scholarly journals A paradigm shift in practice—the benefits of early active wound temporisation rather than early skin grafting after burn eschar excision

2020 ◽  
Vol 48 (2) ◽  
pp. 93-100
Author(s):  
John E Greenwood
Keyword(s):  
Skin Graft ◽  
Paradigm Shift ◽  
Burn Injury ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Graft Harvest ◽  
Major Burn ◽  
Early Closure ◽  
Total Body

After major burn injury, once survival is achieved by the immediate excision of all deep burn eschar, we are faced with a patient who is often physiologically well but with very extensive wounds. While very early grafting yields excellent results after the excision of small burns, it is not possible to achieve the same results once the wound size exceeds the available donor site. In patients where 50%–100% of the total body surface area is wound, we rely on serial skin graft harvest, from finite donor site resources, and the massive expansion of those harvested grafts to effect healing. The result is frequently disabling and dysaesthetic. Temporisation of the wounds both passively, with cadaver allograft, and actively, with dermal scaffolds, has been successfully employed to ameliorate some of the problems caused by our inability to definitively close wounds early. Recent advances in technology have demonstrated that superior functional and cosmetic outcomes can be achieved in actively temporised areas even when compared with definitive early closure with skin graft. This has several beneficial implications for both patient and surgeon, affecting the timing of definitive wound closure and creating a paradigm shift in the care of the burned patient.

scholarly journals Amniotic membrane graft in a recurrent re-fusing temporal tarsorrhaphy: a case report

2020 ◽  
Vol 12 ◽  
pp. 251584142097192
Author(s):  
G. Bryant Giles ◽  
Donovan S. Reed ◽  
Timothy A. Soeken ◽  
Brett W. Davies
Keyword(s):  
Skin Graft ◽  
Amniotic Membrane ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Vehicle Accident ◽  
Graft Donor ◽  
Total Body ◽  
Amniotic Graft

Amniotic membrane grafts (AMGs) are commonly used to treat a variety of ophthalmologic conditions. Complications exist with permanent tarsorrhaphies, including the risk of re-fusion following tarsorrhaphy separation. We report a novel application of amniotic graft in lieu of skin grafts to protect the exposed marginal surface during the initial re-epithelialization period following release of a permanent tarsorrhaphy. We present a 24-year-old man who sustained an 80% total body surface area burn from a motor vehicle accident 16 months prior to presentation at our Oculoplastic service for evaluation of residual lagophthalmos. His original permanent tarsorrhaphies were removed; however, re-fusion occurred temporally in both sides. During a second attempt, AMGs were secured over the eyelid margins, leading to a successful tarsorrhaphy takedown without re-fusion. Periocular burn injuries present particular challenges, as cicatricial changes continue to evolve and viable skin graft areas diminish with each successive graft. In the setting of recurrent auto-tarsorrhaphy, the AMG has shown to be a viable alternative to standard skin grafting. This case demonstrates excellent results in a skin graft sparing procedure that is effective and efficient. Amniotic membrane grafting reduces morbidity by foregoing skin graft donor sites and can achieve similar functional and cosmetic results to standard skin grafting with reduced overall surgical time. As such, AMGs have the potential to supplant standard skin grafting in cases of recurrent auto-tarsorrhaphy, particularly in the setting of diminished available healthy skin tissue.

scholarly journals Early treatment and intensive care of children with burn injury

2017 ◽  
Vol 64 (1) ◽  
pp. 39-42
Author(s):  
Ivana Petrov ◽  
Ivana Budic ◽  
Irena Simic ◽  
Dusica Simic
Keyword(s):  
Pediatric Patients ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Physiological Status ◽  
Hormonal Responses ◽  
Severe Burns ◽  
Immunological Profile ◽  
Major Burn ◽  
Total Body

Major burn injury remains a significant cause of morbidity and mortality in pediatric patients. The treatment of burned children differs substantially from that of adults not only because of the different body proportions but also because of the metabolic processes involved, hormonal responses, the immunological profile, the degree of psychological maturation and healing potential. After assessing the overall physiological status of the child, accurate assessment of the burn injury and appropriate fluid resuscitation are of great importance. The severity of burn injury is characterized by the depth of the burn, total body surface area (TBSA) that is involved, the location of burn injury and the presence or absence of inhalation injury. Early excision and grafting, adequate nutrition, alleviation of the hypermetabolic response, treatment of hyperglycaemia, and physical therapy improve survival and outcomes in children with severe burns.

