Massive hemorrhage from facial fractures is an underrecognized and inconsistently managed phenomenon. Although low in incidence, its timely recognition and better management may reduce the high mortality rate in this group of patients.

Rehabilitation of speech and swallowing postburns reconstructive surgery has not been previously described in detail in the literature. Severe facial burn injury requiring subsequent reconstructive surgery may result in complications including circumoral contracture and aesthetic and functional irregularities. These complications may manifest as facial and labial sensation deficits, poor oral access for intubation and oral/dental hygiene, and inadequate oral competence causing chronic drooling and poor articulation. This report describes the physical rehabilitation of a patient with full-thickness burns to the nose, lips, mouth, and chin following electrical burn injury. The severity of injury sustained placed the patient at high risk for microstomia, dysphagia, and speech disorder. A multidisciplinary team approach was used to coordinate the planning of reconstructive procedures, facilitate patient recovery, and optimize functional and aesthetic outcomes. Speech pathology intervention aimed to 1) facilitate safe transition from nonoral to oral intake, 2) improve articulation and speech intelligibility, and 3) minimize oral contracture development. At 6 months postinjury, the patient can safely tolerate a soft diet, demonstrate speech clarity at preinjury level, and has recovered functional oral range of movement. Rehabilitation of speech and swallowing is an essential factor to consider when planning postburn reconstructive procedures.

Cutaneous zygomycosis is an uncommon but potentially fatal disease. An illustrative case is used to highlight the difficulties in managing these burns patients followed by a review of the literature with special emphasis on the surgical management and outcomes in these patients. English language articles were identified using the MEDLINE database from 1966 to 2006, using key words zygomycosis and mucormycosis. The set was limited to humans and cutaneous disease. All articles (n = 173) were reviewed with special consideration for articles (n = 28) post an extensive review of cutaneous zygomycosis in 1993 by Adam et al. Key clinical features, risk factors, microbiological diagnostics, medical and surgical treatment modalities, outcomes, and prognosis were extracted. In contrast to all overall zygomycosis, cutaneous zygomycosis is associated with immune competency in 50% of cases. Diagnosis remains difficult with extensive and sometimes multiple biopsies confirming the presence of a fungus. Although there are no randomized controlled trials on best care, documented treatment options providing survival benefits include antifungal therapy or surgical debridement. Multiple debridements are routine with amputation not an uncommon scenario. Infection may still progress, despite these aggressive measures. Treated patients with localized cutaneous zygomycosis still have a mortality rate of 31%. Cutaneous zygomycosis is an exceedingly difficult disease to manage with limited evidence to guide management. This review offers some insight to burns surgeons and other health professionals to help provide best practice for patients in the future.

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Background: Several approaches to plate fixation of the proximal phalanx have been proposed, such as the dorsal extensor splitting approach and the lateral or dorso-lateral extensor sparing approach, which aims to minimise invasiveness to promote native extensor tendon glide. This study aimed to meta-analyse the outcomes of these two approaches. Methods: A systematic review of electronic databases was undertaken, and the outcomes of comparative studies meta-analysed. Results: Three studies were included for meta-analysis. Total active motion (TAM) was significantly greater in the extensor sparing group compared to the extensor splitting (Mean difference 8.52 degrees, 95%CI 0.8–16.36, p = 0.03). Conclusions: This study demonstrates that there is preliminary evidence favouring the use of extensor sparing approaches when fixing proximal phalanxes – however, this result requires validation with randomised controlled trials.