The authors treated 24 giant auricular keloids (mean size, 11 cm) from January 2008 to July 2012 using a novel protocol consisting of complete excision, skin grafting, a 1-time intraoperative injection of triamcinolone, immediate radiotherapy, and sustained pressure therapy. At 1 year, the success rate was 87.5%.

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

C hanges in sleep architecture are common phenomena in posttraumatic patients (1) and such altered sleeping patterns have negative implications on various phases of rehabilitation (2). Given that burn injury is one of the worst forms of trauma that can be inflicted on a human being (3,4), the assumption that postburn injury patients are potential candidates in whom such disturbances may be present is highly relevant. Ironically, we are often disappointed by the paucity of literature that is available on this topic. The pursuit of aggressive rehabilitation and moving away from a 'myopic approach' that caters only to physical scars and neglects the mental health of burn patients has been a praiseworthy achievement on the part of burn care professionals (5). Burn rehabilitation has become pre-emptive, comprehensive and objective, taking into account nearly 'all that matters'. Even then, probing the quality and patterns of sleep in postburn patients appears to be one of the last few unchartered territories that has remained unexplored by the burn care physician. Poor sleep quality has a number of negative effects on physical as well as mental health. Apart from its predictable effects on mental health (eg, easy fatigability, depression and pain tolerance) (6,7), it also compromises immune, metabolic and neuroendocrine functions.

Agricultural hand injuries are not totally avoidable and their incidence can be reduced by proper education, but the low economic and literacy status of the patients is a big hurdle. The forearm offers many flaps for reconstruction of hand, which can be used in defects on dorsal or palmar aspect of hand and results in early discharge from the hospital and early rehabilitation. In patients with associated injury to the forearm, abdominal flaps can be used for cover.