scholarly journals Burn Cases, Their Management and Complications: A Review

2016 ◽  
Vol 5 (12) ◽  
pp. 103-105 ◽  
Author(s):  
Rizwan Ali Masood ◽  
Zafeer Naeem Wain ◽  
Rehan Tariq ◽  
Muhammad Asis Ullah ◽  
Irfan Bashir
Keyword(s):  
Cardiogenic Shock ◽  
Body Surface ◽  
Fluid Resuscitation ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Pharmaceutical Journal ◽  
Review Article ◽  
Major Burn ◽  
Silver Compound ◽  
Total Body

Skin being the primary barrier to infection can be damaged by burn injury. Burn injury may lead to distributive, hypovolemic and cardiogenic shock. A burn victim may experience several extremely mortal complications i.e. local and systemic. When the injury exceeds 25 to 30% total body surface area (TBSA) there will be the chances of generalized edema in non-injured tissues. Fluid resuscitation is very effective method in the management of major burn. According to the expert opinion, the fluid resuscitation should be started in adults with 15% and children with 10% burns. In this review article, it has been concluded that opioids, anticonvulsants, antidepressants, benzodiazepines and ketamine are the most commonly used drugs in the management of burn pain. Silver compound or its salts mainly Silver sulfadiazine is an important remedy in topical treatment. Sepsis is the main cause of death in burn victims.Masood et al., International Current Pharmaceutical Journal, November 2016, 5(12): 103-105http://www.icpjonline.com/documents/Vol5Issue12/01.pdf

scholarly journals Usage of intermingled skin allografts and autografts in a senior patient with major burn injury

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1745-1748
Author(s):  
Hongmin Luo ◽  
Huining Bian ◽  
Chuanwei Sun ◽  
Shaoyi Zheng ◽  
Bing Xiong ◽  
...  
Keyword(s):  
Burn Injury ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Skin Grafts ◽  
Burn Wound ◽  
Skin Allografts ◽  
Economic Method ◽  
Major Burn ◽  
Gas Flame ◽  
Extensive Burn

Abstract Mortality rate in older adults following extensive burn injury is extremely high, and management of these patients is challenging. One of the main problems is that autologous split-thickness skin grafts are scarce and the wounds cannot be covered quickly and effectively. Intermingled skin grafting is a low-tech and economic method, which not only maximizes the use of precious autologous skin but also prevents the wounds from infection and consumption. Herein we present a case of extensive burn injury in a 68-year-old female successfully treated with intermingled skin grafting. The patient was accidentally burned by gas flame, resulting in a major burn injury covering 80% of her total body surface area. Early burn wound excision was performed and the wound was temporarily covered with irradiated porcine skin in the first week after injury. Autologous stamp-like skin grafts were applied to the wound bed 4 weeks after injury. In this operation, the results were not satisfactory. The take rate of the skin grafts is only about 50%. We covered the wounds with intermingled skin allografts and autografts 8 weeks after injury: autografts (0.5 cm × 0.5 cm) + fresh close relative’s allografts (1 cm × 1 cm) + cryopreserved allografts (2 cm × 2 cm).

scholarly journals The scalp as a donor site for skin grafting in burns: retrospective study on complications

2016 ◽  
Vol 4 ◽  
pp. 1-6 ◽  
Author(s):  
Dorota Teresa Roodbergen ◽  
Adrianus Fredericus Petrus Maria Vloemans ◽  
Zjir Mezjda Rashaan ◽  
Jacob Cornelis Broertjes ◽  
Roelf Simon Breederveld
Keyword(s):  
Retrospective Study ◽  
Surface Area ◽  
Complication Rate ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Healing Time ◽  
Late Complications ◽  
Split Skin Grafting ◽  
Total Body

