Integration of Multiple Spectral Data via a Logistic Regression Algorithm for Detection of Crop Residue Burned Areas:A Case Study of Songnen Plain,Northeast China

The burning of crop residues in fields is a significant global biomass burning activity which is a key element of the terrestrial carbon cycle,and an important source of atmospheric trace gasses and aerosols.Accurate estimation of cropland burned area is both crucial and challenging,especially for the small and fragmented burned scars in China.Here we developed an automated burned area mapping algorithm that was implemented using Sentinel-2 Multi Spectral Instrument(MSI)data and its effectiveness was tested taking Songnen Plain,Northeast China as a case using satellite image of 2020.We employed a logistic regression method for integrating multiple spectral data into a synthetic indicator,and compared the results with manually interpreted burned area reference maps and the Moderate-Resolution Imaging Spectroradiometer(MODIS)MCD64A1 burned area product.The overall accuracy of the single variable logistic regression was 77.38%to 86.90%and 73.47%to 97.14%for the 52TCQ and 51TYM cases,respectively.In comparison,the accuracy of the burned area map was improved to 87.14%and 98.33%for the 52TCQ and 51TYM cases,respectively by multiple variable logistic regression of Sentind-2 images.The balance of omission error and commission error was also improved.The integration of multiple spectral data combined with a logistic regression method proves to be effective for burned area detection,offering a highly automated process with an automatic threshold determination mechanism.This method exhibits excellent extensibility and flexibility taking the image tile as the operating unit.It is suitable for burned area detection at a regional scale and can also be implemented with other satellite data.

Nonlinear dynamics of the reversed shear Alfvén eigenmode in burning plasmas

In a tokamak fusion reactor operated at steady state,the equilibrium magnetic field is likely to have reversed shear in the core region,as the noninductive bootstrap current profile generally peaks off-axis.The reversed shear Alfvén eigenmode(RSAE)as a unique branch of the shear Alfvén wave in this equilibrium,can exist with a broad spectrum in wavenumber and frequency,and be resonantly driven unstable by energetic particles(EP).After briefly discussing the RSAE linear properties in burning plasma condition,we review several key topics of the nonlinear dynamics for the RSAE through both wave-EP resonance and wave-wave coupling channels,and illustrate their potentially important role in reactor-scale fusion plasmas.By means of simplified hybrid MHD-kinetic simulations,the RSAEs are shown to have typically broad phase space resonance structure with both circulating and trapped EP,as results of weak/vanishing magnetic shear and relatively low frequency.Through the route of wave-EP nonlinearity,the dominant saturation mechanism is mainly due to the transported resonant EP radially decoupling with the localized RSAE mode structure,and the resultant EP transport generally has a convective feature.The saturated RSAEs also undergo various nonlinear couplings with other collective oscillations.Two typical routes as parametric decay and modulational instability are studied using nonlinear gyrokinetic theory,and applied to the scenario of spontaneous excitation by a finite amplitude pump RSAE.Multiple RSAEs could naturally couple and induce the spectral energy cascade into a low frequency Alfvénic mode,which may effectively transfer the EP energy to fuel ions via collisionless Landau damping.Moreover,zero frequency zonal field structure could be spontaneously excited by modulation of the pump RSAE envelope,and may also lead to saturation of the pump RSAE by both scattering into stable domain and local distortion of the continuum structure.

Nomogram for predicting the risk of anxiety and depression in patients with non-mild burns

BACKGROUND Post-burn anxiety and depression affect considerably the quality of life and recovery of patients;however,limited research has demonstrated risk factors associated with the development of these conditions.AIM To predict the risk of developing post-burn anxiety and depression in patients with non-mild burns using a nomogram model.METHODS We enrolled 675 patients with burns who were admitted to The Second Affiliated Hospital,Hengyang Medical School,University of South China between January 2019 and January 2023 and met the inclusion criteria.These patients were randomly divided into development(n=450)and validation(n=225)sets in a 2:1 ratio.Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with post-burn anxiety and depression dia-gnoses,and a nomogram model was constructed.RESULTS Female sex,age<33 years,unmarried status,burn area≥30%,and burns on the head,face,and neck were independent risk factors for developing post-burn anxiety and depression in patients with non-mild burns.The nomogram model demonstrated predictive accuracies of 0.937 and 0.984 for anxiety and 0.884 and 0.923 for depression in the development and validation sets,respectively,and good predictive per-formance.Calibration and decision curve analyses confirmed the clinical utility of the nomogram.CONCLUSION The nomogram model predicted the risk of post-burn anxiety and depression in patients with non-mild burns,facilitating the early identification of high-risk patients for intervention and treatment.

