In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.

Clinical studies generally reveal a trend of variation in the reported prevalence of the palmaris longus (PL) muscle absence. The aim of this study was to find an answer to the question of whether the congenital absence of tendon would affect hand functions or not. A total of 585 subjects, comprised of 305 males and 280 females, were included in our study. Mean age was 8.9±1.4 standard deviation within a range of 6-11. For both sexes, the groups were divided further into three subgroups including 6-7, 8-9, and 10-11 years of age ranges. The grip strength of each hand and pinch strength of all fingers of each subject were measured separately. The absence of PL tendon in the right hand was 35.4 % in females, 25.9 % in males, and 30.4 % in overall average. The distribution of absence of the palmaris longus muscle between both genders was statistically significant. The p value for the right hand was 0.013. The absence of PL tendon in the left hand was 37.5 % in females, 27.9 % in males, and an overall average of 32.5 %. The p value for the left hand was 0.017. In terms of grip strength, a comparison between females and males did not reveal a significant difference. The pinch strength of the second fingers of both hands did not show any difference in both sexes. Pinch strength of the third finger of the right hand was different only in girls of subgroup 6-7 ages (p=0.024). In girls, the pinch strength of the fourth finger of the right hand of subgroups 6-7 and 10-11 ages showed difference (p = 0.009 and p=0.026, respectively). In boys, the fourth finger in subgroup of 8-9 ages showed significant difference in both hands (p=0.011). The fifth fingers of both hands were found different in males for only subgroup of 8-9 ages (p= 0.001). Pinch strength of the fifth finger of the right hand was different in females for only subgroups of 6-7 and 10-11 ages (p=0.023 and p=0.047, respectively). While grip strength of the hand was not affected in the case of absence of the palmaris longus, in both sexes, pinch strength of the fourth and fifth fingers of both hands decreased.

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Previous data have shown that preoperative analgesia may reduce postoperative analgesic demands. The aim of the current study was to determine if preincisional ropivacaine infiltration may reduce postoperative oral pain in infants and small children undergoing elective cleft palate patients.Twenty nonsyndromic cleft palate patients were randomly divided into 2 groups. Injection with ropivacaine hydrochloride, at dose of 0.2 mg/kg, was performed by submucous infiltration of the proposed incisional site groups of patients. In control group, no medication was given before cleft palate repair under general anesthesia. Postoperative pain scores were measured according to Children and Infants Postoperative Pain Scale. Heart rate recordings and noninvasive blood pressure measurements were also done in all the patients.Measurements of Children and Infants Postoperative Pain Scale scores at all the observational postoperative periods showed significantly favorable values in ropivacaine group than in control group (P < 0.05). Six patients in the control group required rescue analgesia, whereas 2 patients required analgesic therapy in the treatment group.Preemptive analgesia using ropivacaine may enhance early postoperative comfort by reducing early postoperative pain in primary cleft repair.

Fat necrosis remains a serious complication in reconstructive flaps. In clinical setting, it is well known that fat tissue is more susceptible to ischemic events. We aimed to evaluate early histological and biochemical changes of adipofascial tissue in an experimantal model. An epigastric flap model in rats was used to evaluate the effect of ischemia-reperfusion (I-R) injury on adipofascial tissue. Two groups of animals (one with ischemia alone and other ischemia-reperfusion group) were used to evaluate the degree of histological edema, congestion and extravascular bleeding, and early biochemical alterations within the adipofascial flaps. The biochemical parameters included glutathione (GSH) and malondialdehyde (MDA). In each group, contralateral groin subcutaneous adipose tissue served as control. These evaluations were compared to normal unmanipulated, contralateral abdominal subcutaneous adipose tissue. The ischemia-reperfused flap group showed histologically significantly much edema congestion and bleeding than the control groups (P < .0001). The control group showed less edema in fat tissue than the ischemia-alone group (P < .05). All of the flaps in the ischemia-only group showed significantly less bleeding and edema than I-R group (P < .001). The ratio of MDA/GSH was 33 in control, 37 in ischemia alone, and 82 in ischemia-reperfusion groups, respectively. This study confirms that significant histologic and biochemical alteration occurs after ischemia and ischemia-reperfusion events in adipose tissue. Marked drop in adipose tissue antioxidant levels after I-R suggested that preemptive measures to this decrease should be undertaken in clinical settings.

Background and aimAllow for protection of briefly ischemic tissues against the harmful effects of subsequent prolonged ischemia is a phenomennon called as Ischemic Preconditioning (IP). IP has not been studied in ischemia-reperfusion (I/R) model of peripheral nerve before. We aimed to study the effects of acute IP on I/R injury of peripheral nerve in rats.Method70 adult male rats were randomly divided into 5 groups in part 1 experimentation and 3 groups in part 2 experimentation. A rat model of severe nerve ischemia which was produced by tying iliac arteries and all idenfiable anastomotic vessels with a silk suture (6-0) was used to study the effects of I/R and IP on nerve biochemistry. The suture technique used was a slip-knot technique for rapid release at time of reperfusion in the study. Cytoplasmic vacuolar degeneration was also histopathologically evaluated by light microscopic examination in sciatic nerves of rats at 7th day in part 2 study.Results3 hours of Reperfusion resulted in an increase in nerve malondialdehyde levels when compared with ischemia and non-ischemia groups (p < 0.001 and p < 0.0001 respectively). IP had significantly lower nerve MDA levels than 3 h reperfusion group (p < 0.001). The differences between ischemic, IP and non-ischemic control groups were not significant (p > 0.05). There was also a significant decrease in vacoular degeneration of sciatic nerves in IP group than I/R group (p < 0.05).ConclusionIP reduces the severity of I/R injury in peripheral nerve as shown by reduced tissue MDA levels at 3 th hour of reperfusion and axonal vacoulization at 7 th postischemic day.

Bacillus anthracis infection can lead to necrosis in tissues and may manifest as a fatal disease in human beings. The authors present a patient with a large area of skin necrosis on the dorsum of the hand that was reconstructed with a reverse flow-through radial forearm flap, and they discuss the relevant literature. To the authors' knowledge, this is the first published report of such extensive necrosis resulting from anthrax limited to the extensor retinaculum of the hand.

A 17-year-old previously unreported patient with Pai syndrome is described. The boy had median cleft of upper lip, a polypoid skin mass over the columella, a minimal cleft of the upper central incisors, frontal alopecia of the anterior hairline, and bifid nose. Magnetic resonance imaging showed pericallosal lipoma. No mental retardation was present, and a chromosomal study showed normal male 46, XY karyotype.