Abstract Background Split skin grafting (SSG) is the cornerstone in the treatment of deep burns and large skin defects. Frequently used donor sites are the thigh, abdomen and buttocks. The scalp is less common while considered as a reliable donor site. Advantages are a large surface area, rapid wound healing, cosmetically favourable results and multiple harvests from the same donor site. Complications include scab formation, chronic folliculitis and alopecia but have been recorded sporadically in previous studies. This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre. Methods A retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012. Data were collected from medical files of included patients, including gender, age, type of burn (scald, flame, other) and total body surface area (TBSA) burned at the time of first surgery. Postoperative variables were healing time of the donor site and incidence of complications. During follow-up, the incidence of late complications was reviewed. Results A total number of 105 grafts were analysed in 93 patients: 58 males (62 %) and 35 females (38 %), with a median age of 2 years and 3 months old. Of the patients, 30 (32 %) had flame burns and 57 (61 %) had scald burns. Eighty-seven percent of patients had a TBSA burned of 5 % or less. All donor sites healed within 14 days. No alopecia or scar hypertrophy developed at the donor sites. Two patients (2.2 %) developed folliculitis; one patient (1.1 %) showed scab formation. Conclusions The scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature, with quick healing and no long-term complications. Therefore, we propose the consideration of the scalp as a primary donor site, especially in young children, where the scalp offers a larger donor site area than the buttocks or thighs.

scholarly journals Treatment of Anaemia in Patients with Acute Burn Injury: A Study of Blood Transfusion Practices

2021 ◽  
Vol 10 (3) ◽  
pp. 476
Author(s):  
Ioana Tichil ◽  
Samara Rosenblum ◽  
Eldho Paul ◽  
Heather Cleland
Keyword(s):  
Blood Transfusion ◽  
Surgical Management ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Perioperative Period ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Burn Care ◽  
Transfusion Requirements ◽  
Total Body

Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.

scholarly journals Squamous Cell Carcinoma Arising at a Skin Graft Donor Site: Case Report and Review of the Literature

2021 ◽  
Vol 7 ◽  
pp. 2513826X2110084
Author(s):  
Weston Thomas ◽  
Kevin Rezzadeh ◽  
Kristie Rossi ◽  
Ajul Shah
Keyword(s):  
Squamous Cell Carcinoma ◽  
Case Report ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Skin Graft ◽  
Donor Site ◽  
Skin Grafting ◽  
Excisional Biopsy ◽  
Graft Donor ◽  
The Right

Introduction: Skin graft reconstruction is a common method of providing wound coverage. Rarely, skin grafting can be associated with the development of squamous cell carcinoma (SCC) in the graft donor site. Case Report: The patient is a 72-year old male with a 15-year history of bilateral hip wounds. He underwent a multitude of treatments previously with failed reconstructive efforts. After presenting to us, he underwent multiple debridements and eventual skin grafting. Within 4 weeks of the final skin graft, a mass developed at the skin graft donor site at the right thigh. Excisional biopsy returned a well differentiated keratinizing SCC. Discussion/Conclusion: This case demonstrates the acute presentation of SCC in a patient following a skin graft without known risk factors. The purpose of this unique case report is to highlight a very rare occurrence of SCC at a skin graft donor site.

662 Single Surgeon Experience Using a Polyactide-based Copolymer Dressing to Over and Secure Split Thickness Skin Grafts in Burn Patients.

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S186-S187
Author(s):  
Eduardo Navarro ◽  
Tera Thigpin ◽  
Joshua S Carson
Keyword(s):  
Skin Graft ◽  
Outer Layer ◽  
Healing Process ◽  
Graft Loss ◽  
Total Body Surface Area ◽  
Surgeon Experience ◽  
Pain Outcomes ◽  
Total Body ◽  
Operative Notes

