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Septic arthritis of the hip in extensive burn
S38
Burns 3 5 S ( 2 0 0 9 ) S1–S47
FRI005
FRI007
Dystrophic calcinosis cutis combining with squamous cell carcinoma in chronic
The use of osmotic tissue expanders in paediatric burn reconstruction
burn scar
S. Chummun ∗ , K.J. Stewart Department of Plastic Surgery, Royal Hospital for Sick Children, Edin-
S. Lee ∗ , K. Kim, J. Hwang, E. Kim Department of Plastic Surgery, Chonnam National University
burgh, United Kingdom
Hospital, Gwangju City, South Korea
Rationale: The use of tissue expanders is well established as a useful modality in soft Rationale: Dystrophic calcinosis cutis (DCC) has been known to be associated with
tissue reconstruction in children and adults. The aim of this study is to present the
postburn scar or cutaneous neoplasms. However, it is rare in the lesion which
use of osmotic tissue expanders in burn reconstruction in a paediatric population.
postburn scar coexists with squamous cell carcinoma (SCC). We present a case
Methods: Patients with burns treated with the OsmedTM osmotic tissue expender at
of calcinosis cutis in a old burn scar with the clinical manifestation of recurrent
the Royal Hospital for Sick Children between 2003 and 2008 were identified. Their
leg burn scars.
casenotes were reviewed and data was collected on the type of reconstruction.
Methods: A 41-year-old male visited our hospital, complaining of pruritus and tin-
Results: 2 patients were identified during the period investigated.
gling sensation on his left thigh. At age 11, he suffered a second degree flame burn
Patient 1: A 10-year old sustained an electric burn while on holidays in Pakistan. The
on his left thigh, healed without any operation. When he was 40 years old, a small
exit wound resulted in a full thickness burn to the left side of his scalp. This was
abscess developed in the center of the burn scar after a minor trauma. 2 months
initially debrided and reconstructed with local pericranial flaps and split skin graft-
later, he had several operative procedures including incision and drainage, all of
ing, which resulted in an area of alopecia. Two 13 ml OsmedTM osmotic expanders
which were unsuccessful. 7 months later, skin ulcer on the medial aspect of his left
were subsequently inserted in subgaleal pockets and the expanders were removed
thigh was happened. On operation, the burn scar including the ulcer was excised
28 days later. The scar was excised fully and reconstructed with the expanded
and the contracture was released. The resulting defect was covered with skin graft.
tissue, resulting in a satisfactory outcome.
During the operation, we came across several calcium stones in the lesion.
Patient 2: A 4-year-old boy sustained a full thickness flame burn to his anterior
Results: Most of all laboratory findings were generally within normal limits, and
neck and clavicle. The burn was initially excised and the area reconstructed with
we detected no another disease which might induce cutaneous calcification.
IntegraTM . Unfortunately, he developed a contracture at his neck scar which lim-
Histopathological examination of the lesion with hematoxylin–eosin revealed infil-
ited his range of movement. 2 OsmedTM osmotic expanders (60 and 200 ml) were
trating tumor nests with hyperchromatic nuclei, prominent nucleoli, and adjacent
inserted at the periphery of the neck scar as a staged procedure for scar revision.
dystrophic calcification. However, there is no contact or relation between the cal-
He developed a wound infection 4 days post-operatively and required removal of
cification lesion and the masses of SCC.
the implants. The scar was subsequently revised using 2 local advancement flaps,
Conclusion: We pointed out that calcification in the subcutaneous tissue, often not
with satisfactory results.
even adjacent to the ulceration, might act as a foreign body causing the ulceration.
