Descriptive epidemiological study of burn admissions to the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital, Kumasi-Ghana, 2009–2016

Objective: To determine the trends in burn admissions, and aetiology, severity and mortality of patients admitted to the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital from May 2009 to April 2016 (7 years). Methods: Patients' data used in this longitudinal and retrospective study were accessed from the records of the Reconstructive Plastic Surgery and Burns Unit. Processed data were depicted in tables and figures as appropriate. Univariate and multivariate analysis and Pearson's rank correlation were used in comparing relevant groups. Data analysis was conducted using Excel version 2013 and SPSS version 17.0. Results: A total of 681 patients, with a male to female ratio of 1.1:1.0, were analysed. The average annual incidence was 97.28 with a progressive decline in incidence. Mortality rate was 24.2%. Majority of the patients were children less than 10 years (43.5%) with scalds as the main aetiology in this group. Open flame was the major aetiology of burns (49.9%). Majority of the patients spent less than 10 days on admission (67.1%). Mean total body surface area was 30.54%. There was correlation between TBSA and disposition, total body surface area and aetiology and number of days in the Burns Intensive Care Unit, total body surface area and aetiology, and aetiology and number of days in the Burns Intensive Care Unit. Conclusions: Children below 10 years were the main victims. There was a shift from scald to open flame burns in this current study. Mean total body surface area and mortality rate have increased. There is urgent need for prevention campaign of flame burn and first aid education on intensive burns.

The Burns Menace: Antibiotics for the Fight against Burns Bacterial Infection, a Systemic Review

Burn wound infection delays wound healing, leading to varying degrees of morbidity and mortality. Various antibiotics are administered to burn patients in burn wound management. The emergence of antibiotic resistance is a menace that costs families and the country. This review seeks to expound on infections related to burn wounds, common bacteria of burn wound infections and choice of antibiotics in burns treatment. Words such as burns, wound infection, burns injury and antibiotics were put into the Google search engine. Only articles related to the subject of burns, burn wound infection and antibiotics were used to write the review. Articles obtained included case reports on burns, research articles, review articles, short notes, briefs, literatures and other articles relating to burns. We found that the choice of antibiotics in the management of burns is an issue of major concern due to the evolution of pathogens causing these infections. The challenge of antibiotic resistance still persists in burns wound management. The commonly used topical antimicrobials included silver sulphadiazine, silver nitrate solution, silver impregnated dressings and mafenide acetate. Mafenide acetate has a wide antibacterial activity and also acts against the usual wound pathogens that were identified: Pseudomonas aeruginosa and Staphylococcus aureus. The role of antibiotic resistance is of major concern. Antibiotics must be administered after culture evidence in order to reduce the chance of increasing evolution of resistant strains of bacteria.

A Short Term Review of Operated Cases in the Plastic Surgery Unit at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Introduction: Surgical problems are of much disturbance to the world and should therefore be given serious attention. The prevalence of these surgical problems, has made plastic surgery become a broadly relevant and acceptable way for addressing problems like injuries, congenital anomalies, surgical infections and malignancies among others. Aim: This study is to quantify and characterize surgical procedures done in the plastic surgery theatre located in the new Accident and Emergency (A & E) Building of KATH. Materials and Methods: Data were obtained from the Operation Register/Theatre Books in the plastic surgery theatre at the A & E Centre on cases operated on from October 1, 2009 to September 30, 2012. Data entry, presentation and analysis were done using Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: Adults formed the majority of patients who sought for plastic surgery with a percentage of 70.3%. The male patients also outnumbered the females recording (61.5%) out of the total number of patients. Most of the cases recorded were acquired cases (93.2%). Reconstructive surgery was the commonest operation performed (30%);in 53.8% cases general anaesthesia was used. Conclusion: Among all the procedures used reconstructive surgery was the commonest surgery performed in the unit and general anaesthesia was the most type of anaesthesia used for the operations.

