And in case you’re not the type to scroll down and read the news – Savestate is on Comic Chameleon! I suppose jamming the Virtual Boy into your face with the controller is one way to keep it in place. All joking aside, Virtual Boy never caused anyone to go blind – it just makes your eyes hurt really bad and gives you a head ache. We won’t talk about the Wii U gamepad and how the map for Mario Kart 8 can only be displayed on it. I’m pretty sure it’s a law that you have to sit crossed-legged 2 feet from the TV when playing retro games.
Summer means sun, and sun means sunburn, especially here in New Zealand, where the sun can burn the skin in only 10 minutes. Horses burn similarly to the way that humans do – that is, the lighter the skin, the easier the burn. Some people stable their horses during the hottest hours of the day – however, this is only beneficial if your stable is well ventilated and cool. Slop on some sunscreen – there are several horse sunscreens available, perhaps from your local tack store or feed shed.
If you don’t want to put sunscreen on your horse there is a good remedy that can help prevent sunburn and help your horse when the skin has already been burnt.
The information contained in this website is not intended to replace guidance from your veterinarian.
Total upper and lower eyelid replacement following thermal burn using an ALT flap - A case report.
We know this and we protect ourselves accordingly, but we don’t always consider that our horses might suffer from sunburn as well. However, even if you have a fully black or bay horse, they are susceptible to the harsh rays of the sun.
If you don’t or can’t stable your horses, which is the case for most people I think, try to make sure they have adequate shade – plenty of tree cover, a paddock lean-to or shelter. Don’t forget that it’s hot as well – consider the weight and density of the rug, because your horse also needs to be cool. This is the best way of protecting your horses eyes and forehead (areas most susceptible) from sunburn. Aloe sunburn treatments will immediately sooth your horse’s burn, and will help re-moisturize and heal your horses skin.
Bowen Therapy and Homeopathy are complementary to veterinary treatment and the general care of the animal.
Many such cases come to the casualty after having incorrect, randomly single layer deep stitches with misaligned tissue.
Sunburn is just as painful for horses as it is for humans, and shows up in much the same way – red, raw skin, hot and sore to the touch, which, if left untreated, can become flaky, cracked and may blister.
Coloured sunblock is a great idea – they make it much easier to tell when your horse has rubbed some off or where you’ve already applied some. Several fly masks also come with muzzle flaps, which will help protect the sensitive, soft skin around your horse’s nostrils and mouth.
When your horse already has sun burn add it to the trough several days in a row, after that once a week is enough for prevention. Due to the complexity of face, it is essential to anticipate the injuries in various structures underneath the wound. Disfigurement following trauma, becomes a social stigma and has the gross detrimental effect on the personality and future of the victim.
Therefore, such cases are most appropriately managed by Plastic Surgeons who have a thorough knowledge of applied anatomy, an aesthetic sense and meticulous atraumatic tissue handling expertise, coupled with surgical skill to repair all the composite structures simultaneously.
The surgeon needs to understand the biomechanics of tissue wounding, biochemistry, molecular biology of wound healing and the art of soft-tissue repair.
It is important to appreciate that many facial malformations in adults can be attributed to trauma in early childhood because trauma has the deleterious effect on the growth and development of facial bones.
The types of soft-tissue injuries encountered include abrasions, tattoos, simple or complex contused lacerations with loss of tissue, avulsions, bites and burns. Common etiologies are road traffic accidents, gunshot injuries, blast injuries, foreign bodies, homicidal trauma, thermal, chemical and electrical burn, suicidal injuries, human bites, animal bites or caused by different animals [1] etc., [Figure 1]a-d.
There may be echymosis, oedema, sub-conjunctival haemorrhage, crepitus, hyperaesthesia, evidence of facial nerve palsy, inadequate excursion of the muscles of expression and mastication, wound with or without exposed vital structures and fractures. One should realize that usually a horizontal injury across the face is likely to damage more vital structures than a vertical injury as it passes through more number of zones. The aesthetic units on the face are frontal, temporal, supraorbital, orbital, infraorbital, nasal, zygomatic, buccal, labial, mental, parotid-masseteric and auricular.
The result of airway compromise is either direct laryngeal injury, presence of foreign bodies, including aspirated teeth and bone fragments, or excessive bleeding from the upper airway. Airway compromise can also occur when the floor of the mouth and tongue lose support from a comminuted mandible fracture. Edema at the base of the tongue or laryngotracheal air way can contribute to sudden respiratory obstruction.
However, one should not hesitate to perform a tracheostomy if need be.Similarly, control of bleeding and volume resuscitation takes an upper hand. The first line of defence in nasal bleeding is packing, whereas oral bleeding is controlled by direct pressure and suture ligation of the bleeding sites. Surgical ligation of the external carotid artery will not control bleeding from its injured branches because of the robust collateralization present and should not be attempted.
