Peripheral nerve entrapments of the lower leg, ankle, and foot

Peripheral nerve entrapments are a relatively rare and heterogeneous group of nerve disorders encompassing a wide variety of etiologies and clinical presentations. These conditions can present significant diagnostic challenges, owing to both the variety of symptoms these patients display, along with the anatomic variation that exists between individuals. Precise knowledge of the anatomic course, the common motor and sensory distributions of each of the peripheral nerves, and judicious use of imaging or electrodiagnostic testing can greatly assist in arriving at a correct diagnosis. In this article, we discuss in detail the anatomy, clinical presentation, diagnosis, and treatment options for peripheral nerve entrapments of the lower extremity involving the sural, saphenous and common, superficial, and deep peroneal nerves.

Pruritus: management algorithms and experimental therapies

Pruritus (itch) is a major symptom in many dermatologic as well as systemic diseases and has a dramatic impact on the quality of life in these patients. The symptom of itch has to be treated on the basis of its pathophysiology and its underlying disease. In daily practice, a "quick" diagnosis of the underlying disease is often difficult, although a rapid relief of the itch is desired. We often treat patients on the basis of the symptomatology. A rational therapeutic ladder for a symptomatic therapy is useful until the final diagnosis has been confirmed. There are probably many subtypes of pruritus, just as there are many diseases that cause itch. The pathophysiology in many subtypes of pruritus is still poorly understood, hindering a rapid and targeted treatment strategy. An extensive diagnostic workup is often required to determine the final cause(s) of the itch. Thus, in daily life, physicians often start with a more or less rational therapeutic strategy to combat the debilitating itch. We present possible therapeutic ladders that form the basis for effective therapeutic itch strategies in various diseases. On the basis of our current knowledge about the different pathophysiologies of itch, on clinical trials or case reports, and our own clinical experience, we aim to present therapeutic ladders for the rapid as well as long-term management of itch. Finally, we summarize current exciting developments of experimental strategies in itch research and in clinical development for itch therapy.

Arteriovenous malformation in the pretragal region: case report

BACKGROUND

Arteriovenous malformation (AVM) in the extracranial region is uncommon. The most common sites are cheek, ear, nose, and forehead in order of frequency in the extracranial region. Although the external ear is the second most common site for the extracranial AVM, AVM in the pretragal region has not been reported until now.

METHODS AND RESULTS

We reported a case of AVM in the pretragal region, which was successfully removed by complete excision after preoperative selective embolization in a 32-year-old man. Combined superselective and particle embolization is a useful method to decrease the blood flow in the pretragal AVM.

CONCLUSION

We successfully treated the patient for the AVM in the pretragal area by complete excision within 72 hours after the preoperative combined superselective and particle embolization. Although our case is similar to auricular AVMs in point of symptoms and treatment, this is the first case reported at this unusual site.

Case report of a new variant of double incomplete superficial palmar arch

A rare, unique and previously non-described form of duplicated incomplete superficial palmar arch is reported in the right hand of a male cadaver. The two incomplete arches were formed from the continuation of two terminal palmar branches of the ulnar artery in the distal third of forearm that were connected by a small transverse artery superficial to the flexor retinaculum. Both arches had no contribution from the radial artery. The palmar digital branches from the lateral arch supplied the lateral two-and-a-half fingers, while those from the medial arch supplied the medial two-and-a-half fingers. The thumb and index had additional blood supply from the princeps pollicis and radialis indicis branches of radial artery. The deep palmar arch was entirely formed by the radial artery with no contribution from the ulnar artery. Previous reports on various patterns of superficial palmar arch are highlighted, and the anatomical and clinical importance of the new pattern are discussed.

High density polyethylene/graphite nano-composites for total hip joint replacements: processing and in vitro characterization

