With regard to post-burn reconstruction of the female breast, which of the following statements is correct?
When Integra® is used in the peripubertal stage for release of contractures of the breast skin envelope, the breast can subsequently develop as normal in terms of both volume and ptosis. In the International Hand Book published by Integra Life Sciences, a case of breast contracture release in an adolescent girl with 6 years follow-up demonstrates that by using Integra® a new cover could be achieved for the breast that could accommodate normal breast development both in size and shape. An important element of this reconstruction was the preservation of the breast bud because without this a breast could not develop. Breast feeding is still possible after post-burn breast reconstruction. It will depend on an intact ductal system and functioning nipple. A very effective way of releasing contractures distorting the breasts and resurfacing areas of the breast is to use tissue expansion.
In the primary treatment of burns:
Luke-warm water should be used for first aid. The specific heat capacity of water is high and it is thus very efficient at removing heat energy. Overly cold first aid is detrimental as it causes reflex vasoconstriction leading to further tissue ischaemia and potentially increasing the extent of the injury in areas of borderline viability.
A 30% partial thickness burn injury with combined severe head injury (Glasgow Coma Scale 7) should initially be managed by neurosurgeons if combined care is not available. The first priority is to assess and maintain the airway and breathing with due attention to the cervical spine.
With regards to burns:
In a child of 10 years, each leg approximates 14% body surface area. Tangential excision was developed by Zora Janzekovic in the late 1960s and published in 1970. Lightning strike causes characteristic Lichtenberg figures. The half-life on room air is 4 hours but is 45 minutes breathing 100% oxygen, and this is reduced to 30 minutes with hyperbaric oxygen. Specfic antidotes for cyanide poisoning include a combination of amyl nitrite, sodium nitrite and sodium thiosulphate, or hydroxycobalamin.
References: 1. Janzekovic Z. A new concept in the early excision and immediate grafting of burns. J Trauma 1970; 10(12): 1103-8.
The following are true about the Le Fort 2 fracture pattern:
All of the choices. All of these are true. These fracture patterns are well described and widely reproduced (Figure below).
Le Fort 2 fracture patterns.
Click to expand