No abstract

Background: Refeeding syndrome is an important, yet commonly overlooked condition affecting patients. It occurs when feeding is commenced after a period of starvation. Head and neck cancer patients are at particular risk owing to prolonged periods of poor nutritional intake. This may be from general effects such as cancer anorexia or from more specific problems of dysphagia associated with this group of patients. Awareness of the condition is crucial in identifying patients at risk and taking measures to prevent its occurrence.

Surgical intervention for thumb duplication can be divided into three categories: simple excision of the accessory thumb, excision of the accessory thumb with reconstruction from available “spare parts,” and combining the two thumbs into one, as described by Bilhaut. This prospectively PROSPERO registered systematic review evaluates the overall, aesthetic and functional outcomes for the latter two options (reconstruction from spare parts vs. combining two thumbs into one), aiming to facilitate evidence-based decision making when addressing thumb duplication and direct future research. The review was performed in accordance with the Cochrane Handbook of Systematic Reviews and PRISMA statement. Embase, PubMed, Medline, and Cochrane databases were systematically searched. Studies offering comparisons of techniques were included. Risk of bias was assessed using the Risk of Bias In Non-randomized Studies—of Intervention tool. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Ten retrospective observational studies were included. Data did not consistently allow analysis by procedure type. Four studies reported similar overall outcomes between techniques, while two specifically reported poor overall outcomes for the Bilhaut procedure. Two studies reported comparatively worse aesthetic outcomes for the Bilhaut procedure with four studies reporting comparatively improved functional outcomes for this procedure. Overall, interpretation of outcomes was challenging with no patient-reported outcome measures used. The quality of the evidence was universally “very low” due to all studies being at risk of methodological bias. Based on the available evidence, surgical techniques for thumb duplication correction appear comparable regarding overall outcome. There is limited evidence suggesting reconstruction with spare parts offers superior aesthetic outcomes at the expense of stability. The level of evidence is III.

The authors review the etiology of U.K. military burns in light of increasing hybrid warfare. Analysis of the nature of these injured personnel will provide commanders with the evidence to plan for on-going and future operations. Case notes of all U.K. Armed Forces burn injured patients who were evacuated to the Royal Centre for Defence Medicine were reviewed. Demographics, burn severity, pattern, and mortality details were included. There were 134 U.K. military personnel with burns requiring return to the United Kingdom during 2001-2007. The median age was 27 (20-62) years. Overall, 60% of burns seen were "accidental." Burning waste, misuse or disrespect of fuel, and scalds were the most prevalent noncombat burns. Areas commonly burned were the face, legs, and hands. During 2006-2007 in the two major conflicts, more than 59% (n = 36) of the burned patients evacuated to the United Kingdom were injured during combat. Burns sustained in combat represent 5.8% of all combat casualties and were commonly associated with other injuries. Improvised explosive device, minestrike, and rocket-propelled grenade were common causes. The mean TBSA affected for both groups was 5% (1-70). The majority of combat burn injuries have been small in size. Greater provision of flame retardant equipment and clothing may reduce the extent and number of combat burns in the future. The numbers of noncombat burns are being reduced by good military discipline.

Netherton syndrome is an autosomal recessive ichthyosis caused by mutations in SPINK5, with the classic triad of linearis circumflexa, trichorrhexis invaginata, and atopy. There are few reports of surgical management in individuals with Netherton syndrome and clinicians may be reluctant to operate for fear of wound-healing complications. This report describes a pediatric case of a Buschke-Lowenstein tumor of the natal cleft in a patient with Netherton syndrome that had failed to respond to medical management. We reviewed the literature for previous cases of surgery in individuals with Netherton syndrome using MEDLINE and PubMed searches. Our patient underwent surgery to remove the lesion without complication. Using conventional dressings and topical negative-pressure therapy, the wound was managed and healed within a reasonable time frame despite the underlying skin condition. This case indicates that surgery and topical negative-pressure therapy is a safe and reasonable treatment for individuals with Netherton syndrome.