The main objective of the present study is to investigate how the thermal, rheological, mechanical and cytotoxicity behavior of High Density Polyethylene (HDPE) can be changed by the addition of graphite nano particles (GNPs) at different contents. The HDPE/GNPs composites were prepared using melt blending in a co-rotating intermeshing twin screw extruder. The in vitro tests results showed that the original material (HDPE) and all HDPE/GNPs composites do not exhibit any cytotoxicity to the WISH cell line. The microscopic examination of the nano-composite tensile-fractured surface found a good distribution of GNPs in the HDPE matrix. The Differential Scanning Calorimetry (DSC) results indicated that the crystallization percentage increased by adding GNPs to HDPE up to 4%. The XRD patterns of the HDPE/GNPs composites showed an increase in peak intensity compared to neat HDPE. This increase echoed the crystallinity results obtained from DSC. The rheological tests showed that the complex viscosity of the HDPE increased as the percentage of GNPs increased due to the restriction of the molecular mobility. The tensile test results showed that with increasing the GNPs content, Young's modulus and the yield strength of the HDPE/GNPs composite increased while the strain at fracture decreased. Finally, the preliminary results of the abrasion test indicated that the abrasion rate decreased by increasing the GNPs ratio up to 4% content. The prepared HDPE/GNPs composites appear to have fairly good comprehensive properties that make them a good candidate as a bearing material for the total joint replacement.

Extravasation management: clinical update

OBJECTIVE

To present a clinical update on the prevention, detection, and evidence-based management of vesicant chemotherapy extravasations.

DATA SOURCES

Journal articles, published and unpublished case reports, personal experience.

CONCLUSION

In the 4 years that have elapsed since the publication of the original article, much more is known about vesicant chemotherapy extravasation, and effective evidence-based treatments now are available. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants and cited in nursing guidelines. The anthracycline extravasation treatment dexrazoxane for injection, the first and only extravasation treatment with proven effectiveness, is now available as Totect (dexrazoxane; TopoTarget USA, Rockaway, NJ, USA) in the US and Savene (SpePharm, Amsterdam, The Netherlands) in Europe.

IMPLICATIONS FOR NURSING PRACTICE

Nurses who administer vesicant chemotherapy agents need to be aware of the most current evidence (or lack of evidence) for various types of extravasation treatment. Well-informed nurses are patient advocates and instrumental in detecting, managing, and documenting extravasations. Most importantly, nurses play a key role in preventing vesicant chemotherapy extravasations.

Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis

BACKGROUND

In treating patients with brachial plexus injury, there are no comparative data on the outcomes of nerve grafts or nerve transfers for isolated upper trunk or C5-C6-C7 root injuries. The purpose of our study was to compare, with systematic review, the outcomes for modern intraplexal nerve transfers for shoulder and elbow function with autogenous nerve grafting for upper brachial plexus traumatic injuries.

METHODS

PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for studies in which patients had surgery for traumatic upper brachial plexus palsy within one year of injury and with a minimum follow-up of twelve months. Strength and shoulder and elbow motion were assessed as outcome measures. The Fisher exact test and Mann-Whitney U test were used to compare outcomes, with an alpha level of 0.05.

RESULTS

Thirty-one studies met the inclusion criteria. Two hundred and forty-seven (83%) and 286 (96%) of 299 patients with nerve transfers achieved elbow flexion strength of grade M4 or greater and M3 or greater, respectively, compared with thirty-two (56%) and forty-seven (82%) of fifty-seven patients with nerve grafts (p < 0.05). Forty (74%) of fifty-four patients with dual nerve transfers for shoulder function had shoulder abduction strength of grade M4 or greater compared with twenty (35%) of fifty-seven patients with nerve transfer to a single nerve and thirteen (46%) of twenty-eight patients with nerve grafts (p < 0.05). The average shoulder abduction and external rotation was 122° (range, 45° to 170°) and 108° (range, 60° to 140°) after dual nerve transfers and 50° (range, 0° to 100°) and 45° (range, 0° to 140°) in patients with nerve transfers to a single nerve.

CONCLUSIONS

In patients with demonstrated complete traumatic upper brachial plexus injuries of C5-C6, the pooled international data strongly favors dual nerve transfer over traditional nerve grafting for restoration of improved shoulder and elbow function. These data may be helpful to surgeons considering intraoperative options, particularly in cases in which the native nerve root or trunk may appear less than optimal, or when long nerve grafts are contemplated.

Blood transfusion requirements in cleft lip surgery

OBJECTIVE

Cleft lip surgery is a common procedure performed by surgeons worldwide. The aim of the study was to determine blood transfusion requirements and factors influencing blood transfusion in cleft lip surgery.

METHODS

Transfusion rate in 100 consecutive patients who had cleft lip surgery was prospectively evaluated at the Lagos University Teaching Hospital, Nigeria. Data collected included age and sex of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Cardiovascular parameters at the point of transfusion were also recorded. Each patient was made to donate a unit of homologous blood prior to surgery.