Multidisciplinary treatment of molten aluminum combined burn:An unusual case report

Molten aluminum is among the most common causes of burns in the metal industry.However,only few reports are available on molten aluminum injuries.Herein,we report an unusual case of molten aluminum burn.The patient had burns not only on the body surface but also in the respiratory tract and esophagus,adding to the difficulty of treatment.Multidisciplinary consultation and cooperation led to the development of a treatment plan for the patient,which included tracheotomy,respiratory management,endoscopic therapy,infection control,and psychological support.To our knowledge,this is the first report of molten aluminum-induced burns involving the face,neck,respiratory tract,esophagus,and eyes.We also describe our experience with multidisciplinary treatment for the management of molten aluminum burns.

Infection control and prevention in burn victims:The role of nurses

Burn injury is a major public health concern,with an estimated 180,000 deaths each year associated with burn-related infections.The majority of these occur in low-and middle-income countries,and almost two-thirds occur in the World Health Organization African and South-East Asia Regions.There is a risk of an escalation of burn injury site infections if nurses who are directly involved in burn care do not develop a mechanism to mitigate this risk in the coming years.Hence,this study aims at explaining what burn injuries are and how nurses can prevent the occurrence of infection among burn victims.This review analyzed published studies using keywords such as burn injury,infection in burn patients,and nurses’involvement in infection prevention and control(IPC)on search engines such as PubMed,Science Direct,and Google Scholar.The literature was retrieved and reviewed for eligibility to capture just the variables indicated in this seminar objective;the date range chosen in the literature search was from 2015 to 2023.The study found that many patients die from burn injuries as a result of exposure to infection and most nurses are not adequately informed about infection control.The study also found that nurses’responsibilities include proper hand hygiene,wound care,the use of personal protective equipment,antibiotic medication,cleaning the patient’s surroundings,and preventing patient cross-contamination.Burn injuries pose a significant risk to patients,necessitating infection control and prevention.Therefore,nurses in burn units should be informed on IPC practices and also educate patients,families,and coworkers on their importance.

Community Knowledge and Attitude about Burns First Aid (BFA) in Jazan, Saudi Arabia

Introduction and Significance: Burn injury (BI) is a considerable health issue which is responsible for around 300,000 deaths and affecting about 11 million people every year worldwide. In Saudi Arabia, the prevalence of BIs array from 112 to 518 per 100,000 per year. The appropriate awareness of performing first aid could facilitate to improve the outcomes of burns. Purpose and Objectives: To appraise the community that acknowledges burns, first aid, and associated factors among the community population in Jazan City, Saudi Arabia. The paper aims to identify limitations to encourage additional research and persuade legislators to develop improved burn-injury care recommendations and training programs. Materials and Methods: An observational-based sample survey was conducted among the people who live in Jazan City aging 13 years or more, during April 5 to May 5, 2023. Data collection was done by a validated online self-administrated questionnaire sent randomly to community members in different parts of Jazan City via social media platforms. Collected data were coded and cleaned by an excel program, and finally exported on SPSS 26.0 software. The variables were analyzed using descriptive statistics like frequencies and percentages. Also, the Chi-square test was used to investigate the relation between different variables, with a significance value of P Results: This study included 243 participants (about 62%) among them were mostly male participants (151) having a university degree. The majority of participants 75% did not take any form of BFA training in the past. This study shows that 69.9% of the participants have inadequate awareness, despite 72% having a constructive attitude towards burn first aid. Previous burn-related first aid training was significantly associated with participants’ knowledge of BFA at a p-value less than 0.05. Conclusion: This study indicates a high frequency of Jazan population having inadequate knowledge of burn first aid despite the high prevalence of a favorable attitude. There is a need to develop an effective nationwide burn prevention program and early burn first aid treatment in Saudi Arabia and promote a consistent guideline for burn first aid.