The Hemeostatic Efficacy of ANKAFERD after Excision of Full Thickness Burns: A Comparative Experimental Study in Rats

Objective: In order to evaluate the effects of Ankaferd blood stopper (ABS) on post-excisional burn wound bleeding via monitoring early blood hemoglobin level changes and to make a comparison with a standart topical treatment, a controlled experimental study was conducted. Design and Interventions: A contact burn model of full-thickness injury with 30% TBSA was used. Following the burn injury, excisions of burned areas were done at postburn 48th hour. 24 male Spraque Dawley rats were divided into control, adrenaline, ABS-solution and ABS-pad treatment groups. In control group no treatment was done for bleeding, but the other three groups had topical treatments. Samples were taken at the begining of the study, just before and 1 hour after the burn wound excisions for measurement of haemoglobine (Hb) levels and additionally the external bleeding amounts were measured by weighing the topical pads. Measurements and main results: Baseline Hb levels of control, adrenaline, ABS-solution and ABS-pad treatment groups were 15.06 ± 0,83, 15,82 ± 0.83, 16.23 ± 1.14 and 15.16 ± 1.46 respectively. At the 48th hour of postburn injury, the Hb levels of these groups were 13.82 ± 0.58, 13.68 ± 1.26, 13.79 ± 0.90 and 13.57 ± 0.89. Mean blood loss amounts (ml) after burn wound excisions in groups were 1.44 ± 0.26, 0.65 ± 0.07, 0.53 ± 0.08 and 0.44 ± 0.09. Conclusions: ABS was found to be as effective as topical adrenaline on reducing excisional bleeding in the experimental burn injury model.

Hypertrophic Scar Formation and Wound Healing Modulation Fatty Acids as Modulators of Severe Scars

Scar tissue usually generates severe discomfort in the short and long term. Common symptoms include anesthetics sequelae, pruritus, joint malfunction, new wounds on the scar surface, and pain. There are several treatments for scars, like compression, topical or intralesional steroid infiltration, 5-fluorouracil, dermabrasion, and surgeries with new scar tissue. For adult patients, it is easier to choose the treatment. However, compression is commonly applied in children to prevent treatments that have adverse effects. This study reports the outcomes of 15 patients submitted to abdominoplasty, traumatic wounds and post-burn scar treatments, which showed significant changes after the continuous use of an ointment composed of petrolatum, cod liver oil, BHT, Chamomilla recutita (chamomile) oil, Helianthus annuus (sunflower) oil, and Prunus amygdalus dulcis (sweet almond) oil. As components of the stratum corneum, unsaturated fatty acids influence the cutaneous structural and immune status and permeability. They also interfere with the maturation and differentiation of the stratum corneum and inhibit the production of proinflammatory eicosanoids, reactive species (ROS and RNS), and cytokines, thereby influencing the inflammatory response and possibly wound healing. This article aims to share our experience with the regular use of an ointment in adult and pediatric patients for three months. The increase in proinflammatory cytokine production at wound sites, resulting in a noninvasive, therapeutical, and effective cutaneous wound healing and scarring modulation, may provide a physiopathological explanation for the fast improvement of scars.

Survival analysis and mortality predictors of hospitalized severe burn victims in a Malaysian burns intensive care unit