RESULTS

Mean estimated blood loss during surgery was 26.5 ± 47.1 ml. Most patients (92%) lost between 2 and 50 ml of blood. Mean estimated blood loss in unilateral cleft lip surgery was not significantly differently from that of bilateral cleft lip surgery (P=0.46). Only five patients (5%) required blood transfusion. The mean blood transfused was 50.0 ± 16.9 ml. All the patients transfused had a preoperative haematocrit of <30% (23-27%). The cross-match-to-transfusion ratio for cleft surgery was 20. The transfusion index was 0.05 and overall blood-ordering quotient was 20.

CONCLUSION

Cleft lip surgery is a low volume blood loss surgery. Homologous blood donation prior to cleft lip surgery in patients with preoperative haematocrit of 30% or more is not necessary. For patients with preoperative haematocrit of less than 30%, type and screen of donated blood should be adequate.

Repair of dorsal defects over the middle phalanx and proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

PURPOSE

We report the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of soft tissue defects on the dorsum of the middle phalanx and proximal interphalangeal joint involvement.

METHODS

From October 2005 to November 2008, we treated 16 digits in 16 patients in our unit. There were avulsion (n = 3), third-degree burn (n = 7), and crush (n = 6) injuries. The mean flap size was 2.3 × 1.8 cm (range, 1.8 × 1.7 cm to 2.6 × 2.3 cm). The mean pedicle length was 1.7 cm (range, 1.0-2.3 cm). At follow-up, we measured active joint motion. The scar pain at the donor site was determined by the patient's self-reported assessment. We measured cold intolerance using the self-administered Cold Intolerance Severity Score questionnaire.

RESULTS

All flaps survived completely. At the final follow-up after 2 years, the mean active motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 90°, 105°, and 57°, respectively. All scars on the donor sites were painless. All patients were mildly cold intolerant.

CONCLUSIONS

This transposition flap raised from the dorsum of proximal phalanx is useful and reliable for coverage of a dorsal defect over the middle phalanx and proximal interphalangeal joint with minimal donor site morbidity.

Cleft lip and palate: understanding genetic and environmental influences

Clefts of the lip and/or palate (CLP) are common birth defects of complex aetiology. CLP can occur in isolation or as part of a broad range of chromosomal, Mendelian or teratogenic syndromes. Although there has been marked progress in identifying genetic and environmental triggers for syndromic CLP, the aetiology of the more common non-syndromic (isolated) forms remains poorly characterized. Recently, using a combination of epidemiology, careful phenotyping, genome-wide association studies and analysis of animal models, several distinct genetic and environmental risk factors have been identified and confirmed for non-syndromic CLP. These findings have advanced our understanding of developmental biology and created new opportunities for clinical translational research.

The spectrum of median craniofacial dysplasia

Given the multiple permutations in craniofacial malformations, classification of median craniofacial dysplasia or midline Tessier no. 0 to 14 clefts has been difficult and disjointed. In this review, the authors present a summary of normal embryology, prior terminology, and their proposed new classification system. Median craniofacial dysplasia has tissue agenesis and holoprosencephaly at one end (the hypoplasias), frontonasal hyperplasia and excessive tissue (the hyperplasias) at the other end, and abnormal splitting or clefting and normal tissue volume (dysraphia) occupying the middle portion of the spectrum. These three distinct subclassifications have different forms of anomalies within their groups.

Traumatic funicular phlebitis of the thoracic wall resembling Mondor's disease: a case report

Introduction

Mondor's disease is a peculiar form of thrombophlebitis, involving a superficial vein in the subcutaneous fat of the breast or anterior chest wall.

Case presentation

The author presents a case of a 35-year-old male Japanese patient with cord-like induration in the right lateral thoracic wall. This lesion was diagnosed as traumatic funicular phlebitis, resembling Mondor's disease.

Conclusion

Traumatic funicular phlebitis, resembling Mondor's disease, is a clinical entity which may give suggestive insight to the etiology of Mondor's disease itself.

The mechanism of TGF-β signaling during palate development

Cleft palate, a malformation of the secondary palate development, is one of the most common human congenital birth defects. Palate formation is a complex process resulting in the separation of the oral and nasal cavities that involves multiple events, including palatal growth, elevation, and fusion. Recent findings show that transforming growth factor beta (TGF-β) signaling plays crucial roles in regulating palate development in both the palatal epithelium and mesenchyme. Here, we highlight recent advances in our understanding of TGF-β signaling during palate development.