Abstract Introduction In both partial thickness burns and skin graft donor sites, coverage with Polylactide-based copolymer dressing (PLBC dressing) has been shown to result in expedited healing and improved pain outcomes when compared to more traditional techniques. These advantages are generally attributed to the way in which PLBC remains as an intact coating over the wound bed throughout the healing process, protecting wounds from the contamination and microtraumas associated with changes more conventional dressings. At our institution, we began selectively utilizing PLBC as a means of securing and protecting fresh skin graft, in hopes that we would find similar benefits in this application. Methods Clinical Protocol-- The PLBC dressing was used at the attending surgeon’s discretion. In these cases, meshed STSG was placed over prepared wound beds. Staples were not utilized. PLBC dressing was then placed over the entirety of the graft surface, securing graft in place by adhering to wound bed through intercises. (Staples were not used.) The graft and PLBC complex was further dressed with a layer of non-adherent cellulose based liner with petroleum based lubricant, and an outer layer of cotton gauze placed as a wrap or bolster. Post operatively, the outer layer (“wrap”) of gauze was replaced as needed for saturation. The PLBC and adherent “inner” liner were left in place until falling off naturally over the course of outpatient follow-up. Retrospective Review-- With IRB approval, patients treated PLBC over STSG between April 2018 to March 2019 were identified via surgeon’s log and pulled for review. Documentation gathered from operative notes, progress notes (inpatient and outpatient) and clinical photography was used to identify demographics, mechanism of injury, depth, total body surface area percentage (TBSA%), size of area treated with PLBC dressing, graft loss, need for re-grafting, signs of wound infection, antibiotic treatment, and length of stay. Results Twenty-two patients had STSG secured and dressed with PLBC. Median patient age was 36.5 years. Median TBSA was 5.1%, and median treated area 375 cm2. Follow up ranged from 21 to 232 days post-operatively, with two patients lost to follow up. All patients seen in outpatient follow up were noted to have “complete graft take” or “minimal” graft. None of the areas treated with PLBC dressing required re-grafting. There were no unplanned readmissions, and no wound infections were diagnosed or treated. Practitioners in in-patient setting and in follow up clinic reported satisfaction with the PLBC dressing. Conclusions The PLBC dressing was a feasible solution for securing and dressings STSGs. Future work is needed to determine whether its use is associated with an improvement in patient outcomes.

Combined Complex Skin Repair in Patient With Extensive Burns: A Case Report

2021 ◽  
Author(s):  
Xingxin Gao ◽  
Min Zhang ◽  
Yuan Lin ◽  
Dehui Li ◽  
Liming Zhang
Keyword(s):  
Recombinant Human Growth Hormone ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Human Growth ◽  
Skin Grafting ◽  
Current Treatment ◽  
Limiting Factors ◽  
Split Thickness Skin Graft ◽  
Skin Repair ◽  
Extensive Burns

Abstract Auto-skin grafting is the current treatment of choice for extensive burns. Nevertheless, the lack of donor sites for skin grafting remains one of the greatest limiting factors for the treatment of extensively burned patients. We present the case of a 53-year-old male patient with deep and full thickness burns on 91% of the total body surface area. We used the Meek technique for split-thickness skin graft expansion to treat this patient. In order to obtain sufficient skin for grafting, we repeatedly harvested the same anatomical areas. Acceleration of burn wounds, recipient, and donor site healing was achieved by systemic treatment with recombinant human growth hormone and topical recombinant human epidermal growth factors. This combined, complex treatment modality contributed to the successful skin repair in this patient.

scholarly journals Pediatric burn resuscitation: past, present, and future

2017 ◽  
Vol 5 ◽  
Author(s):  
Kathleen S. Romanowski ◽  
Tina L. Palmieri
Keyword(s):  
Fluid Resuscitation ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Shock ◽  
Basic Principles ◽  
Future Directions ◽  
Number Of Children ◽  
History Of ◽  
Adults And Children ◽  
Total Body

Abstract Burn injury is a leading cause of unintentional death and injury in children, with the majority being minor (less than 10%). However, a significant number of children sustain burns greater than 15% total body surface area (TBSA), leading to the initiation of the systemic inflammatory response syndrome. These patients require IV fluid resuscitation to prevent burn shock and death. Prompt resuscitation is critical in pediatric patients due to their small circulating blood volumes. Delays in resuscitation can result in increased complications and increased mortality. The basic principles of resuscitation are the same in adults and children, with several key differences. The unique physiologic needs of children must be adequately addressed during resuscitation to optimize outcomes. In this review, we will discuss the history of fluid resuscitation, current resuscitation practices, and future directions of resuscitation for the pediatric burn population.

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