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The concept of tissue expansion by the placement of inflatable subcutaneous silicone implants was popularised by Radovan in the late 1970s and is now widely used in clinical practice. After the initial placement of the expander, a series of outpatient visits is required during which the expander is serially inflated. These visits can be very stressful for the patient and are costly in terms of patient transport and clinic time. We present a series of 26 expanders (in eight patients) that were inflated at home by the patient or a relative, and compare the results with those from 30 expanders (in 15 patients) inflated in the outpatient department. The results show that whilst there was a slightly higher incidence of minor infections in the group inflated at home (42% versus 23%, P> 0.05), the overall success rate of the operation was greater in the home-inflation group (96% versus 90%, P> 0.05). However, these differences were not statistically significant. This study provides evidence to support the practice of inflation at home, which is safe, cost effective and less stressful for the patient., (Copyright 2001 The British Association of Plastic Surgeons.)

Chromium poisoning can occur from the cutaneous absorption of chromium from burns that are as small as 1% of the total body surface area. In this case report, we describe a patient with 10% total body surface area burns caused by hot chromic acid. The amount of chromium removed by peritoneal dialysis and the amount of chromium in the urine were estimated, as well as the chromium content in the excised skin, serum, and red blood cells. The extent of chromium load from this type of injury and subsequent risk of systemic poisoning is not predictable, and we therefore believe that systemic toxicity is best prevented by early excision of the burned skin.

A prospective, controlled clinical trial was undertaken to assess the efficacy and safety of two types of silicone gel, Silastic Gel Sheeting (SGS) and Cica-Care (CC), in the management of hypertrophic scars. Forty-two patients were randomly assigned to SGS and CC groups and their hypertrophic scars were divided into treated and control areas. Extensometric measurements were made at monthly intervals for 6 months and significant improvement of the treated areas relative to the control areas was observed. The two gels were not significantly different in efficacy or safety, but CC, being more adhesive and more comfortable than SGS, has advantages in ease of use and patient acceptability.

A preliminary report of a trial of Silastic gel in the treatment of patients with hypertrophic bum scars.

A report of a case of salmonella enteritidis which caused septicaemia in a patient who had suffered major burns.

Two cases involving the development of systemic toxicity and prolonged wound healing in small percentage area burns to chromic acid are reported. The treatment of chromic acid burns is reviewed and a protocol of management suggested.

Forty-seven children under the age of 5 years admitted for contact burns into the Burns Unit of the Birmingham Accident Hospital during the period 1981-88 were reviewed. Contact burns formed only 3.93 per cent of all the thermal injuries seen in this age group for the same period. Most of the children were between 1 and 2 years of age and the hands and face were more frequently burned. The hot electric iron was the commonest cause of burns in the study. Although the sizes of the burns were generally small, the potential scarring and disability were recognized and this influenced the management. The prevention of contact burns from hot electric irons has been discussed and the need to look out for non-accidental injuries emphasized.

During the first year of use of tissue expansion at the Birmingham Accident Hospital, 24 patients had expansion procedures at 29 sites. Most of these were to revise burn scars. A number of complications occurred and five procedures were abandoned. The advantages and problems of the technique are discussed.