Conclusion: The osmotic tissue expander is an interesting reconstructive adjunct,
According to these facts, it is very possible that in our case tissue injury by burn, scar
specially when dealing with a paediatric population. However, the high rate of
formation, calcification, ulceration, and malignant transformation were developed
infection, despite meticulous aseptic technique and intra-operative intravenous
in order. Therefore, we believe that the DCC occurred as a consequence of post-
antibiotics, has deterred us from using it in routine clinical practice. We await the
burn scar, but not SCC. This fact also suggests a possibility that many dystrophic
development of more refined devices with slower rate of inflation and longer safety
calcifications associated with a variety of each disease.
track record before advocating their regular use.
doi:10.1016/j.burns.2009.06.150
doi:10.1016/j.burns.2009.06.152
FRI006
FRI009
Septic arthritis of the hip in extensive burn
The management of combat related soft tissue wounds due to blast injuries: Expe-
S. Kim ∗ , C. Jeong, D. Choi, J. Lee General Surgery, Hana Hospital Burn Center, Busan, South Korea
riences with the use of a collagen–elastin matrix (Matriderm® )
Rationale: In the patient with extensive burn injury, the occult site of infection such as septic arthritis is easy to overlook because a painful hip joint may be confused
T.F. Schilling ∗ , E. Kollig Department of Trauma and Reconstructive Surgery, German Armed Forces Central Hospital, Koblenz, Germany
for painful burn wounds around pelvic area. We describe a extensive burned young
Rationale: Depending on their extension and depth, burn injuries result in scar for-
adult who experienced a septic hip joint with methicillin resistant Staphyllococcus
mation impairing functional and aesthetic outcome. The use of dermal substitutes
aureus bacteremia.
like a collagen–elastin matrix (Matriderm® ) has been shown to minimise scar con-
Methods: A 22-year-old male who had full thickness burns of whole body (90%) pre-
traction and improve biomechanical properties of skin grafts, which is of special
sented with fever, groin pain, and immobility of right hip joint about 3 months after
interest in deep tissue defects due to blast injuries. This is an institutional report
injury. He manifested a leukocytosis and an elevated erythrocyte sedimentation
on the experience with the use of Matriderm® in German soldiers wounded in
rate. The physical findings, radiographic findings and bone scan were diagnostic
Afghanistan.
for a septic arthritis. With destructive changes in the joint, his active range of
Methods: In August 2008, two German soldiers sustained blast injures with II–III
motion was limited by 80% in extension and abduction, and all resisted ranges of
burns and a TBSA of 20–30%. Initial treatment including escharatomy and external
motion produced pain.
fixation took place in Afghanistan. The patients were transferred to a German mil-
Results: Conservative therapy (antibacterial agent) and burn wound coverage (repet-
itary burn centre. After multiple debridements and definitive osteosynthesis, the
itive skin graft) was performed as presurgical management. After about 30 days, his
remaining soft tissue defects on hands, forearms and thighs were covered with
pain and fever were subsided and he had started physical therapy including muscle
combined Matriderm® and split thickness skin grafts. Initial take rate was 80%.
strengthening, and muscle balancing exercises 3–5 times per week for 8 months.
Patients were discharged to a rehabilitation unit four, respectively, 5 months later.
He had made progress with respect to flexibility, strength, and muscle coordina-
Results: All soft tissue defects could successfully be covered with combined
tion. About 16 months after burn injury when his hip joint had been fused, he had
Matriderm® and split thickness skin grafts. The collagen–elastin matrix was easy
surgical therapy (total hip arthroplasty). At the present, his active range of motion
to apply. Short term follow-up showed good results, especially on hands and fore-
was improved by 60% in extension and abduction.
arms. Long term results concerning aesthetic and functional outcome including
Conclusion: Septic arthritis in the extensive burns may be misdiagnosised for painful
range of movement of wrist and finger joints are not available yet.
burn wounds. Hematogenous septic hip arthritis by sustained bacteremia is rare,
Conclusion: In both patients, combined application of Matriderm® and split thick-
but clinical examination combined with appropriate laboratory and radiographic
ness skin grafts proved to be a reliable method for reconstruction of soft tissue
studies can lead to prompt diagnosis and treatment.
