Tangential excision of scalp burns: experience from the Bradford fire disaster

Tangential excision of deep dermal scalp burns does not appear to be widely practised. During the Bradford Football fire victims sustained mixed depth scalp burns. These were mainly as a result of radiant heat, although falling molten bitumen was the cause of injury in a few patients. Deep dermal or full thickness burns of the scalp were tangentially excised and skin grafted. One patient did not have a graft applied after tangential excision. The early results of graft take were satisfactory. Subsequently, however, 56 per cent required further grafting; the reasons for this are discussed. Ten months after the incident there is no difference in appearance between areas of primary grafting and areas of secondary healing.

The complications of tissue expansion in breast reconstruction: a review of 75 cases

Seventy-five consecutive cases of breast reconstruction using tissue expansion are reviewed and the complications encountered are discussed. We conclude that, with careful patient selection, tissue expansion offers a simple, safe and reliable method of breast reconstruction.

Use of external reservoirs in tissue expansion

The use of tissue expanders having external reservoirs is presented. Twenty-four patients had 36 tissue expanders placed in the scalp, face, neck, upper limbs, chest, and lower limbs. All patients, apart from one, were taken to completion. This patient had erosion of the skin over expander and was only partially completed after removal of the expander. Apart from one instance of deflation at the end of the expansion where the skin could still be used, there were no other complications, in particular, no infections. The advantages of this technique are reduced operating time, ease of injection into the reservoir, lack of pain for the patient, early detection of reservoir or filling tube junction leakage, and lack of complications associated with the reservoir. This procedure is not recommended on at least theoretical grounds for breast expansion, where a permanent implant is to be inserted.

Breast reconstruction by tissue expansion

The techniques of tissue expansion for use in breast reconstruction is described, together with the results of its use in 33 patients. The advantages and disadvantages of tissue expansion in relation to other currently favoured techniques are discussed. It is concluded that tissue expansion represents a major advance in the field of breast reconstruction.

A prospective study of nasal fractures

A prospective survey of 60 patients requiring manipulation under anaesthetic for nasal fractures has been carried out using pre- and post-operative photographs in conjunction with a standardized proforma. The results are presented and discussed.

The correction of scalp hair defects by tissue expansion

This paper presents the results and complications in the correction of partial scalp alopecia in ten patients using the technique of 'tissue expansion'. The average size of defect that was covered by expanded hair bearing scalp was 45.9 cms2, and the largest defect covered measured 11 X 6 cm. This series indicates that tissue expansion is now one of the most promising methods available for dealing with the difficult problems of partial alopecia which can present to surgeons and physicians in a wide range of specialties.

Treatment of burns casualties after fire at Bradford City football ground

On 11 May 1985 the main stand of Bradford City Football Club caught fire. Within four minutes the stand was alight from end to end. Fifty three people were burnt to death and about 250 injured; 83 required admission to hospital, and 55 of these were treated by primary excision of their burns and skin grafting. In such disasters the help of staff from other hospitals and areas is essential. Patients should be assessed to see whether they have burns that will ultimately be fatal; if they have they should not be sent to regional burns units, where they would take up beds that could be used for patients with treatable burns. All districts should ensure that their plans for accidents in which burns injuries predominate are adequate.

Continuous subcutaneous tissue pH measurement as a monitor of blood flow in skin flaps: an experimental study

A miniaturised glass pH probe that makes possible the continuous measurement of subcutaneous tissue pH is described. This instrument has been evaluated as a monitor of blood flow in experimental skin flaps. A rapid fall in tissue pH in response to either arterial or venous occlusion was observed. The results suggest that this technique may be a useful method of monitoring microvascular free flaps.

Cross-leg fasciocutaneous flaps

Twelve patients with cross-leg fasciocutaneous flaps are reported. Of the 12 flaps, 11 healed without loss, with satisfactory cover of the recipient area, and without trouble in the donor area.

Repair of lower leg injuries with fascio-cutaneous flaps

Experience with sixteen consecutive cases of lower leg skin loss has confirmed the reliability of Pontén's fascio-cutaneous or "super flap" (1981) in the management of these difficult injuries. The technique has several important advantages compared with the conventional lower leg flaps of both the ipsi-lateral and cross-leg variety.

Total surgical management of Binder's syndrome

Binder's syndrome consists of nasomaxillary hypoplasia with a characteristic nasal deformity. Occlusion may be normal or class III. The cephalometric appearances are almost characteristic. The Le Fort II osteotomy is ideal for correcting the problem, though initial results were not entirely satisfactory because of incomplete correction of the nasal deformity. Over the past few years the periosteum of the floor and lateral walls of the pyriform cavity has been widely dissected to obtain adequate nasal advancement. The alar base, nostril sill, and nasal spine area have been selectively augmented with carved bone or cartilage grafts. Lengthening of the columella has been achieved by advancement of bilateral nostril sill flaps into the columella. Advancement of the maxilla with a previously normal occlusion may require orthodontic treatment, either preoperatively or postoperatively, to ensure normal occlusion. The authors have treated 26 patients with this condition over the last ten years.

The pattern of lymph node metastases in intra-oral squamous cell carcinoma

Histological study of all radical neck dissection specimens from 98 patients with clinically operable intra-oral squamous cell carcinoma has been carried out since 1973 to establish not only the presence of positive nodes but their site in the neck. All cases treated primarily by other methods such as radiotherapy or chemotherapy were excluded. Positive lymph nodes, found in 73 specimens, were grouped according to the site of the primary lesion. In no patient were nodal metastases found in the posterior triangle or in the submental region. No tumour deposits were found in the salivary glands nor were any found either in or superficial to the sternomastoid muscle. Obviously several factors must be taken into account in deciding the place of "functional" as distinct from radical neck dissection in the treatment of intra-oral malignancy, but the findings in this survey provide evidence in favour of the simpler less radical approach.

Cialit preserved homograft cartilage in nasal augmentation: a long-term review

Costal cartilage was harvested from cadavers less than 55 years old, stored in Cialit at a temperature of 4 degrees C and kept in a "cartilage bank" for no longer than one year. The cadaver cartilage was used largely for nasal augmentation and this paper describes the results of 67 cartilage homograft implants in patients who have been followed up for 1-8 years. These suggest that Cialit preserved cartilage homograft should be the first choice of material in nasal augmentation.