Angioinvasive mucormycosis in burn intensive care units:A case report and review of literature

BACKGROUND Mucormycosis is a rare,rapidly progressive and often fatal fungal infection.The rarity of the condition lends itself to unfamiliarity,delayed treatment,and poor outcomes.Diagnosis of fungal infections early enough to enable appropriate treatment occurs in less than half of affected patients.CASE SUMMARY An 11-year-old girl with a history of 15%total body surface area scald burns involving both lower limbs progressed to develop angioinvasive mucormycosis.This further led to a thrombosis of the right external iliac artery and vein and rapidly progressive necrosis of surrounding soft tissues.She also had dextrocardia and patent foramen ovale.A right hip disarticulation and serial aggressive debridements were performed but she went on to develop systemic sepsis with multisystem involvement and succumbed to the infection.Pathology revealed mucor species with extensive vascular invasion.CONCLUSION This case highlights the importance of maintaining vigilance for mycotic infections and acting appropriately when there are signs of fulminant wound infection.

Analysis of the Cicatricial Acceleration Method (MAC®) in Skin Repair in Wistar Rattus norvegicus with Induced Chemical Burns

Introduction: The cicatricial acceleration method (MAC®) promotes photobiological effects of an anti-inflammatory and healing nature. Its therapeutic radiation is emitted, producing photobiostimulant effects that result in rapid tissue repair and better tissue quality. The treatment of burns has always been a challenge, which involves both performing surgery and controlling and guiding scar regeneration, avoiding possible morbidities. Objective: To evaluate the effects of applying the MAC methodology with an AlGa (aluminum, gallium arsenide) laser on the time and quality of tissue repair in the skin of rats after induced chemical burns. Method: 22 adult male rats were subjected to a second-degree chemical burn on the back using 50% trichloroacetic acid. After the burns, the animals were randomly separated into 2 groups: control and experimental. The control group (G1) received placebo laser therapy and the laser group (G2) underwent laser irradiation with an energy density of 100 J/cm2. Histological analysis and macroscopic evaluation were carried out by means of the paper template method. Results: Group G1 showed (53%) of the necrosis area and group G2 showed (11%) necrosis area. Conclusion: The cicatricial acceleration method (MAC®) favored the repair of wounds caused by a 2nd-degree chemical burn, optimizing time and improving quality.

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.

Humic Acid Effects on Reducing Corn Leaf Burn Caused by Foliar Spray of Urea-Ammonium Nitrate at Different Humic Acid/Urea-Ammonium Nitrate Ratios

Technologies for reducing corn leaf burn caused by foliar spray of urea-ammonium nitrate (UAN) during the early growing season are limited. A field experiment was carried out to evaluate the effects of humic acid on corn leaf burn caused by foliar spray of undiluted UAN solution on corn canopy at Jackson, TN in 2018. Thirteen treatments of the mixtures of UAN and humic acid were evaluated at V6 of corn with different UAN application rates and different UAN/humic acid ratios. Leaf burn during 1 2, 3, 4, 5, 6, 7, and 14 days after UAN foliar spray significantly differed between with or without humic acid addition. The addition of humic acid to UAN significantly reduced leaf burn at each UAN application rate (15, 25, and 35 gal/acre). The reduction of leaf burn was enhanced as the humic acid/UAN ratio went up from 10% to 30%. Leaf burn due to foliar application of UAN became severer with higher UAN rates. The linear regression of leaf burn 14 days after application with humic acid/UAN ratio was highly significant and negative. However, the linear regression of leaf burn 14 days after application with the UAN application rate was highly significant and positive. In conclusion, adding humic acid to foliar-applied UAN is beneficial for reducing corn leaf burn during the early growing season.

