ecologi cal niche is the skin and mu cous mem branes of humans (1). There are more than 80 types of this or gan ism based on a cell wall con stitu ent known as the M-protein, which is also one of its key viru lence fac tors. Group A strepto coc cus can cause a va ri ety of ill nesses rang ing from mild con di tions such as pha ryn gi tis to less com mon, but more de struc tive in fec tions, such as ne cro tiz ing cel lu li tis (2). In the 1800s, there was a world wide pan demic of strep tococ cal in fec tions. From 1885 to the early 1980s, a gen eral decrease in the number of in fec tions oc curred, even be fore the ad vent of an ti bi ot ics. This de cline was thought to be due to cleaner and less crowded liv ing con di tions (3). Be gin ning in 1985, an in creas ing number of out breaks of acute rheu matic

A small percentage of spinal cord injured (SCI) patients with frequent recurrent pressure sores will eventually develop massive ulcers of the buttocks that are no longer amenable to local tissue coverage. The amputation of one leg and the creation of a total thigh musculocutaneous flap (TTF) may then be appropriate. The purpose of this paper is to evaluate the indications for and the efficacy of this procedure in nine SCI patients who underwent 10 TTF between February 1989 and November 1994. These patients had numerous previous hospitalizations (mean 12.1 admissions) and operations (mean 13.1 operations) for pressure sores. Past psychiatric evaluation found seven of eight males to have a similar history of social, financial and behavioral problems. The typical presentation was a septic, malnourished patient with massive ulceration of his buttocks. Only after wound and patient stabilization was the TTF chosen as a salvage procedure. The operation was long and associated with excessive blood loss. The most common complications were wound dehiscence or partial necrosis (five of 10), sepsis (five of 10), hemodynamic instability (five of 10), and chronic drainage (four of 10). The reoperation rate for complications was six of 10 cases. Long term follow-up (mean 3.5 years) on seven of eight surviving patients showed that these patients had resumed independent living but they had all developed new pressure sores as early as three months post TTF. The underlying risk factors for pressure sores had not changed. The total thigh flap operation remains a last resort procedure in a very small percentage of spinal cord injured patients because of its high morbidity, high reoperative rate for complications, and inability to prevent recurrence of pressure sores.

A small percentage of spinal cord injured (SCI) patients with frequent recurrent pressure sores will eventually develop massive ulcers of the buttocks that are no longer amenable to local tissue coverage. The amputation of one leg and the creation of a total thigh musculocutaneous flap (TTF) may then be appropriate. The purpose of this paper is to evaluate the indications for and the efficacy of this procedure in nine SCI patients who underwent 10 TTF between February 1989 and November 1994. These patients had numerous previous hospitalizations (mean 12.1 admissions) and operations (mean 13.1 operations) for pressure sores. Past psychiatric evaluation found seven of eight males to have a similar history of social, financial and behavioral problems. The typical presentation was a septic, malnourished patient with massive ulceration of his buttocks. Only after wound and patient stabilization was the TTF chosen as a salvage procedure. The operation was long and associated with excessive blood loss. The most common complications were wound dehiscence or partial necrosis (five of 10), sepsis (five of 10), hemodynamic instability (five of 10), and chronic drainage (four of 10). The reoperation rate for complications was six of 10 cases. Long term follow-up (mean 3.5 years) on seven of eight surviving patients showed that these patients had resumed independent living but they had all developed new pressure sores as early as three months post TTF. The underlying risk factors for pressure sores had not changed. The total thigh flap operation remains a last resort procedure in a very small percentage of spinal cord injured patients because of its high morbidity, high reoperative rate for complications, and inability to prevent recurrence of pressure sores.