defects due to blast injuries. Further studies are needed to investigate long term
doi:10.1016/j.burns.2009.06.151
results, potential advantages in the treatment of blast injuries and to compare it with other artificial skin substitutes. doi:10.1016/j.burns.2009.06.153
Burns 3 5 S ( 2 0 0 9 ) S1–S47
FRI005
FRI007
Dystrophic calcinosis cutis combining with squamous cell carcinoma in chronic
The use of osmotic tissue expanders in paediatric burn reconstruction
burn scar
S. Chummun ∗ , K.J. Stewart Department of Plastic Surgery, Royal Hospital for Sick Children, Edin-
S. Lee ∗ , K. Kim, J. Hwang, E. Kim Department of Plastic Surgery, Chonnam National University
burgh, United Kingdom
Hospital, Gwangju City, South Korea
Rationale: The use of tissue expanders is well established as a useful modality in soft Rationale: Dystrophic calcinosis cutis (DCC) has been known to be associated with
tissue reconstruction in children and adults. The aim of this study is to present the
postburn scar or cutaneous neoplasms. However, it is rare in the lesion which
use of osmotic tissue expanders in burn reconstruction in a paediatric population.
postburn scar coexists with squamous cell carcinoma (SCC). We present a case
Methods: Patients with burns treated with the OsmedTM osmotic tissue expender at
of calcinosis cutis in a old burn scar with the clinical manifestation of recurrent
the Royal Hospital for Sick Children between 2003 and 2008 were identified. Their
leg burn scars.
casenotes were reviewed and data was collected on the type of reconstruction.
Methods: A 41-year-old male visited our hospital, complaining of pruritus and tin-
Results: 2 patients were identified during the period investigated.
gling sensation on his left thigh. At age 11, he suffered a second degree flame burn
Patient 1: A 10-year old sustained an electric burn while on holidays in Pakistan. The
on his left thigh, healed without any operation. When he was 40 years old, a small
exit wound resulted in a full thickness burn to the left side of his scalp. This was
abscess developed in the center of the burn scar after a minor trauma. 2 months
initially debrided and reconstructed with local pericranial flaps and split skin graft-
later, he had several operative procedures including incision and drainage, all of
ing, which resulted in an area of alopecia. Two 13 ml OsmedTM osmotic expanders
which were unsuccessful. 7 months later, skin ulcer on the medial aspect of his left
were subsequently inserted in subgaleal pockets and the expanders were removed
thigh was happened. On operation, the burn scar including the ulcer was excised
28 days later. The scar was excised fully and reconstructed with the expanded
and the contracture was released. The resulting defect was covered with skin graft.
tissue, resulting in a satisfactory outcome.
During the operation, we came across several calcium stones in the lesion.
Patient 2: A 4-year-old boy sustained a full thickness flame burn to his anterior
Results: Most of all laboratory findings were generally within normal limits, and
neck and clavicle. The burn was initially excised and the area reconstructed with
we detected no another disease which might induce cutaneous calcification.
IntegraTM . Unfortunately, he developed a contracture at his neck scar which lim-
Histopathological examination of the lesion with hematoxylin–eosin revealed infil-
ited his range of movement. 2 OsmedTM osmotic expanders (60 and 200 ml) were
trating tumor nests with hyperchromatic nuclei, prominent nucleoli, and adjacent
inserted at the periphery of the neck scar as a staged procedure for scar revision.
dystrophic calcification. However, there is no contact or relation between the cal-
He developed a wound infection 4 days post-operatively and required removal of
cification lesion and the masses of SCC.
the implants. The scar was subsequently revised using 2 local advancement flaps,
Conclusion: We pointed out that calcification in the subcutaneous tissue, often not
with satisfactory results.
even adjacent to the ulceration, might act as a foreign body causing the ulceration.