However, they may be helpful in identifying foreign material in cases of gun shot or blast injuries.
Nevertheless, concomitant facial fractures require radiographic evaluation.Evaluation of woundThe examination should be done in the operation theatre under proper light, magnification, copious irrigation and homeostasis. It is important to evaluate what tissue constituents are lost and what tissues are exposed. Sometimes the wound apparently may look small but might have wide undermining with overlying devascularisation.
Such an undermined tissue should be primarily excised until the bleeding margins are reached.

On the cheek, lips, periorbital areas, forehead, etc., there are underlying muscles, which are likely to be damaged depending upon the magnitude of injury.
In certain areas like pre-auricular region, the parotid gland and facial nerve may be damaged. In major trauma, while instituting the resuscitative measures, the wound may be dealt after 4-6 hours. In cases of loss of tissue, two-dimensional and three-dimensional measurement of the wound is taken to assess the size of the tissue required to cover. A search for foreign material is undertaken preventing prolonged inflammatory response and infection. The choice of reconstruction depends upon the location of the defect, dimension, and tissue constituents. The final selection is decided by considering the tissue requirement and donor site morbidity. The surgeon has many geometrical local or regional flaps in his armamentarium, but that does not mean they have to be applied randomly. One may reconstruct a defect nicely but the donor site morbidity is likely to discredit the craftsmanship.
A well-chosen reconstruction performed in an acute situation, may deteriorate because of contamination of the traumatic field or contused soft tissue included in the reconstructive design. Associated fractures are stabilised first, followed by soft-tissue repair.Lacerations repaired properly achieve less conspicuous scar. Vermillion cutaneous border of the lip, the free margin of the alar rim, the grey line of the eyelids, and the helical rim of the ear provides guidelines for the restoration of normal anatomic position.Many wounds suggest significant tissue loss, on first impression.
However, by a careful replacement of tissue, it becomes apparent that most of the tissue is present. Similarly, in cases of avulsion, initial inspection may indicate loss of tissue but a closer examination reveals that the tissue has simply retracted or folded. If there is no loss of tissue, the irregular margins are neatly freshened; key stitches are applied followed by completion of the repair.
This provides anatomical alignment of tissue, obliterates the dead space and prevents complications like hematoma, infection, wound dehiscence, tension on the suture line and hypertrophic scarring.Periorbital and frontal injuryThe eyelids are inspected for ptosis, suggesting levator apparatus injury. Rounding or laxity of the canthi suggests canthal injury or naso-orbital-ethmoidal fracture. In case of periorbital injury, it is important to judge the integrity of Levator palpebrae superioris, Orbicularis oculi and Frontalis muscles. Similarly, the supraorbital and supratrochlear nerves that emerge to provide sensory innervation to the forehead and scalp, may get damaged in association with the eyebrow. In major trauma, the eye globes along with surrounded periorbital structures are destroyed. If the proximal end of the canaliculus is not found, a lacrimal probe may be inserted into the punctum and passed distally out of the cut end of the canaliculus. The distal end of the canaliculus may be located by introducing a pool of saline in the eye and by instilling air into the other intact canaliculus. The stent is left in place for 2 months to 3 months.NoseThe nose is at a high risk to trauma due to its prominent position. A speculum examination of the internal nose is done for mucosal lacerations, exposed cartilage or bone, or septal hematoma [Figure 3]a-d.
A new classification system and an algorithm for the reconstruction of nasal defects has been proposed. In septal fracture, if lining is present on one side, it does not pose a significant problem. If lining is missing on both sides, a mucosal flap should be used to cover at least one side. If there is a loss of important support structures, they should be reconstructed immediately using bone or cartilage grafts.
Delay will result in contraction and collapse of the soft tissue making later reconstruction difficult. When lacerations involve the underlying cartilaginous support, all layers should be repaired after appropriate anatomic reduction. The mobile skin of the cephalic portion can be undermined and mobilized to cover small wounds. The skin on the caudal dorsum, tip and ala is adherent and less mobile and often defies primary closure. Larger defects need local flaps, which should be done primarily if the bone or cartilage is exposed.EarsInjury to ears is common as it is also a prominent organ. The injury to the cartilage may be in the form of crushing, laceration or sharp incised injury. It is important to find out whether the skin cover is totally bare or intact on at least one surface of the cartilage. The periauricular area should be assessed as most of the time this tissue is utilized for reconstruction.The two most prominent concerns in ear injuries are hematoma and chondritis. Hematomas must be evacuated as quickly as possible to avoid cartilage resorption followed by deformity. In partial amputation with relatively large pedicle, the prognosis is good following conservative debridement and meticulous repair. If the pedicle is narrow with inadequate or no perfusion, it should be treated like a complete amputation. In case of exposed cartilage, local or regional flaps should be considered to salvage the cartilage. In complete amputation, one may make an effort to salvage the cartilage frame by burying it in a subcutaneous pocket at the post auricular area or abdomen. The oral cavity is inspected for loose or missing teeth, evidence of injury to the mucosa with submucosal or sublingual hematoma. In severe horizontal compound wounds, all the possible soft tissue and bony elements from skin to bone may be damaged, including maxillary sinus.In intraoral injury, the muscle and overlying mucosa can be approximated as a single layer or individually. Lip lacerations can result in important cosmetic defects if not sutured in a precise manner. Even minor misalignments of the white roll or vermilion border are conspicuous from a distance.

