COMPARATIVE ASSESSMENT OF SALINE VERSUS OCTENIDINE DIHYDROCHLORIDE DRESSING IN DIABETIC FOOT ULCERS

Diabetic foot ulcers are a common presenting complaint in many institutions catering to rural populations. The reasons for this can be the undiagnosed diabetes and lack of knowledge regarding complications. Care of diabetic foot ulcers involves systemic as well as local interventions. Among the local care methods is regular dressings using a good antimicrobial agent. Here Octenidine Dihydrochloride has shown promise. The present study was done to assess the efcacy of Octenidine Dihydrochloride in diabetic foot ulcers. The study used a pool of 80 subjects divided in two equal groups who were randomly subjected to saline and Octenidine Dihydrochloride dressings. The study observed that the mean rate of healing and wound coverage was signicantly better in Octenidine treated subjects when compared to saline group. Octenidine Dihydrochloride is a better topical agent when compared to saline in the present population sample.

Historical Evolution of Skin Grafting—A Journey through Time

Autologous skin grafting was developed more than 3500 years ago. Several approaches and techniques have been discovered and established in burn care since then. Great achievements were made during the 19th and 20th century. Many of these techniques are still part of the surgical burn care. Today, autologous skin grafting is still considered to be the gold standard for burn wound coverage. The present paper gives an overview about the evolution of skin grafting and its usage in burn care nowadays.

660 Decreasing Burn Excision Time by Using a Circular Dermatome

Introduction Excision of burn-injured tissue can be accomplished by a variety of means. The most commonly used tools in the burn community are straight blades of varying lengths fitted to guards of different depths. A traditional straight dermatome can also be used for excision. We describe here the use of a circular dermatome, which in addition to allowing curvilinear excision holds the promise of expediting burn excision as well. Methods IRB approval was obtained for a prospective study of the use of a circular dermatome device for the excision of burns. Patients with deep partial- and full-thickness burns were eligible for inclusion in the study. Eight patients undergoing nine procedures were included. The excisions were performed exclusively with the dermatome, with use of standard equipment only for smaller areas (hands/feet). The size of the dermatome, depth of excision, and time of excision with the dermatome were noted. Total operative time (recorded as “procedure start” to “procedure end”) was also recorded, as was the subsequent wound coverage material. Results A total of nine cases were included. The four-inch diameter blade was most commonly used, typically at depths of 25 or 30/1000thinch. The sizes of the areas excised ranged from 392cm2 to 4694 cm2. The total time of excision was short (2 to 10 minutes), and total case times varied greatly (31 to 262 minutes) due to differences in wound coverage. Excision time per cm2 was calculated in seconds due to the brevity of the excision and typically fell between 0.1 to 0.3 seconds per centimeter squared. The outlier (0.7s/cm2) was encountered early in the study and represented a challenge of technique. Cases where wound coverage was achieved with allograft or with standard split-thickness skin graft had case times of 2 to 5 seconds per square centimeter; the outlier (11s/cm2) was the result of a use of an unrelated new technology. Conclusions Rapid excision of a large area of burn can be accomplished with the circular dermatome. The device can also be used of course to take autograft. When the case consists completely of excision and allografting or conventional split-thickness skin grafting, the total operative time can be very short indeed. The dermatome may be beneficial additionally for longer cases where operating room time saved in excision may be used for other purposes.

Scalp Reconstruction with Novel Unopposing Double Hatchet Flaps- A Case Series

Though there are regional and distant approaches for acquired scalp defect reconstruction, use of local flaps always have the advantage of retaining the topography of scalp. As in treatment of any other defect the choice of a local flap in scalp wound coverage is dictated by the location, size, and depth of the defect and by the availability of adjacent tissue for reconstruction. The versatile and adaptable triangular hatchet flap with a partial skin and subcutaneous bridged pedicle has great versatility. When used singularly or in pair to cover small and medium sized defects, utilising both rotation and advancement components for its movement, has the benefit of maintaining cosmetic appearance. Double hatchet flaps are used commonly in an opposing manner so as to convert a circular wound to a ‘S’ shaped suture line. In the current case series, with a description of four representative cases, authors have presented a modification of this double hatchet flap in unopposing configuration instead of an opposing pattern to cover scalp defects when the type and extent of injury affecting the scalp prevents in heaving flaps at 180 degree to each other. Authors opine that this technique adds into the ever expanding armamentarium of reconstructive surgeon and can be made use of in the aforementioned conditions wherein the standard pattern cannot be employed to cover moderate sized scalp defects.