Conclusion: The osmotic tissue expander is an interesting reconstructive adjunct,
According to these facts, it is very possible that in our case tissue injury by burn, scar
specially when dealing with a paediatric population. However, the high rate of
formation, calcification, ulceration, and malignant transformation were developed
infection, despite meticulous aseptic technique and intra-operative intravenous
in order. Therefore, we believe that the DCC occurred as a consequence of post-
antibiotics, has deterred us from using it in routine clinical practice. We await the
burn scar, but not SCC. This fact also suggests a possibility that many dystrophic
development of more refined devices with slower rate of inflation and longer safety
calcifications associated with a variety of each disease.
track record before advocating their regular use.
doi:10.1016/j.burns.2009.06.150
doi:10.1016/j.burns.2009.06.152
FRI006
FRI009
Septic arthritis of the hip in extensive burn
The management of combat related soft tissue wounds due to blast injuries: Expe-
S. Kim ∗ , C. Jeong, D. Choi, J. Lee General Surgery, Hana Hospital Burn Center, Busan, South Korea
riences with the use of a collagen–elastin matrix (Matriderm® )
Rationale: In the patient with extensive burn injury, the occult site of infection such as septic arthritis is easy to overlook because a painful hip joint may be confused
T.F. Schilling ∗ , E. Kollig Department of Trauma and Reconstructive Surgery, German Armed Forces Central Hospital, Koblenz, Germany
for painful burn wounds around pelvic area. We describe a extensive burned young
Rationale: Depending on their extension and depth, burn injuries result in scar for-
adult who experienced a septic hip joint with methicillin resistant Staphyllococcus
mation impairing functional and aesthetic outcome. The use of dermal substitutes
aureus bacteremia.
like a collagen–elastin matrix (Matriderm® ) has been shown to minimise scar con-
Methods: A 22-year-old male who had full thickness burns of whole body (90%) pre-
traction and improve biomechanical properties of skin grafts, which is of special
sented with fever, groin pain, and immobility of right hip joint about 3 months after
interest in deep tissue defects due to blast injuries. This is an institutional report
injury. He manifested a leukocytosis and an elevated erythrocyte sedimentation
on the experience with the use of Matriderm® in German soldiers wounded in
rate. The physical findings, radiographic findings and bone scan were diagnostic
Afghanistan.
for a septic arthritis. With destructive changes in the joint, his active range of
Methods: In August 2008, two German soldiers sustained blast injures with II–III
motion was limited by 80% in extension and abduction, and all resisted ranges of
burns and a TBSA of 20–30%. Initial treatment including escharatomy and external
motion produced pain.
fixation took place in Afghanistan. The patients were transferred to a German mil-
Results: Conservative therapy (antibacterial agent) and burn wound coverage (repet-
itary burn centre. After multiple debridements and definitive osteosynthesis, the
itive skin graft) was performed as presurgical management. After about 30 days, his
remaining soft tissue defects on hands, forearms and thighs were covered with
pain and fever were subsided and he had started physical therapy including muscle
combined Matriderm® and split thickness skin grafts. Initial take rate was 80%.
strengthening, and muscle balancing exercises 3–5 times per week for 8 months.
Patients were discharged to a rehabilitation unit four, respectively, 5 months later.
He had made progress with respect to flexibility, strength, and muscle coordina-
Results: All soft tissue defects could successfully be covered with combined
tion. About 16 months after burn injury when his hip joint had been fused, he had
Matriderm® and split thickness skin grafts. The collagen–elastin matrix was easy
surgical therapy (total hip arthroplasty). At the present, his active range of motion
to apply. Short term follow-up showed good results, especially on hands and fore-
was improved by 60% in extension and abduction.
arms. Long term results concerning aesthetic and functional outcome including
Conclusion: Septic arthritis in the extensive burns may be misdiagnosised for painful
range of movement of wrist and finger joints are not available yet.
burn wounds. Hematogenous septic hip arthritis by sustained bacteremia is rare,
Conclusion: In both patients, combined application of Matriderm® and split thick-
but clinical examination combined with appropriate laboratory and radiographic
ness skin grafts proved to be a reliable method for reconstruction of soft tissue
studies can lead to prompt diagnosis and treatment.
defects due to blast injuries. Further studies are needed to investigate long term
doi:10.1016/j.burns.2009.06.151
results, potential advantages in the treatment of blast injuries and to compare it with other artificial skin substitutes. doi:10.1016/j.burns.2009.06.153