The ongoing challenges with renal vascular access

Renal vascular access is pivotal in the care of the haemodialysis patient; however, it remains a significant challenge to maintain vascular access in the dialysis population. There are a number of renal vascular accesses in use: arteriovenous fistula, arteriovenous graft, and central venous catheter, with the arteriovenous fistula being the ideal choice. Poor vascular access can lead to serious consequences for patients, resulting in morbidity and even mortality. There are also significant cost implications for healthcare providers in terms of hospital admissions, and other associated costs for patients who are admitted late for vascular access referral or as a result of associated complications of vascular access. The nurse and other members of the healthcare team are fundamental in the management of a patient's renal vascular access.

Telerobotic anterior translocation of the ulnar nerve

The application of telerobotics in the biomedical field has grown rapidly and is showing very promising results. Robotically assisted microsurgery and nerve manipulation are some of its latest innovations. The purpose of this article is to update the community of shoulder and elbow surgeons on that field. Simple anterior subcutaneous translocation of the ulnar nerve was first experimented in two cadavers, and then performed in one live patient who presented with cubital tunnel syndrome. This procedure is the first reported case using the robot in elbow surgery. In this paper we attempt to analyze various aspects related to human versus robotically assisted surgery.

Polymorphisms in CHDH gene and the risk of tooth agenesis

BACKGROUND

Tooth agenesis is one of the most common anomalies of human dentition and is due to a complex and not fully elucidated etiology. The purpose of this study was to evaluate the possibility that polymorphic variants of genes encoding the main folate and choline metabolism enzymes might be associated with the risk of hypodontia in the Polish population.

METHODS AND RESULTS

We analyzed 21 polymorphisms of 13 candidate genes and found that single nucleotide polymorphisms (SNPs) in the CHDH gene are significantly correlated with the risk of dental agenesis. The strongest association was found for the SNP located in the intronic sequence of CHDH. Individuals carrying one copy of the rs6445606 C allele had an over two-fold decreased risk of having hypodontia (odds ratio [OR]CTvsTT=0.434; 95% confidence interval [CI], 0.2724-0.6915; p=0.0004; pcorr=0.0084). A reduced risk of tooth agenesis was also observed in individuals with one or two copies of the rs6445606 C allele compared to T allele carriers (ORCT+CCvsTT=0.524; 95% CI, 0.3386-0.8097; p=0.0035; pcorr=0.0735). Moreover, the gene-gene interaction analysis revealed a significant epistatic interaction between CHDH (rs6445606) and PLD2 (rs3764897) in the susceptibility to hypodontia (p=0.004).

CONCLUSION

Our study identified CHDH and PLD2 as novel candidate genes, the nucleotide variants of which could be associated with the risk of tooth agenesis.

Gigantomastia in pregnancy with an accessory axillary mass masquerading as inflammatory carcinoma

Giagantomastia is a rare disorder known to occur in pregnancy, causing enlargement of the breasts greater than that of gravid enlargement. The histological features of gigantomastia are glandular hyperplasia and an increase of stromal tissue. Illustrated by one documented case, cytomorphology of gigantomastia was misdiagnosed as a phyllodes tumor. We document the cytomorphology of an axillary mass in a gravid woman of 24 years with gigantomastia. She presented in her first trimester with bilateral mastalgia and swelling, nonresponsive to antibiotics. Imaging excluded mass breast lesions and a pituitary prolactinoma. The breasts progressively enlarged, became warm, tender, and developed skin ulcerations and a peau d'orange appearance. Subsequently she developed a mass in her left axilla. On aspiration of the mass, some of the cytomorphological features were suspicious for a metastasis, which correlated well with her clinical features. Careful evaluation suggested cytomorphology to be compatible with benign accessory breast tissue with possible hormone related changes of pregnancy. Histology of the excised axillary mass confirmed this diagnosis. Thus, awareness of this rare condition and careful evaluation is mandatory to avoid misdiagnosis in a similar clinical context.

Marjolin's ulcers in sub-Saharan Africa

BACKGROUND

Cutaneous malignancies are considered rare among Africans. Trauma, its sequelae, and other chronic non-healing wounds are known to predispose to malignant degeneration. Not much is known of the demographics of Marjolin's ulcers in sub-Saharan Africa.

