Twelve patients from 11 to 57 years of age who underwent surgical release of postburn first web space thumb adduction-pronation contracture had the resulting defect resurfaced successfully with a medium-thickness, unmeshed, split-thickness skin graft (STSG). This procedure provided satisfactory, durable cover and maintained the gain in thumb abduction. All hands had combined dorsal and volar scarring that required incision. If indicated, partial division of the midbelly of the distal border of the adductor and distal midborder of the first dorsal interosseous was performed to increase both radial and palmar thumb abduction. Immediate or delayed skin grafting, the latter with a dynamic grafting splint, was carried out. Fifteen hands (from 12 patients) were assessed one year or more after surgical release. The mean postoperative radial abduction angle measured on photographs between the first metacarpal shaft and index proximal phalanx was 42°±13°, which was greater than the preoperative mean of 23°±12° (P=0.001) but less than the mean of 57°±12° for 20 nonburned control subjects (P=0.002). The mean postoperative palmar abduction angle measured between the first metacarpal and the proximal phalanx of the index finger was 54°±19°, which was greater than the preoperative mean of 18°±21° (P<0.001). An STSG was simple and quick to harvest for the burned hand at or near full growth size, and was successful in maintaining the increased abduction gained in the first web space for most of the patients who were treated.

Development of heterotopic bone about the elbow in burn patients, although uncommon, is a problem that carries significant morbidity. We describe a new technique for resection of heterotopic bone at the elbow involving an olecranon osteotomy. The timing of surgery depends upon two factors: the quality of surrounding soft tissues and the presence of ulnar nerve compression.

s of Poster Presentations at the Canadian Trauma Association Meeting September 1989: PDF Only

Staphylococcus aureus was the most common organism colonizing the burn wound and causing burn wound infection. Pseudomonas aeruginosa caused wound infection almost as often and was the organism most frequently isolated from blood cultures. A delay of more than 24 hours between burn and initiation of definitive wound care increased the incidence of burn wound infection due to S. aureus and group A streptococci. In patients admitted within 24 hours of burn, the incidence of burn wound infection due to group A streptococci did not differ significantly between those who did or did not receive a prophylactic systemic antibiotic Silver sulfadiazine cream was a more effective topical prophylactic antibacterial against P. aeruginosa but less effective than gentamicin used topically against S. aureus and enterococcus. As indicated by seven years of use, topical silver sulfadiazine remains effective prophylaxis against infection due to P. aeruginosa and other gram-negative organisms, although infection due to enterococcus has increased