USG SAVED THE DAY: PRE-PROCEDURAL USG SPINE FOR SPINAL ANAESTHESIA IN A PARTURIENT WITH THORACO-LUMBAR SCOLIOSIS WITH POST BURN CONTRACTURE NECK

Introduction: Incidence of Scoliosis is approximately 2% and higher in females. Therefore, anaesthesiologist should be familiar with its implications for safe anaesthetic management1. Such parturients present unique challenges for administration of regional anaesthesia. Reporting one such case with a successful outcome using pre procedural Ultrasound spine for spinal anaesthesia. A 27 years, 39 weeks Case Report: primigravida of height 132 cm, with cephalo pelvic disproportion in labour with grade III scoliosis and post burn contractures involving neck, was posted for emergency cesarean section. Patient underwent surgery successfully under SAB after accessing spine by ultrasonography for identifying point of insertion, depth of intrathecal space & needle trajectory.2 Ultrasound is Conclusion: boon for accessing spine in patient with difcult spinal anatomy and pregnancy for deciding correct spinal interspace and successful outcome with fewer attempts.

MANAGEMENT OF POST BURN CONTRACTURE OF NECK IN A TERTIARY BURN CARE CENTRE

Background: Post burn contracture is one of the most common problems in our country and usually seen in lower socio-economic people. Burn contractures of the neck can produce a signicant impact on quality of life by reducing a patient's ability to perform activities of daily living Methods: A prospective study was conducted with a sample size of 30 patients with post burn neck contracture conducted for a duration of 24 months. After meticulous surgical planning, patients underwent contracture release and split skin grafting/z-plasty followed by rigorous splintage and physiotherapy. Majority of the patients were in the age group of 11-30 years (63%).70% of the Results: patients sustained burns in the range of 21-40% and 80% were due to ame burns.46.66% (14) of patients had severe contracture while 13.33% (4) had extensive mento-sternal adhesions. 90% of the patients underwent release + SSG while 10% underwent z-plasty. Postoperatively cervico-mental angle of 100-120 degrees was achieved Skin grafting is a simple, reliable and safe operation however postoperative splinting is n Conclusion: ecessary. The use of skin grafts continues to deliver excellent results with adequate restoration of cervico-mental angle.

Outcome of the acellular dermal matrix and split thickness skin graft in release of post burn contractures in hand.

Objective: To determine the frequency of success of acellular dermal matrix and split thickness skin graft in release of post burn contractures in hand using Vancouver scar scale. Study Design: Descriptive Case Series. Setting: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st March, 2019 to 30th October, 2019. Material & Method: A descriptive case series conducted at Plastic Surgery Department, Jinnah Burn and Reconstructive Surgery Center, Lahore. A sample size of 75 patients, who full filled the inclusion criteria, was selected through non probability consecutive sampling Informed consent was obtained from all the patients. Pre-operative photography was done to compare the post-operative results. After the release of contractures, coverage with acellular dermis and split thickness skin graft was performed. All the patients were followed up to 2 months and the outcome was assessed by Vancouver Scar Scale. The collected data was entered and analyzed by using SPSS version 20. Descriptive statistics were calculated. Quantitative variables like age, size of scar were presented as mean, ± standard deviation. Qualitative variables were presented as frequencies and percentages. Results: Mean age of patient was 30 ± 9 years. Among them 40 were males and 35 females. Vancouver scale showed successful outcome (score ≤4) in 70.66 % of the patients. Partial release of contracture was the major complication seen in 5.33% of cases. Conclusion: Acelluar dermal matrix followed by split thickness skin graft is a very reliable option for coverage after release of post-burn contractures in hand as it provides very pliable, thin and lax skin with good color match and better contour to surrounding tissue.

Early reconstruction of the burn contractures and sequels

The goal of burn reconstruction should be to preserve, restore, maintain function, and improve appearance so the patient can be reinserted to society. The major problem after burn is hypertrophic scar and contractures. Prevention starts early during the acute phase of the injury and continues to the rehabilitation period. Early excision and grafting improves skin quality and decreases scar hypertrophic formation. The use of splints, pressure garment and rehabilitation may help to prevent contractures. Burn contractures are tight and are due to a shortened scar that limits joint movement. Burn contracture needs to be released in several important areas of the body. Surgical procedures were performed in the acute phase to correct ectropion, microstomia, and to release burn scar contractures in the neck, axilla, and hand. Surgeries began 6 to 12 months after discharge and the purpose was to decrease hypertrophic scar and release contractures. Ablative fractional CO2 laser has revolutionized the scar treatment, decreasing the thickness of the scar, and improving mobility in the patients. We review the surgical procedures performed by plastic and reconstructive surgery during the acute and post-acute burn phase.