The following is true regarding fasciotomies of the foot:
None of the above. The medial and dorsal approaches are commonly used. The medial approach affords access to all four compartments of the foot and is made along the plantar border of the first metatarsal. The dorsal approach involves two incisions along the second and fourth interspaces.
References: 1. Broughton, G II. Compartment syndrome. In: Essentials of plastic surgery handbook: a UT Southwestern Medical Center handbook. Janis JE. St. Louis, USA: Quality Medical Publishing Inc., 2007: 634.
Calorific requirements for burn-injured adult patients are:
25kcal/kg + 40kcal/% burn. The calculation is undertaken as follows: 25kcal x usual body weight in kilograms + 40 x % total body surface area burned. This is the Curreri formula (adult). For children, the formula is 60kcal/kg + 35kcal/% burn. Feeding should be given enterally when possible and the decision between naso-enteral feeding or a formal jejunostomy will depend on patient factors and ideally commence within 24 hours of admission for major burns. Many other formulae also exist, and there is no consensus as to the best regime.
When looking at the successful outcome of postburn surgical functional reconstruction which of the following do you think is the most critical determinant of the final result?
The motivation and compliance of the patient (and/or parents). One can be an excellent surgeon but achieve poor outcomes if there is no program of postoperative rehabilitation. Equally, excellent surgeons with good postoperative rehabilitation teams can still have poor outcomes if patients are poorly motivated. In nearly every case of excellent functional outcome in the field of post-burn reconstruction you will find a highly motivated patient. The converse is also true and so patient selection is very important.
When considering the aesthetic reconstruction of post-burn facial scarring which has resulted in extensive textural abnormality but no deformity of anatomical features, which of the following would be your method of choice for skin resurfacing?
Sequential dermabrasion of entire sections of the face (lower, middle, upper third) and application of sheets of medium thickness skin using tissue glue and steri-strip fixation and no sutures. As in many aspects of reconstructive surgery there will be individuals who have a strong preference for certain strategies. In this question the problem of extensive textural abnormality is the focus of concern. As such, any extensive full thickness skin/scar excision will carry a significant risk of scarring secondary to infection and impaired healing. The alternative is to keep the bulk of the dermal matrix and to flatten the textural abnormality with dermabrasion or ablative laser therapy. Mechanical dermabrasion does carry health risks because of the associated aerosol spray but the use of protective masks and screens can prevent contamination. Using sequential dermabrasion of entire sections of the face and applying intact sheets of medium thickness graft and using an atraumatic fixation technique, optimal results can be achieved.
When considering extensive burn scarring restricting movement of all joints of both upper limbs, which should be the order of priority for surgical release?
The axilla of the dominant hand should be treated first. The hand is unable to function without restoration first of proximal mobility, and the dominant limb is a priority. There is no point in performing complicated reconstructive surgery in the hand of an immobile upper limb. The principle is to work from trunk to extremity and in the upper limb consider the sequential release of axilla, elbow, wrist then hand and prioritizing the side that will give the dominant hand optimum function.
References: 1. Young RC, Burd A. Paediatric upper limb contracture release following burn injury. Burns 2004; 30(7): 723-8.
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