Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel’s sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.
Wound management is a major clinical challenge and puts a significant financial burden on the NHS. Because of the rise in long-term conditions including diabetes, obesity and an ageing population, practitioners regularly encounter a wide variety of wound types. In recent years, there has been a resurgence of interest in the use of medical-grade honey in the management of wounds. Honey is anti-inflammatory in action and has the capability to treat local infection, promote autolytic debridement, deodorise wounds and promote granulation tissue. Revamil is a recent addition to the range of honey dressings available and is intended to manage the majority of problems that may arise during wound care episodes. The attributes of Revamil will be illustrated through four case studies.
Phytophototoxic burn injuries refer to dermal loss after contact with light-sensitizing plants and subsequent exposure to sunlight, which can at their most severe result in full-thickness burns. Phytophototoxic injuries secondary to the Herb of Grace, otherwise known as Ruta Graveolens or the "Common rue" plant, are very rare. The authors report the first case to have been referred directly and solely managed in a specialist burns unit along with a review of the literature. The authors report a case of a 50-year-old gentleman who suffered a phytophototoxic burn injury to his hand 2 days after contact with the "common rue." Unaware of the exacerbating effects of further sun exposure, this gentleman presented with skin loss and was treated conservatively with dressings. The authors would advocate that phytophototoxic injuries secondary to the "Common Rue," which result in skin loss in special anatomical areas including the hands, feet, face, or genitalia, should be referred to a specialist burns care service to ensure that they are appropriately managed. The delay in presentation makes it vital for Burns and Plastic Surgeons treating these injuries to be aware of this plant and consider it in their differential diagnosis. Due to its widespread presence, it remains paramount to provide patient education regarding the use of appropriate protective wear and avoidance of sun for 48 hours postinjury in order to prevent exacerbation of symptoms after the initial exposure.
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