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Alloderm? and thin skin graft after scar shaving and release in post-burn scar contracture
S76
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Alloderm? and thin skin graft after scar shaving and release in post-burn scar contracture Oh S.J., Jang Y.C., Lee J.W., Seo D.K., Koh J.H. Hallym Burn Center, Hangang Sacred Heart Hospital, Korea E-mail address: [email protected] (S.J. Oh). Aims: Post-burn scar contracture around joints has been needed releasing and coverage with FTSG, thick thickness skin graft, and flaps for relief of motion limitation. Thin scar with irregular pigmentation and contour surface have been accepted cosmetically effective results after scar shaving and thin skin graft. Alloderm?s dermal substitute and has been used simultaneously with thin skin graft covered the wound of total skin loss. In our study, we introduce and evaluate outcomes of a new method for the reconstruction of post-burn scar contractures. Material and methods: This procedure performed 36 sites among 27 patients during last 2.5 years. Male was 13 patients, female 14. The age distribution was 3 patients (under 10 years of age), 10 patients (11–20 years), 7 patients (21–30 years), 4 patients (21–30 years) and 3 patients (41–50 years). In the site distribution shoulder and upper arm was 11 cases; elbow, 5; forearm and wrist, 10; popliteal and ankle, 3; hand, 4 and others, 3. Contracture hypertrophic scar including surrounding thin scar area was initially shaved with razor blade and derma-abrader. Contracted area was released by transverse incisions. Releasing area was covered with Alloderm? and then entire wound was covered with thin skin graft (6–7/1000 in. in thickness). Results: Our cases showed functionally and aesthetically good outcomes similar to thick thickness skin graft under adequate postoperative care over 1 year. Donor sites show acceptable appearance. Hypertrophic scar in too much shaved area can be developed focally. Conclusion: We recommend that this procedure can be a new option for reconstruction of post-burn scar contracture. doi:10.1016/j.burns.2006.10.179 High-tension electrical injuries reconstruction ´ ´ Gonzalez I.F., Zubizarreta F.J.G., Carmona M.U., Abajas J.M.B., Lopez V.T., Estefan´ıa J.C. Cruces Hospital, Burns Unit, Spain ´ E-mail address: [email protected] (I.F. Gonzalez). The observations demonstrate the importance of early diagnosis and treatment of compartment syndrome by means fasciotomies and escharotomies in the patients that have suffered high-tension electrical injuries. In our series this procedure diminished the incidence of limb amputation. We agree with most of the authors in the importance of an aggressive and early surgical debridement of the necrotic tissues or those in which the viability is doubtful, maintaining a conservative attitude to the management of exposed tendons and nerves. In these structures we consider that anatomical continuity is very important when their viability is questioned, keeping them “in situ”. In the same surgical procedure the wound is covered by a flap, a free flap if necessary, which avoids desiccation of the remaining tissues. Free tissue transplantation offers advantages when compared with multistage pedicled flaps, allowing a good quality coverage, well vascularized and very useful for deep burns affecting structures such as bone, tendons, cartilage, etc. Devitalized tendons, nerves and denuded bone can be saved with this method even in the presence of infection. We described our experience with different surgical procedures from the pedicled flaps to the microsurgical flaps and more recently with perforator flaps. We agree with most of the authors in the importance of aggressive ad early surgical debridement of the necrotic tissues, covering the wound with a flap, a free flap if necessary, in the same surgical procedure. doi:10.1016/j.burns.2006.10.180 Clinical use of heparin in acute second degree burns Oh S.J., Jang Y.C., Lee J.W., Seo D.K., Koh J.H., Kim S.J., Jung Y.R. Hallym Burn Center, Hangang Sacred Heart Hospital, Korea E-mail address: [email protected] (S.J. Oh). Aims: Heparin therapy through topical or systemic application in acute burn wound has been reported in the previous literatures to improve pain relief and also reduce healing time and scar formation of burn wound. In our study, we report preliminary evaluation of topical heparin effect in acute second degree burns related to sites of burns, depth of burn injury, healing time, operation rate and degree of scaring. Material and methods: Our clinical data collected 421 patients during last 15 months. In sex distribution, male were 246, female 175. The children under age 10 were the most common (161 patients). The multiple sites of burns were the most common (217 patients). Deep second degree burns were the most common (295 patients). We apply daily over three times of topical application of heparin on the burned wound combined with closed or open dressing. Skin grafting was performed in some patients to be
