Biodegradeable temporising matrix use in a traumatic chest wound

The Welsh Centre for Burns and Plastic Surgery is responsible for a population of 10 million people in Wales and England. We describe the use of biodegradable temporising matrix (BTM) in a large traumatic chest wound in a 23-year-old woman. BTM is a synthetic dermal substitute and has been utilised to achieve soft tissue coverage in complex wounds. This wound was sustained after the patient fell from a tractor into a large silage rake, resulting in injuries to her chest and limbs. Following meticulous debridement, her resulting full thickness skin defect measured 30 × 30 cm extending from the sternal notch to the upper abdomen, with bone, muscle and breast tissue exposure. The central chest area is complex to reconstruct due to the contours of the breasts and tendency to contracture following skin graft reconstruction. We demonstrate the first reported use of BTM for breast reconstruction, as far as we are aware.

A comparison of volume and anthropometric breast measurements using the Crisalix and VECTRA XT 3-dimensional surface imaging systems in women who have undergone breast-conserving surgery

Introduction Three-dimensional surface imaging (3D-SI) of the breasts enables the measurement of anthropometric distances and breast volume. These measurements may be used in surgical planning and to facilitate clear communication with patients. The aim of this study was to compare measurements using a portable 3D-SI system, Crisalix, with a more established non-mobile camera, the VECTRA XT. Methods Participants were imaged three times using the Crisalix and the VECTRA XT system. Breast volume, sternal notch to nipple distance, nipple to nipple distance and breast width were measured. Intra-observer agreement was measured using the co-efficient of variation (CV). Agreement between the two methods was represented with Bland Altman agreement plots. Results Intra-method variation was low for both methods (maximum CV 3.3% for Crisalix and 3.2% for VECTRA XT), with only nipple-to-nipple distance being statistically significant, marginally in favour of VECTRA. The mean inter-method differences were small but the limits of agreement (LoA) were wide for all parameters: best for sternal notch to nipple distance, mean difference (MD) -0.03cm and LoA 1.8 to -1.8cm; the widest LoA were for breast volume: MD 31.1cm3 and LoA 286.7 to -244.6cm3. Conclusion This is the first comparison of anthropometric distances and breast volume measured using the two most widely used 3D-SI systems, Crisalix and VECTRA XT. Intra-method variation is low but currently it would not be appropriate to use the two systems interchangeably due to the wide limits of agreement for all four parameters assessed.

Potential forensic implications of kerokan therapy – a traditional Indonesian therapy associated with neck bruising

Kerokan is a traditional Indonesian treatment involving abrading the skin over various parts of the body with a blunt object such as a coin or a piece of ginger which may create suspicious injuries. Here, the case of a 30-year-old woman who had undergone kerokan therapy is reported. She was complaining of retro-sternal pain and epigastric discomfort and subsequently became markedly short of breath and died. The observation of injuries predominantly located around the neck initiated a police investigation and forensic autopsy. Scattered abrasions, blisters and bruises were present on the forehead, the bridge of the nose extending to the ala, the upper and anterior aspect of the chin and the sternal notch, with discrete fresh and scabbed abrasions around the neck, over the sternum and on the backs of both hands. There were, however, no facial or conjunctival petechiae and no bruising of the underlying strap muscles, or fractures of the hyoid bone or thyroid cartilage. Histology revealed that myocarditis was the cause of death. Traditional practices may cause unusual bruises, abrasions, blisters and burns that may raise suspicion of inflicted injury from an assault. Knowledge of the manifestations of socio-ethnic practices such as kerokan is important in the evaluation of trauma in specific cultural groups.