Use of free scalp flaps in burns

Injury. 13. 175-l 77

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Abstracts Bacteriology

and infection

Monoarthritisfrom

blackthorn

injury

Chronic arthritis in a single joint may follow recognized or unrecognized penetration of the joint. Thorns and bristles may be responsible but cannot be demonstrated by means of X-ray examination. In 2 cases the exudate was subjected to centrifugal force and the precipitate examined with a microscope; fragments ofblackthorn were identified. Blake D. B., Bacon P. A., Scott C. A. et al. (1981) Monoarthritis from blackthorn injury: a novel method ofdiagnosis. Br. Med. .I. 282,36 1. Renal failure

Of 106 persons with tetanus that required artificial ventilation, 23 developed renal failure and 19 of these showed signs of sympathetic over-activity. This may have owed somethmg to the treatment of hypotension with sympathomimetic drugs. Seedat Y. K., Omer M. A. K., Seedate M. A. (198 1) Renal failure in tetanus. Br. Med. J. 282,360. Vascular

injuries

Subclavian

vascular injuries

Ninety-three patients with subclavian vascular injuries admitted between 1955 and 1978 had been reviewed. Only 2 patients ;had blunt trauma, the remainder suffered from penetrating stab or gunshot wounds. The mortality rate had fallen from 35 per cent to 4 per cent which was accounted for by a good preoperative assessment, a staged surgical approach and the frequent use of interpositional grafts instead of attempts at end to end arterial suture. A comment was made that obstruction of the subclavian artery did not lead to ischaemia of the limb due to a good collateral circulation around the shoulder, a point confirmed in severe brachial plexus injuries with associated vascular injuries. Graham J. M., Felicano D. V., Mattox K. L. et al. (1980) Management of subclavian vascular injuries. J. Trauma 20, No. 1 I. Oedbme

bleu

Four examples of this self-induced condition are described but the .authors found no common mental

factor other than the wish to gain attention. They favour a policy of not intervening. Brunning J., Gibson A. G. and Perry M. (1980) Oedtme bleu: a reappraisal. Lancef 1,8 10. *Percutaneous

subclavian

vein catheters

The authors review major complications discovered in 8 patients among 1500 patients who received subclavian venipunctures over a 6-month period at their institution. Retained catheter fragments were found in 2 patients and required surgical removal facilitated by dividing the clavicle. Four patients sustained intrapleural instillation of resuscitation fluid secondary to the perforation of their great vessels by the catheter. At least one fatality was associated with this infusion. Venous air embolism was found in 2 other patients one of whom expired from this complication. The authors propose that to avoid these major complications junior houseofficers and nurses should be better educated in the problems associated with subclavians. Daily inspection of catheters, early removal of unnecessary catheters, and improved equipment are also necessary to prevent these complications. In the discussion the authors state that their incidence of pneumothorax is less than 1 per cent. Feliciano D. V. et al. (1979) Major complications of percutaneous subclavian vein catheters. Am. J. Surg. 138,869. Burns Use of free scalp flaps in burns

Four free flap scalp transfers for secondary scalp and forehead reconstruction in burned children are reported. These may be of use in the solution of unusual and difficult reconstructive problems. Cole 0. R. (1980) Secondary scalp and forehead reconstruction using free flaps. Burns 7, 13 1. Another

burn severity risk index

This is concerned with another mortality index which takes into account the seven variables: sex; age; percentage body area burned; percentage second degree burn; percentage third degree bum; number of cortical sites burned and the oresence of inhalation injury. Difficulties will arise in the distinction between second degree and third degree burns on the first day of