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Alloderm? and thin skin graft after scar shaving and release in post-burn scar contracture Oh S.J., Jang Y.C., Lee J.W., Seo D.K., Koh J.H. Hallym Burn Center, Hangang Sacred Heart Hospital, Korea E-mail address: [email protected] (S.J. Oh). Aims: Post-burn scar contracture around joints has been needed releasing and coverage with FTSG, thick thickness skin graft, and flaps for relief of motion limitation. Thin scar with irregular pigmentation and contour surface have been accepted cosmetically effective results after scar shaving and thin skin graft. Alloderm?s dermal substitute and has been used simultaneously with thin skin graft covered the wound of total skin loss. In our study, we introduce and evaluate outcomes of a new method for the reconstruction of post-burn scar contractures. Material and methods: This procedure performed 36 sites among 27 patients during last 2.5 years. Male was 13 patients, female 14. The age distribution was 3 patients (under 10 years of age), 10 patients (11–20 years), 7 patients (21–30 years), 4 patients (21–30 years) and 3 patients (41–50 years). In the site distribution shoulder and upper arm was 11 cases; elbow, 5; forearm and wrist, 10; popliteal and ankle, 3; hand, 4 and others, 3. Contracture hypertrophic scar including surrounding thin scar area was initially shaved with razor blade and derma-abrader. Contracted area was released by transverse incisions. Releasing area was covered with Alloderm? and then entire wound was covered with thin skin graft (6–7/1000 in. in thickness). Results: Our cases showed functionally and aesthetically good outcomes similar to thick thickness skin graft under adequate postoperative care over 1 year. Donor sites show acceptable appearance. Hypertrophic scar in too much shaved area can be developed focally. Conclusion: We recommend that this procedure can be a new option for reconstruction of post-burn scar contracture. doi:10.1016/j.burns.2006.10.179 High-tension electrical injuries reconstruction ´ ´ Gonzalez I.F., Zubizarreta F.J.G., Carmona M.U., Abajas J.M.B., Lopez V.T., Estefan´ıa J.C. Cruces Hospital, Burns Unit, Spain ´ E-mail address: [email protected] (I.F. Gonzalez). The observations demonstrate the importance of early diagnosis and treatment of compartment syndrome by means fasciotomies and escharotomies in the patients that have suffered high-tension electrical injuries. In our series this procedure diminished the incidence of limb amputation. We agree with most of the authors in the importance of an aggressive and early surgical debridement of the necrotic tissues or those in which the viability is doubtful, maintaining a conservative attitude to the management of exposed tendons and nerves. In these structures we consider that anatomical continuity is very important when their viability is questioned, keeping them “in situ”. In the same surgical procedure the wound is covered by a flap, a free flap if necessary, which avoids desiccation of the remaining tissues. Free tissue transplantation offers advantages when compared with multistage pedicled flaps, allowing a good quality coverage, well vascularized and very useful for deep burns affecting structures such as bone, tendons, cartilage, etc. Devitalized tendons, nerves and denuded bone can be saved with this method even in the presence of infection. We described our experience with different surgical procedures from the pedicled flaps to the microsurgical flaps and more recently with perforator flaps. We agree with most of the authors in the importance of aggressive ad early surgical debridement of the necrotic tissues, covering the wound with a flap, a free flap if necessary, in the same surgical procedure. doi:10.1016/j.burns.2006.10.180 Clinical use of heparin in acute second degree burns Oh S.J., Jang Y.C., Lee J.W., Seo D.K., Koh J.H., Kim S.J., Jung Y.R. Hallym Burn Center, Hangang Sacred Heart Hospital, Korea E-mail address: [email protected] (S.J. Oh). Aims: Heparin therapy through topical or systemic application in acute burn wound has been reported in the previous literatures to improve pain relief and also reduce healing time and scar formation of burn wound. In our study, we report preliminary evaluation of topical heparin effect in acute second degree burns related to sites of burns, depth of burn injury, healing time, operation rate and degree of scaring. Material and methods: Our clinical data collected 421 patients during last 15 months. In sex distribution, male were 246, female 175. The children under age 10 were the most common (161 patients). The multiple sites of burns were the most common (217 patients). Deep second degree burns were the most common (295 patients). We apply daily over three times of topical application of heparin on the burned wound combined with closed or open dressing. Skin grafting was performed in some patients to be