British journal of plastic surgery
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We have used 57 fasciocutaneous flaps in 24 patients to correct burn contractures. There were six complications, four of which healed with dressings alone. The flaps were used either locally (22 patients) or as a cross-leg flap (2 patients). ⋯ Firstly, there is no skin graft, which may result in further contracture. Secondly, if a patient does not have a skin graft on the secondary defect (83% in this series), the patient has the advantage of a shorter hospital stay. The techniques of the design and raising of fasciocutaneous flaps for burn reconstruction are discussed.
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Admissions to the McIndoe burns unit over the period 1975 to 1984 were reviewed and 123 patients over the age of sixty-five were studied in detail. Comparison with standardised mortality curves showed no difference in survival rates, but review of individual cases suggests that regular examination of elderly patients could shorten admission times and reduce the mortality by encouraging prompt identification and treatment of medical complications. ⋯ Excision of burns on or before the fifth day resulted in longer admissions and increased the number of procedures per patient. Disagreement in the recent literature on this point suggests the need for a randomised, controlled trial of early excision in the elderly patient.
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Full thickness wounds, one on either side of the backs of rabbits, were covered with meshed or non-meshed split thickness skin grafts. The wounds were measured over a 3 month period and the minimum and maximum sizes of the wounds determined as well as the rate of growth. Wounds covered with meshed grafts contracted to 55% of the original size while those covered with non-meshed grafts contracted to 81.5% (p = less than 0.0001). The meshed wounds grew to 114.6% of original area and non-meshed grew to 153.3% (p = 0.035) after 13 weeks.
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The effects on anaesthesia of adding hyaluronidase to subcutaneous lignocaine were evaluated in a volunteer's forearm. Three beneficial effects were demonstrated: Onset of anaesthetic was immediate. ⋯ The area of anaesthesia was more than doubled compared to the control without hyaluronidase. The indications for the use of hyaluronidase in plastic surgery and its effectiveness as an adjunct to nerve blocks are discussed.