Detection of Burned Areas through Spectral Indices Analysis of Sentinel-2A Satellite Images in the Abokouamékro Wildlife Reserve (Central, Côte D’Ivoire)

In Côte d’Ivoire, the recurring and unregulated use of bushfires, which cause ecological damage, presents a pressing concern for the custodians of protected areas. This study aims to enhance our comprehension of the dynamics of burnt areas within the Abokouamékro Wildlife Reserve (AWR) by employing the analysis of spectral indices derived from satellite imagery. The research methodology began with the calculation of mean indices and their corresponding spectral sub-indices, including NDVI, SAVI, NDWI, NDMI, BAI, NBR, TCW, TCG, and TCB, utilizing data from the Sentinel-2A satellite image dated January 17, 2022. Subsequently, a fuzzy classification model was applied to these various indices and sub-indices, guided by the degree of membership α, with the goal of effectively distinguishing between burned and unburned areas. Following the classification, the accuracies of the classified indices and sub-indices were validated using the coordinates of 100 data points collected within the AWR through GPS technology. The results revealed that the overall accuracy of all indices and sub-indices declines as the degree of membership α decreases from 1 to 0. Among the mean spectral indices, NDVI-mean, SAVI-mean, NDMI-mean exhibited the highest overall accuracies, achieving 97%, 95%, and 90%, respectively. These results closely mirrored those obtained by sub-indices using band 8 (NDVI-B8, SAVI-B8, and NDMI-B8), which yield respective overall accuracies of 93%, 92%, and 89%. At a degree of membership α = 1, the estimated burned areas for the most effective indices encompassed 2144.38 hectares for NDVI-mean, 1932.14 hectares for mean SAVI-mean, and 4947.13 hectares for mean NDMI-mean. A prospective approach involving the amalgamation of these three indices could have the potential to yield improved outcomes. This study could be a substantial contribution to the discrimination of bushfires in Côte d’Ivoire.

NO reduction by CO over TiO_2-γ-Al_2O_3 supported In/Ag catalyst under lean burn conditions

TiO2/γ-Al2O3 supported In/Ag catalysts were prepared by impregnation method,and investigated for NO reduction with CO as the reducing agent under lean burn conditions.The microscopic structure and surface properties of the catalysts were studied by N2 adsorption-desorption,X-ray diffraction,transmission electron microscopy,X-ray photoelectron spectroscopy,ultraviolet-visible spectroscopy,H2 temperature-programmed reduction and Fourier transform infrared spectroscopy.TiO2/γ-Al2O3 supported In/Ag is a good catalyst for the reduction of NO to N2.It displayed high dispersion,large amounts of surface active components and high NO adsorption capacity,which gave good catalytic performance and stability for the reduction of NO with CO under lean burn conditions.The silver species stabilized and improved the dispersion of the indium species.The introduction of TiO2 into the γ-Al2O3 support promoted NO adsorption and improved the dispersion of the indium species and silver species.

Burning rate and other characteristics of strontium titanate （SrTiO3） supplemented AP/HTPB/Al composite propellants

In a quest of search for a new burning rate modifier for composite propellant, strontium titanate (SrTiO3), a perovskite oxide has been chosen for evaluation in a composite propellant formulation based on its other catalytic applications. Initially, SrTiO3 was characterized for particle size, morphology and material/ phase identification (using XRD). By varying SrTiO3 content in a standard composite propellant, different compositions were prepared and their performance and processing parameters like the end of mix (EOM) viscosity, mechanical properties, density, burning rate, pressure exponent (n-value), etc. were measured. The results reveal that 2% SrTiO3 causes more than 12% enhancement in propellant burning rate (at 70 ksc pressure) in comparison to the standard propellant composition. The pressure exponent also increases to 0.46, whereas the standard composition was having its value as 0.35.

Performance assessment of water mist applied in gas burning suppression in underground coal mine

The main objective of the present study was introduced water mist suppressiontechnology to prevent and control gas burning which occurred during drilling at Wu20160working-face in No.10 coal mine of Pingdingshan Ltd..Based on the self-developed ex-periment platform,a series of fire suppression tests to evaluate the performance of a watermist system were conducted.The detailed measurements of the spray characteristics,i.e.,the Sauter Mean Diameter(SMD),the velocity and spray angle which are the main pa-rameters considered in the Study,were obtained by using LS-2000 Sizer.The amount ofwater consumed and the water flux density distribution over the cross section downstreamthe nozzle exit were measured by cup collector method.The operating pressure of thewater mist nozzle is set to 0.5 MPa,the droplet SMD of 104 pm,the water flux density dis-tribution from 0.71 to 8.47 L/(m^2.min),the average velocity of 2.14 m/s.The experimentalresults show that the averaged time required for extinguishment is 3.14 s,and the corre-sponding amount of water used during fire test is about 0.11 kg.The gas fire suppressionsystem reduces the temperature in combustion chamber of the experimental apparatusbelow the ignition point of the gas,which can effectively avoid the occurrence of the gasfire in coal mine.

