Indications for removal of teeth in the line of a mandibular fracture include:
All of the above. All of these are indications for extraction.
References:
1. Potter JK. Facial skeletal trauma (adult/pediatric). In: Essentials of plastic surgery. Janis JE. St Louis, USA: Quality Medical Publishing Inc., 2007: 251.
Which two of the following statements are true regarding pigmentary changes following burn injury?
Small areas of post-burn vitiligo can be treated with dermabrasion and application of melanocyte cultures. Pigmentary changes following burns can be particularly distressing in dark skinned patients. Post-burn vitiligo can have adverse cultural stigmata. Overall, hyperpigmentation is more often seen particularly in grafts. It is not a post-inflammatory problem in many cases and can be difficult to resolve. There are reports of successful treatment of small areas of stable vitiligo with dermabrasion and application of melanocyte (containing) cell culture.
References: 1. Grover R, Morgan BD. Management of hypopigmentation following burn injury. Burns 1996; 22(8): 627-30.
Cyanide poisoning:
Can be treated with amyl nitrite, sodium nitrite and sodium thiosulphate or hydroxycobalamin. Cyanide poisoning can rapidly cause death. Having an effective antidote readily available is essential for facilities that provide emergency care. In cases of cyanide ingestion, both the nitrite/thiosulphate combination and hydroxycobalamin are effective antidotes. Hydroxycobalamin offers an improved safety profile for children and pregnant women. Hydroxycobalamin also appears to have a better safety profile in the setting of cyanide poisoning in conjunction with smoke inhalation. However, current data are insufficient to recommend the empiric administration of hydroxycobalamin to all victims of smoke inhalation.
References: 1. Shepherd G, Velez LI. Role of hydroxycobalamin in acute cyanide poisoning. Ann Pharmacother 2008; 42(5): 661-9.
Which one of the following statements do you think would have the greatest consensus support from a panel of international burns experts?
The greatest challenge of the complex post-burn reconstruction is to match the reconstructive need with the potential donor tissue as every patient has a different pattern of scarring and deformity. The management of burns has a good grounding in ‘experience-based medicine’. Ear reconstruction is a considerable challenge with healthy peri-auricular tissue. In the presence of scarring it becomes very difficult and many experts would simply not embark on autologous reconstruction particularly if osteointegration and prosthetic support is available. Thin split thickness grafts should not be used as upper eyelids. The grafts will contract and problems will recur. Genital reconstruction is extremely challenging particularly when donor sites are limited but there are experts who can perform such surgery. Appropriate referral for such reconstruction would be much more preferable than the alternative of ‘forcing’ gender reassignment. The goals of reconstruction in children and adults can differ but generally functional independence is the theme. The statement, however, which is least controversial relates to the challenge of the match of donor tissue to recipient sites. The individual and specific nature of the scarring of burn patients may require radically different reconstructive strategies in two patients who have similar functional problems to address.
With regards to arm fasciotomies, which one is true?
The posterior compartment is decompressed using a lateral incision. The anterior compartment is decompressed using a medial incision. There is no lateral compartment in the arm. The radial and ulnar nerves travel in both compartments for part of their course, so medial and lateral incisions to decompress both compartments are needed to decompress each one of these nerves.
References: 1. Velmahos GC, Toutouzas KG. Vascular trauma and compartment syndromes. Surg Clin N Am 2002; 82: 125
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