Background:Prognostic measures to determine burn mortality are essential in evaluating the severity of individual burn victims.This is an important process of triaging patients with high risk of mortality that may be nursed in the acute care setting.Malaysian burn research is lacking with only one publication identified which describes the epidemiology of burn victims.Therefore,the objective of this study was to go one step further and identify the predictors of burn mortality from a Malaysian burns intensive care unit(BICU)which may be used to triage patients at higher risk of death.Methods:This is a retrospective cohort study of all admissions to Hospital Sultan Ismail’s BICU from January 2010 till October 2015.Admission criteria were in accordance with the American Burn Association guidelines,and risk factors of interest were recorded.Data was analyzed using simple logistic regression to determine significant predictors of mortality.Survival analysis with time to death event was performed using the Kaplan-Meier survival curve with log-rank test.Results:Through the 6-year period,393 patients were admitted with a male preponderance of 73.8%.The mean age and length of stay were 35.6(±15.72)years and 15.3(±18.91)days.There were 48 mortalities with an overall mortality rate of 12.2%.Significant risk factors identified on simple logistic regression were total body surface area(TBSA)>20%(p<0.001),inhalation injury(p<0.001)and presence of early systemic inflammatory response syndrome(SIRS)(p<0.001).Survival analysis using Kaplan-Meier survival curve showed similar results with TBSA>20%,presence of SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival(p<0.001).Conclusion:The predictors of mortality identified in a Malaysian BICU were TBSA>20%,early SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival outcome.The immunological response differs from individual patients and influenced by the severity of burn injury.Early SIRS on admission is an important predictor of death and may represent the severity of burn injury.Patients who required mechanical ventilation were associated with mortality and it is likely related to the severity of pulmonary insults sustained by individual patients.This data is important for outcome prognostication and mortality risk counselling in severely burned patients.

Infection control in severely burned patients

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 thecontrol 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.

Rhabdomyolysis, compartment syndrome and thermal injury

Rhabdomyolysis(RML) after electrical burns and crush injuries is a well-known clinical entity, but its occurrence following thermal injury has not gained so much attention. Capillary leak syndrome and following polycompartmental syndrome are devastating end results of major thermal injuries. In the current review, polycompartment syndrome within the clinical picture of systemic oedema and its relationship to RML is discussed along with its management and prevention.

Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair

AIM: To determine the influence of intra-abdominal pressure(IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. METHODS: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study.IAP monitoring was performed via both a balloontipped nasogastric probe [intragastric pressure(IGP), Ci MON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure(IBP), Uno Meter Abdo-Pressure Kit, Uno Medical, Denmark] on five consecutive stages:(1) after tracheal intubation(AI);(2) after ventral hernia repair;(3) at the end of surgery;(4) during spontaneous breathing trial through the endotracheal tube; and(5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.RESULTS: The IAP(measured via both techniques) increased on average by 12% during surgery compared to AI(P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube(P < 0.01). In parallel, the gradient between РаСО2 and Et CO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/Fi O2 decreased by 30% one hour after tracheal extubation(P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20%(P < 0.025). At all stages, we observed a significant correlation between IGP and IBP(r = 0.65-0.81, P < 0.01) with a mean bias varying from-0.19 mm Hg(2SD 7.25 mm Hg) to-1.06 mm Hg(2SD 8.04 mm Hg) depending on the study stage. Taking all paired measurements together(n = 133), the median IGP was 8.0(5.5-11.0) mm Hg and the median IBP was 8.8(5.8-13.1) mm Hg. The overall r2 value( n = 30) was 0.76(P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mm Hg(2SD 4.2 mm Hg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing IBP and IGP( n = 117).CONCLUSION: During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/Fi O2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance.

A Long Term Review of Surgically Treated Enlarged Breasts

Introduction: Breast hypertrophy (excessive enlargement of breast), a condition though rare, is well pronounced in some females. Surgery either by reduction mammaplasty or sub-cutaneous mastectomy is often employed in treatment of this condition. Aim: This study seeks to find out the long term level of satisfaction of the surgery on these persons after about 10 - 12 years after treatment. Materials and Methods: From January 1994 to December 2000, the Komfo Anokye Teaching Hospital (KATH) carried out surgeries on 43 females who presented with several degrees of breast hypertrophy. Patients were asked to answer questionnaires on their condition pre-operatively and post-operatively during the long term review process. Results: Thirty-four (79.1%) patients out of the 43 were available for the review with the patients stating there was much (100%) improvement in terms of the pain they felt in the neck, upper and lower back regions. There was no re-occurrence of the condition in any of the patients;29 (85.3%) stated they were satisfied and that their new breast size(s) was/were excellent for them. Conclusion: The pre-operative complications experienced by these patients were resolved hence this surgical procedure was good and the quality of life of these persons had been improved.