Effects of nutritional support route on intestinal structure and function in the early stage of severe burn injury

Objective:To assesstheclinicaleffectsof enteralnutritionon intestinalstructureandfunctionintheearly stageof severeburns.Methods :Nineteencasesof severeburninjuryweredividedrandomlyintoenteralnutrition group(EN)andparenteralnutritiongroup(PN).Gastrin,motilin,malondialdehyde(MDA),superoxidedismutase(SOD),endotoxin,tumornecrosis(TNF),diamineoxidase(DAO)andlactulose/mannitol(L/M)weredeterminedon postburnday1,4,8,14(PBD)respectively.Results:Serumgastrinandmotilinon PBD4and8weresignificantly higherinENgroupthanin PN group(P<0.05-0.01).PlasmaMDAon PBD4andPBD8was obviouslylowerin EN groupthaninPNgroup(P<0.01).PlasmaSODon PBD4andPBD8was significantlyhigherinENgroupthaninPN group(P<0.01).Atthemosttimepoints,endotoxinandTNFweresignificantlylowerinENgroupthaninPN group(P<0.01).SerumDAOtendedto decreaseinENgroup,andon PBD4itwasobviouslylowerinENgroupthaninPN group(P<0.01).GutpermeabilityL/Mon PBD4,PBD8wasobviouslyinENgrouplowerthaninPN group(P<0.05-0.01).Therewas positivecorrelationbetweenL/MandDAO,andbetweenMDAandTNF(P<0.05-0.01),and negativecorrelationbetweenL/MandSOD(P<0.01).Conclusion:On thebasisof thefindings,itis consideredthat theearlyenteralnutritionis moreeffectiveto preservethesecretionandmotilityof gastrointestinaltract,decrease intestinalischemiaandreperfusioninjury,reduceintestinalpermeability,decreaseplasmaendotoxinandmediators,andmaintainmucosabarrierfunction.Enteralnutritionis superiorto parenteralnutritionintheearlystageof severe burninjury.

Effective administration of cranial drilling therapy in the treatment of fourth degree temporal,facial and upper limb burns at high altitude:A case report

BACKGROUND Fourth degree burns damage the full thickness of the skin and affect underlying tissues.Skin grafting after debridement is often used to cover the wounds of salvageable severe burns.A granulation wound can be formed by drilling the skull to the barrier layer to solve the problem of skull exposure.Low oxygen levels present at high altitudes aggravate ischemia and hypoxia which can negatively impact wound healing.The impaired healing in such cases can be ameliorated by hyperbaric oxygen therapy.CASE SUMMARY We describe a patient who presented with fourth degree burns to the left temporal and facial regions upon admission in December 2018.The periosteum of the skull and the deep fascia of the face were exposed.After the first stage of debridement and skin grafting,the temporal skin did not survive well.Granulation was induced by cranial drilling,and then a local flap was transferred to cover the wound.The left temporal and facial wounds were completely covered and the patient recovered well.CONCLUSION Skin grafting and flap transfer after early debridement to cover the wound and control infection were of great significance.In the later stages of the patient's treatment,survival of the skin graft and skin flap was observed.The second stage repair was performed to achieve successful skin grafting by cranial granulation.Granulation was formed by drilling the skull,and then the wound was closed,which is suitable for cases with skull exposure and wounds with poor blood supply.We consider that hyperbaric oxygen treatment and improving tissue oxygen supply were beneficial in this patient.