In superficial laceration, the first suture should be placed at the vermilion border and then the remainder should be closed. Great care must be taken to separately reapproximate the underlying orbicularis oris muscle. Avulsive injuries with even small pedicle should be approximated due to the possibility of survival. Wound crossing a line from the tragus to the oral commissure should be viewed as potential injury to the parotid duct.
In suspected case, a 22 gauge catheter is inserted intraorally to cannulate the Stensen duct and a small quantity of saline is injected. The use of methylene blue or other contrast materials should be avoided because staining of the area only complicates localization of the proximal end of the duct. If the parotid duct is divided, two ends should be identified and repaired over a fine stent. Many of the gunshot injuries of the parotid gland have associated facial nerve palsy, which is difficult to identify initially.
If it is anterior to the parotid gland, the branches of the seventh nerve are examined with loupe magnification or under the operative microscope. The nerve stimulator is a useful tool for identification of the distal segment within 48 h of injury. After 48-72 h, the distal nerve segments will no longer conduct the impulse to the involved facial musculature. One should specially test the elevation of the brow, forced closure of the eyes, voluntary smile and eversion of the lower lip. If the orbicularis oculi and frontalis muscles are functioning, it means that the temporofacial division of the facial nerve is intact. Similarly, the continuity of the buccal, mandibular and cervicofacial branches can be assessed by the function of the buccinator, orbicularis oris and other muscles. Thus, the trauma, extending anterior to the parotid gland is crucial as far as the function of the muscles of expression is concerned.
If the proximal ends of the facial nerves cannot be located, the uninjured proximal nerve trunk can be located and followed distally to the cut end of the nerve.
If primary repair is not possible, the proximal and distal nerve ends should be tagged with non-absorbable suture for easy identification during future repair.
Nerve regeneration typically occurs at a rate of 1 mm per day after a month lag [13] .Grafts and flapsThe reconstructive options for soft tissue vary from skin grafts to different types of flaps. When there is only skin loss, which cannot be approximated, post-auricular full thickness skin graft is the choice followed by the supraclavicular and medial arm. One should avoid using fancy flaps with multiple limbs as ultimately it may result in an extra scar.
After the wound is demarcated, the planned flap is sketched slightly larger and wider than the defect to compensate for tissue retraction.
Sometimes thicker flaps require secondary debulking and scar revision after 4 to 6 months to achieve better aesthetic result. Respiratory tract damage is secondary to chemical injury from the inhalation of products of incomplete combustion.
Management of burns of the face is particularly difficult as many important functional organs are involved.
Most electrical burns occur in the perioral region, nose and ears, as they are prominent organs, coming into frequent contact with live wires.
Usually they are third-degree burns with extensive coagulation necrosis extending for a considerable distance.
Intermediate burns are treated with twice hydrotherapy, debridement and topical antibacterials. During the early phase of eyelid burn, local conservative measures with frequent application of ophthalmic ointment and taping of eyelids suffice. Early split skin grafting should be performed to prevent ectropion of the upper eyelid with possible corneal exposure.
During the waiting phase, the patient is encouraged to exercise by frequent opening and closing of the eyes.
Incision and drainage with resection of involved cartilage has been recommended for suppurative chondritis. If the overlying skin is destroyed, early split skin grafting prevents further complications. A full thickness burn of the ear invariably damages and exposes the cartilage, which must be covered with vascularised tissue. The frame-work is either buried under a post auricular skin flap, a local cervical flap or a temporoparietal facial flap with skin graft.Nose and mouthThe skin is adherent to the underlying cartilage at the caudal portion of the nose. In thermal burns most of the time the mucosa may remain unaffected providing adequate circulation to the cartilaginous frame.
Such full thickness defects often require several operative procedures to achieve reasonable results. Vestibular stents are worn continuously to prevent the nostril from either being obliterated or severely narrowed.
An useful elastic appliance, fitting into the corners of the mouth, along with intermittent physiotherapy of mouth opening and closing prevents such complication. Acute wounds of different etiologies offer a significant challenge to the reconstructive surgeons.
Critical assessment of the nature and magnitude of the wound is of enormous importance, in relation to the ultimate surgical outcome. Locoregional flaps of different constituents and combinations are popular and of enormous value in managing moderate size defects.
Failure arises more often than not from the inability to recognize the extent of an injury, rather than from the inability to treat the recognized injury.

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