Management of Diabetic Foot Ulcers Using Negative Pressure with Locally Available Materials

Introduction: Diabetic ulcers are one of the main causes of morbidity and hospitalisation and thereby affecting the quality of life of persons suffering from the condition. The aim of the study was to assess the level of satisfaction of persons who underwent treatment for diabetic ulcers using negative pressure produced from locally available materials. Materials and Methods: Creating negative pressure using locally available materials such as sterilized foam, tubes with diameter between 0.5 and 0.8 cm, transparent adhesive plaster and a suction machine. Results: Thirty-seven patients were enrolled in the current study;70.3% (n = 26) were known diabetic patients on regular treatment while 29.7% (n = 11) were diagnosed when they presented for the first time with ulcers. Patients were made to grade their level of satisfaction with therapy involving these locally used materials. Out of the 37 patients, 35 (94.6%) stated their therapy was excellent while 1 (2.7%) said the therapy was good;therapy was discontinued in one patient (2.7%) who had some complication. Conclusion: Desirable outcomes were obtained when patients were treated using negative pressure wound therapy (NPWT) produced using locally manufactured materials. Patients were able to pay for the therapy since the cost was reasonably low.

Influence of immobilization and sensory re-education on the sensory recovery after reconstruction of digital nerves with direct suture or muscle-in-vein conduits

The influence of duration of immobilization and postoperative sensory re-education on the final outcome after reconstruction of digital nerves with direct suture or muscle-in-vein conduits was investigated. The final sensory outcome of 35 patients with 41 digital nerve injuries, who either underwent a direct suture（DS） or a nerve reconstruction with muscle-in-vein conduits（MVC）, was assessed the earliest 12 months postoperatively using static and moving two-point discrimination as well as Semmes-Weinstein monofilaments. There was no significant difference in sensory recovery in cases with an immobilization of 3–7 days versus 10 days in the DS or MVC group. Moreover, no statistically significant difference in sensory recovery was found in cases receiving postoperative sensory re-education versus those not receiving in the DS or MVC group. An early mobilization does not seem to have a negative impact on the final outcome after digital nerve reconstruction. The effect of sensory re-education after digital nerve reconstruction should be reconsidered.

Serum and Blister Fluid Pharmacokinetics of Amikacin in Severe Burn Patients

Objective: To characterize amikacin pharmacokinetics in serum and in blister fluid of severe burn patients to guide optimal treatment timing. Methods: Patients (N = 32) were divided into four groups based on amikacin administration timing and groups received drug minutes to hours after injury. In Groups A, B, C, and D, amikacin (400 mg, IV) was administered 3 - 4, 10, 20 and 30 h post burn injury, respectively (N = 8 for all groups). Next blister fluid and venous blood samples from 9 patients were obtained at 0, 0.25, 0.5, 1, 2, 3, 4, 5, 6, and 7 h after drug infusion. Amikacin concentrations were measured with a fluorescent polarization immunoassay and pharmacokinetics was deduced using DAS3.2.5. Statistical analyses performed with SPSS13.0. Results: Compared with normal values, t1/2z of amikacin from burn patients was shortened in serum but amikacin half-lives in blister fluid was significantly greater than serum half-life values (p < 0.05). Groups A and B had greater pharmacokinetic values at each time point, and Group D did not achieve antibacterial concentrations of amikacin. Conclusion: Early amikacin administration in severe burn patients offers greater concentrations of drug in serum and blister fluids.