Disruption of bone and skeletal muscle in severe burns

Severe burn injury triggers the body＇s nonspecific adaptive responses to acute insult, including the systemic inflammatory and stress responses, as well as the sympathetic response to immobilization. These responses trigger inflammatory bone resorption followed by glucocorticoid-induced apoptosis of osteoblasts and probably osteocytes. Because these patients are catabolic, they suffer concomitant muscle wasting and negative nitrogen balance. The use of anabolic agents such as recombinant human growth hormone and oxandrolone results in improved bone mineral content and muscle strength after approximately I year. Use of bisphosphonates within the first 10 days of a severe burn completely blocks the resorptive bone loss and has the added advantage of appearing to preserve muscle protein from excessive breakdown. The mechanism for the protective effect on muscle is not currently known. However, if the effect of bisphosphonates on muscle can be confirmed, it raises the possibility that bone communicates with muscle.

A model supported by GIS for locating and quantifying PM_(2.5) emission originated from residential wood burning

A research method was presented for spatially quantifying and allocating the potential activity of a fine particle matter emission （ PM2.5 ）, which originated from residential wood burning （RWB） in this study. Demographic, hypsographic, climatic and topographic data were compiled and processed within a geographic information system（GIS）, and as independent variables put into a linear regression model for describing spatial distribution of the potential activity of residential wood burning as primary heating source. In order to improve the estimation, the classifications of urban, suburban and rural were redefined to meet the specifications of this application. Also, several definitions of forest accessibility were tested for estimation. The results suggested that the potential activity of RWB was mostly determined by elevation of a location, forest accessibility, urban/non-urban position, climatic conditions and several demographic variables. The linear regression model could explain approximately 86% of the variation of surveyed potential activity of RWB. The analysis results were validated by employing survey data collected mainly from a WebGIS based phone interview over the study area in central California. Based on lots free public GIS data, the model provided an easy and ideal tool for geographic researchers, environmental planners and administrators to understand where and how much PM2.5 emission from RWB was contributed to air quality. With this knowledge they could identify regions of concern, and better plan mitigation strategies to improve air quality. Furthermore, it allows for future adjustment on some parameters as the spatial analysis method is implemented in the different regions or various eco-social models.

Up-regulation of Tim-3 Expression Contributes to Development of Burn-induced T Cell Immune Suppression in Mice

T cell immunoglobulin and mucin domain 3 （Tim-3） is well known to negatively regulate T cells responses, but its role in burn-induced T cells immune suppression remains unclear. In the present study, in order to identify the relationship between Tim-3 expression and post-burn T cells immune suppression, C57BL/6 mice were subjected to burn injury or sham injury, and the liver and spleen were harvested at the day 1 after operation. The expression level of Tim-3 on hepatic or splenic T cells and the functional properties of Tim-3＋ T cells were evaluated. It was found burn injury induced dramatically elevated Tim-3 expression on both hepatic and splenic CD4＋ and CD8＋ T cells in contrast with the post-burn depletion of T cells. Furthermore, Tim-3 expression was correlated with the suppressive phenotype of T cells following burn injury, including increased expression of anti-inflammatory cytokine IL-10, decreased expression of pro-inflammatory cytokines IFN-γ and TNF-α, reduced T cell proliferation and elevated co-expression of Tim-3 and PD-1. Moreover, Tim-3＋ T cells subsets were more prone to spontaneous apoptosis than Tim-3- T cells subsets. Our findings reinforce the idea that the up-regulated expression of Tim-3 on T cells after burn injury plays an important role in the development and maintenance of burn-induced T cell immune suppression.

Bilateral Pedicled Superficial Epigastric Flap in the Management of Circumferential Combined Degloving and Full Thickness Burn Hand Injury—A Case Report

We report a case of combined hand trauma in the form of circumferential degloving injury of the hand with full thickness friction burns of the hand, forearm and the distal part of the upper arm. On exploration the hand was found avascular with loss of vital structures and full thickness burns. As a salvage procedure the hand was embedded in the subcutaneous tissue of the abdomen for 4 weeks and after that elevated as an inferiorly based flap on the bilateral superficial inferior epigastric arteries. Two weeks later the hand was freed by division of the base of the flap bilaterally. The details and description of the injury, the procedure and the outcome are discussed.