METHODS

Pathology records on patients suspected to have Marjolin's ulcers submitted to the Pathology Department were extracted from a database of 75,124 specimens. A review of the English literature on Marjolin's ulcers from Nigeria, a sub-Saharan country, was also performed.

RESULTS

Of 210 specimens from suspected Marjolin's ulcers, 167 records had a histological diagnosis of malignancy, with a male to female ratio of 1:1.4, and a mean age of 48 years (range: 4-97 years). There were 163 (97.6%) squamous cell carcinomas, 3 (1.8%) sarcomas, and 1 (0.6%) malignant melanoma. Burn scars, chronic ulcers, osteomyelitis, and "other" ulcers constituted 82 (49%), 70 (42%), 9 (5.4%), and 6 (3.6%), respectively. Subjects in six sub-Saharan Marjolin's ulcer studies had a mean age between 36 and 42 years, with a mean latent period 16 years.

CONCLUSIONS

Marjolin's ulcers in sub-Saharan African have a shorter latent period, and they occur in younger patients. Provision of early stable wound cover is essential for prevention of malignant degeneration of scars, while early appropriate intervention is crucial in the treatment of chronic ulcers.

An ideal composite graft donor site for postburn alar rim deficiencies: root of helix

One of the challenging postburn face deformities is alar rim defects or deformities. Small through-and-through defects of the nasal ala may be managed with a composite graft of auricular tissue, obtained from the earlobe, the helical rim, and the root of the helix. We use usually the root of the helix for postburn alar defect correction as a composite graft donor site. The advantage of these composite grafts is that the procedure is a single-stage operation with excellent contour correction and a well toleration of donor site morbidity by the patient.

Unilateral intercordal neural communication coexistent with variant branching pattern of posterior cord of brachial plexus

Variant branching pattern of the cords of brachial plexus coupled with erroneous communications has been an area of concern for surgeons opting to explore this region. Anaesthetic blocks and surgical approaches are the highlights of these interventions, where a keen familiarization of the anatomy of this region is mandatory. The present case description reports a unilateral variant branching pattern of the posterior cord coexistent with a neural communication between lateral and medial cords in an adult male cadaver. This intercordal neural communication between lateral and medial cords was oriented obliquely and measured 2.2 cm in length. Furthermore, the posterior cord revealed a variant branching pattern. It branched into three upper subscapular nerves and a common trunk for the thoracodorsal and lower subscapular nerves. The lowest of the three upper subscapular nerves gave a communicating twig to the thoracodorsal nerve. Inspite of uncountable reports on variations ofbrachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anesthetists and surgeons, besides being of academic interest for the anatomists.

The wash-out technique in the management of delayed presentations of extravasation injuries

Late presentation of extravasation injuries from chemotherapeutic agents is not uncommon. Twenty-four patients with extravasation injuries presented with upper limb extravasation but without any skin necrosis between the second and the fourteenth day following injury day. We flushed out the infiltrated area with 300-500 ml of normal saline through multiple stab incisions. All 24 patients responded well to the procedure and no further complications occurred. The average time for the complete healing of the wounds was 15 days. All the patients were able to continue their chemotherapy treatment without delay. Patients were followed up for a mean period of 13 months. They all recovered with no functional deficit and only mild scarring. Early recognition and immediate treatment of extravasation injuries are of paramount importance. In cases with no evidence of skin necrosis, a delayed wash-out procedure appears to be very effective in removing the extravasated drug and minimizing further tissue damage.

Adeloye-odeku disease in aseer region of saudi arabia

Adeloye-Odeku disease, also known as congenital inclusion dermoid cyst (CIDC) of the anterior fontanelle was first described in a publication in 1971 by Adeloye A and Odeku EL, as a solitary congenital subgaleal inclusion dermoid cyst of the anterior fontanelle in Nigerians. This rare lesion, (0.1-0.5% of all cranial tumors and 0.2% of all inclusion cysts), was initially thought to be an African cyst. The universal distribution of this cyst has subsequently been shown in accumulated literature of other ethnic distribution, Caucasians, Indians, Chinese, Japanese, Turkish and others. This is the first published report that we know of Adeloye-Odeku disease in Saudi Arab children in Abha, Saudi Arabia. Four patients with Adeloye-Odeku disease, two boys and two girls, Saudi patients with ages ranging from 3months to 9years are presented. All had CT and MRI brain scans. Successful surgical excision of the cyst was achieved in each of the three patients who consented for surgery and there was no recurrence. The parents of the oldest patient declined surgical intervention but agreed to outpatient follow up.