Tertiary bone grafting with or without premaxilla osteotomy in adult alveolar clefts—Techniques and early outcome

The outcome of alveolar bone grafting in adult patients is sparsely reported. Here, we present a description of the surgical techniques used in a Nigerian teaching hospital and a preliminary report of the first five cases of adult alveolar cleft bone grafting accomplished with or without repositioning the premaxilla. Although, evidence of bone resorption was observed within 6 months after the operation, satisfactory bone level and aesthetic outcome was recorded in all cases. We concluded that tertiary alveolar bone grafting is desirable for all cases where alveolar clefts have persisted into adulthood to enhance the psyche of the cleft patients and to motivate them for further rehabilitation. Prompt placement of dental implant into the grafted area is recommended to mitigate subsequent resorption of the bone graft.

Quality Assurance in Wound Management in a Developing Country: How Satisfied Are Our Patients?

Background: Quality is important in every setting especially in the health service where the needs of patients should be an utmost priority. However, this is sometimes not the situation in most health care centres due to increasing stress because of inadequate resources and increasing demands for services. This present study seeks to assess quality assurance in the management of wounds. Method: A descriptive survey involving 280 participants;data was collected using structured questionnaire. The questionnaires included some quality indicators which were used to assess the quality of care patients received from the health facility. Results: Out of the 280 participants, females were 57.1% (n = 160) and males, 42.9% (n = 120). Ages of the participants ranged from 15 - 70+ years with a mean age of 35.8 ± 1.5;28.6% (n = 80) of staff had an excellent attitude while 5.7% (n = 16) had a fair attitude. The condition of 112 did not require surgery (40.0%), however, out of the 168 who underwent surgery, 32 (19.0%) were not satisfied while 136 (81.0%) were satisfied. Also, 97.1% (n = 272) were accorded privacy, 51.4% (n = 144) were assured of confidentiality, 48.6% (n = 136) were educated on diagnoses and treatment, 91.4% (n = 256) understood pharmacy instruction, 57.1% (n = 160) were satisfied with time spent in the facility, 97.1% (n = 272) were not shun by nurses because of their wounds. Conclusion: Patient satisfaction should be the priority of all persons working in the health facility. In accessing quality service, patient satisfaction can be met if quality assurance measures are put in place. This quality assurance measures should include all units of the health delivery system since it would help to ensure judicious use of resources in order to meet the health needs of patients.

Evaluation of bone remodeling in regard to the age of scaphoid non-unions

AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin(HE), tartrate resistant acid phosphatase(TRAP), CD 68, osteocalcin(OC) and osteopontin(OP). Histological examination was performed in a blinded fashion.RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU(P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts(P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts(P = 0.008; r = 0.43). SNU older than 6 mo showed a signifi-cant decrease of the number of fibroblasts(P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU.CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.

Lymphedema: Complications and Management

Introduction: Lymphedema is a condition of the lymphatic system characterized by tissue swelling of body parts especially the limbs as a result of fluid retention. This debilitating condition may result in morbidity and immobility, incapacitating and causing economic burdens as well as affects the individual’s physiological and psychological well being. Aim: The aim of the review is to expound extensively on lymphedema and its associated complications and their management. Methods: Information was obtained by searching on-line literatures, published articles and news reports on lymphedema, causes, diagnoses, complications and personal clinical experience. Also patients’ data were obtained from Komfo Anokye Teaching Hospital Plastic Surgery Consulting Room and Surgical Operative Records in Kumasi, Ghana. Results: Extensive information was obtained from the various sources which formed the basis of this article highlighting especially the complications which include infections and lymphangiosarcoma resulting from long-standing untreated lymphedema.Conclusion: Since management of the condition is possible, patients are encouraged to seek early treatment when they experience any form of swelling. Long-standing lymphedema may result in serious complications includinginfections: cellulitis, lymphangitis and lymphangiosarcoma resulting from severe cases of untreated lymphedema.

