Burns 3 3 S ( 2 0 0 7 ) S1–S172
Monopolar cautery tip suction-guard Dermanin X.F. 1 , Rosenberg L. 2 Soroka University Medical Center, Israel E-mail address: [email protected]
(X.F. Dermanin). Several factors may determine the safety of using the monopolar cautery and all should concern every surgeon. Limiting the area and length of the exposed metal tip addresses many of these factors. The standard operating procedure is to slide on top of this tip a plastic tube insulating it from accidental contact with surround tissues by leaving only its end protruding and only this end will be in controlled contact with the tissues. Another issue is the elimination of the fumes caused by the cautery action especially in close cavities or deep recess. This problem is solved by holding a suction tip in proximity of the cautery tip, usually by the surgeon assistant. Same approach is used for suction of blood or ﬂuids. For years the author is using the following suction-guard. Steps in preparing suction-cautery using a disposable suction-feeding catheter-tube: (1) Discarding perforated tip of suction catheter. (2) Dividing the catheter in part (e.g. 270◦ of a circle) and at a distance from the tip of the catheter corresponding to the length of the diathermy blade. (3) Folding the catheter at the divided point and inserting the diathermy knife into the folded tube. (4) The remaining length of the tube is ﬁxed to the handle of the diathermy by means of paper skin closures. The advantages of this instrument: (1) Tip of suction catheter is exactly at the point of cautery. (2) Metal cautery blade is insulated except for the very tip (this can be varied according to the operator). (3) Prevents accumulation of smoke in enclosed spaces that can obscure vision. Smoke is directed towards the tip of the catheter and away from the operator. (4) Tip of suction catheter can be directed towards accumulations of blood or ﬂuid and thus enabling a clear vision of the operating ﬁeld. (5) The whole set-up is easily dismantled by cutting away the paper skin closures and discarding the suction catheter. 1 Malta. 2 Israel.
doi:10.1016/j.burns.2006.10.223 Cell or scalpel? Cost-beneﬁt of cultured keratinocytes in the treatment of burns Duinslaeger L. Military Hospital Queen Astrid, Brussels, Belgium E-mail address: [email protected]
¨ Cultured keratinocytes and their lysates do stimulate reepithelialisation of a burn wound, covered with meshed autologuous conventional split-thickness grafts. Cultured keratinocytes also stimulate signiﬁcantly healing of donor sites. However, scientiﬁc literature is still very scarce concerning cost–beneﬁt or cost-effectiveness of this technique, most of the studies suffering from small sample sizes, weak designs and other methodological shortcomings. The results concerning CK treatment options can very often hardly be compared with the conventional treatments due to methodological reasons, e.g. because the factors included in the cost analyses vary broadly between the studies. This makes it difﬁcult to unambigiously identify cost-effectiveness advantages of CK or conventional options, respectively. Although the studies have to be interpreted very cautiously, the data do not exclude potential beneﬁts and even possible savings for the health care system in the long term, but on the other hand, also do not clearly support them with the data available up to now. In case of extensive burn wounds cultured keratinocyte treatment seems to be an option in case of impossibility of treatment with conventional techniques or in life-threatening situations. No data clearly conﬁrm a cost–beneﬁt of this technique in burns. Treatment of donor sites with this technique however, or more likely with lysates of cultures, is probably more indicated in terms of cost-effectiveness, but further preclinical and clinical research is mandatory. Actual available literature data and personal results and calculations will be discussed. doi:10.1016/j.burns.2006.10.224