Polymorphisms located in the region containing BHMT and BHMT2 genes as maternal protective factors for orofacial clefts

Nonsyndromic cleft lip with or without cleft palate (NCL/P) is one of the most common craniofacial malformations; however, its aetiology is still unclear. Because the effects of maternal nutrition on fetal development are well known, we decided to pursue the question of whether polymorphic variants of genes encoding enzymes involved in choline metabolism might be associated with the maternal risk of having a baby with NCL/P. Analysis of 18 single nucleotide polymorphisms (SNPs) of betaine-homocysteine methyltransferase (BHMT), betaine-homocysteine methyltransferase-2 (BHMT2), choline dehydrogenase (CHDH), choline kinase (CHKA), dimethylglycine dehydrogenase (DMGDH), choline-phosphate cytidylyltransferase A (PCYT1A), and phosphatidylethanolamine N-methyltransferase (PEMT) provided evidence that polymorphisms located in the region containing BHMT and BHMT2 were protective factors against NCL/P affected pregnancies in our population. The strongest signal was found for the SNP located in the intronic sequence of BHMT2. Women carrying two copies of the rs625879 T allele had a significantly decreased risk of having offspring with orofacial clefts. These results were significant, even after correction for multiple comparisons. Moreover, the gene-gene interaction analysis revealed a significant epistatic interaction of BHMT2 (rs673752), PEMT (rs12325817), and PCYT1A (rs712012) with maternal NCL/P susceptibility. Altogether, our study identified a novel gene, the nucleotide variants of which were be associated with a decreased risk of having a baby with NCL/P.

Deep palmar communications between the ulnar and median nerves

Innervation of the hand is supplied via the radial, median, and ulnar nerves. A common border of sensory distribution between the ulnar and median nerves is along the fourth digit. However, this sensory distribution may be affected by communication between these two nerves. Among the known communications between the median and ulnar nerves, the deep anastomotic branch in the hand is the least described and rarely illustrated in the literature. This study aims to provide data on the prevalence of a deep communicating branch via cadaveric dissection. We examined 50 hands taken from 25 adult cadavers. Communicating branches were found in 16% of the hands examined, with rami occurring bilaterally in two specimens. By describing the origin and pathway of this communicating branch, we hope to provide surgeons and clinicians with knowledge that may help avoid iatrogenic injuries.

Adult isolated congenital anterior urethrocutaneous fistula

Isolated congenital anterior urethrocutaneous fistula (CAUF) is an extremely rare deformity and few cases have been reported in the English language literature. Moreover, adult CAUF has not been reported up to now. We present a rare adult patient with this unusual isolated CAUF deformity. The possible etiology and treatment strategy are discussed.

Prevention of burns: 13 years' experience in Northeastern India

Burns are noteworthy causes of morbidity and mortality in India. Community-based interventions in the forms of multi-strategic and multi-focussed preventive programs are, however, lacking. This study, undertaken in the remote corner of Northeastern India, aims at reducing the incidence of burns through focussed attention towards sensitising the community with well-structured preventive programmes. Participatory community seminars, shop floor visit to industrial locations, use of print and electronic media and lectures and demonstrations in schools were the tools used in the preventive programmes. Analysis of inpatient and outpatient records of burn-injured patients treated in the Burn Unit and a scoring system in the school education programme helped in the assessment of the impact of Burn Preventive Programs (BPPs). For convenience of assessment, a comparative analysis of the results in early (block I) and later part (block II) of the study period was made. Results showed reduction of admission and also reduction in percent total body surface area (%TBSA) burn in the majority of the patients in block II in comparison to block I. Water was used to extinguish fire in 36.1% patients in block I and 73.4% patients in block II. Water was also used to cool burn wounds by 31% patients in Block I, and by 72% patients in block II. While 80% of the patients made inappropriate topical applications on the wounds in block I, only 34.4% did so in block II. Increased awareness amongst the general population was reflected by reduction of average reporting time in hospital after injury and significant reduction of firecracker burns from 21.5% (block I) to 14.6% (block II). Similarly, improved awareness amongst the students was evident from the improved scoring by the majority of the students and reduction in burns amongst them in the later part of block II. The results indicate that BPP has made a positive impact in society.