Use of a selective enzymatic debridement agent(Nexobrid■)for wound management:Learning curve

AIM To evaluate the efficacy of Nexobrid~? in the initial management of burns and lessons learned with the procedure.METHODS From January 27^(th) 2015 until January 25^(th) 2016, 25 patients aged between 18-94 years old with deep partial and full thickness burns were treated with Nexobrid~? covering 1%-30% of their total body surface area(TBSA). The debridement was applied in the first 96 h post-injury following the protocol suggested for Nexobrid~?. In patients with burns of more than 15% TBSA a second application of Nexobrid~? was performed. After the removal of the product-4 h post application and after a 2 h period of wet dressing-we used several products to cover the wound like Suprathel~?, Biobrane~?, Mepitel~? with wet dressing, silver sulphadiazine 1% cream, and in some cases even autografts. We treated patients with inhalation injury as well. All the procedures were done under deep sedation, regional blocks in extremities or general anaesthesia in the intensive care unit room or in the operating theatre.RESULTS After these first 25 cases, we have observed that patients with partial thickness burns treated with Nexobrid~?, experienced great benefits in the reduction of the need for autografting compared with the standard of care. This isbecause after selective enzymatic debriding of the burn scar we can distinguish different wound beds, which can coexist in the same patient, and we also managed to associate each one to its ability to epithelize. In major burns, besides the improvement in wound healing, we observed an important improvement in their general state. This may be because SIRS significantly improved through a bloodless debridement of necrotic tissue, decreasing the requirements of vasoactive drugs and fluid resuscitation. Circumferential burns also benefited from enzymatic debridement, observing a decrease in the number of compartment syndromes and the need for escharotomies. At present, we have not observed a positive effect in the evolution and outcome of major burns with inhalation injury.CONCLUSION The introduction of Nexobrid~? shows significant improvement in burn treatment. Cumulative experiences are necessary to adapt its application in all Burns Centres.

The Use of Rotation Flap to Cover a Facial Defect—A Case Study

Background: There are often situations that require the correction of facial defects. Local fasciocutaneous flaps provide a reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Among the various options of local flaps is the use of a rotation flap. Aim: The aim of this work is to demonstrate the reliability of the rotation flap in the correction of facial defects and its ability to achieve a good aesthetic outcome by applying the knowledge of facial aesthetic units. Case Presentation : This is a case report of a 28-year-old woman who suffered an avulsion injury to the face with loss of facial tissue resulting in exposure of the left zygomatic bone. The defect measured 5 cm × 6 cm. A rotation flap was used to cover the defect after the wound had been previously irrigated and debrided. Her wounds healed well. She suffered no facial nerve injury. The rotation flap resulted in a good colour match with no disruption of facial contour. Conclusion: The Rotation flap provides a reasonable option for reconstruction of facial defects with good colour and texture match.

Does Ringer Lactate Used in Parkland Formula for Burn Resuscitation Adequately Restore Body Electrolytes and Proteins?

Objective: Evaluation of the effect of Ringer Lactate, as the resuscitative burn fluid according to Parkland Formula, on restoring the levels of body electrolytes and proteins. Design: A retrospective cohort study. Setting: The National Burns Unit, Mafraq Hospital, Abu Dhabi, United Arab Emirates (UAE). Patients: One hundred and fifteen patients admitted with fresh burns between 1st of January 2011 and 31st of December 2013, who met inclusion and exclusion criteria. Methods: Team collected demographic and clinical data for each patient using a standard form. Patients received Ringer Lactate solely as the resuscitative burn fluid according to Parkland Formula. Baseline (pre-) and third-day (post-) variables included levels of sodium, potassium, chloride, proteins, and albumin. Researchers then performed paired comparisons of serum electrolytes and protein levels. Results: Mean values showed maintenance of the potassium and chloride levels within the normal range after administering the Ringer Lactate, significant decline in sodium, and a marked hypoproteinaemia and hypoalbuminaemia post-resuscitation. Conclusions: Ringer Lactate used as the mere resuscitative post burn fluid is suboptimal. Sodium supplementation may be required to correct hyponatremia. Colloids, preferably intravenous albumin should be added, as advised by the original Parkland Formula.