- Email: [email protected]
Treatment of the palmar of the burned hand with flaps
Burns 3 3 S ( 2 0 0 7 ) S1–S172
S19
The liquid alcohol in Brazilian current context ˜ F.S.V. a,b , Kroeff M.S. a,b , Pereima M.J.L. a,b Tibola J. a,b , Barbosa E. a,b , Renck L.I. a,b , Guimaraes a
Universidade Do Estado De Santa Catarina, Brazil ˜ Brazil Hospital Infantil Joana De Gumsao, E-mail address: [email protected] (J. Tibola).
b
In Brazil about 150,000 peoples/year suffer burns with liquid alcohol. The Congress representatives analyze the Project of Law 4664/04 that prohibits the sailing of this product. To prevent accidents, it was proposed the commercialization in gel only. In 2002, through resolution of the ANVISA, there was the prohibition of liquid alcohol sailing with substitution for gel version, which was allowed to show reduction of cases in burnings with the product. In detriment, preliminary one was granted in favor of a group of manufacturers, that allowed to its sale, provoking retrocession and, consequently, increasing the number of accidents. Bibliographical research made in database and government websites that objective to ratify the liquid alcohol as causal agent of burnings and, therefore, the relevance of mechanisms that control its sale. It shows that sale prohibition of liquid alcohol will cause enormous impact in the health Brazilian system. Besides to avoid the suffering, the absence of accidents with liquid alcohol will reduce expends for SUS. In the few months that the measure of the ANVISA was working, it has registered fall of 60% in the occurrences of burnings and reduction of the number of deaths. The results are excellent and they should not be ignored by the society nor for the responsible agencies. doi:10.1016/j.burns.2006.10.048 Use of collagen-elastin matrix (matriderm) for dermal reparation: 12 months experiences in the treatment of severe hand burn injuries Kamolz L.P., Frey M., Meissl G., Nathschlaeger G., Haslik W. Division of Plastic and Reconstructive Surgery, Austria E-mail address: [email protected] (L.P. Kamolz). Introduction: More and more patients survive also severe burn injuries. Thereby the focus of interest lies not only in high survival rates, but also the regained quality of life becomes more important. A major part of life quality in burn injuries is restoring full hand function and a satisfying aesthetic appearance of the hand. Thereby one of the main objects is to achieve an earliest possible, but durable and mechanical stable coverage to minimize scar formations and to restore pliability of the skin to maintain full range of motion. Method: Matriderm is an absorbable collagen-elastin matrix used for dermal reparation. The collagen is of bovine origine, all donor animals are tested for bse. Until now six patients with deep dermal and full thickness dorsal hand burns were treated with matriderm on our department. After early debridement of the burned hand was performed matriderm was applied to the wound bed and immediately grafted with skin grafts. All patients were evaluated within the first two weeks and after 12 months. Result: All grafts were adherent to the wound bed during the observation period. An excellent take rate of the matrix and the split skin graft could be observed. No haematoma occurred under the matriderm-matrix and there was no need for further grafting. No signs of topical or systemic allergic reactions were observed. All patients showed a very satisfying cosmetic and functional result after 12 months. The mean VSS was 2.5. There was no need for secondary procedures, the range of motion of the hand was unlimited in each case. No unstable scar formations or blisters could be observed. Conclusion: Matriderm can be used successfully for dermal reparation in hand burn injuries. Our first experiences show promising results, but further studies are necessary to confirm these results. doi:10.1016/j.burns.2006.10.049 Treatment of the palmar of the burned hand with flaps Hosseinian M.A. Beheshty University Faculty of Medicine, 20, North, East Vanak SQ, 19699 Tehran, Iran E-mail address: [email protected]. Introduction: Contractured of the palmar of the crushed or burned hand, and acute hand injuries with significant loss of soft tissue exposing deep structures such as tendons, nerves, bones and joints, covering by flap should be performed. The goals in hand reconstruction are optimal functional, aesthetic and anatomic reconstruction of the palm. We evaluated different methods for 5 years. Material and methods: Fifty palmar of the burned hand since 1993 have treated with different methods of these total, eight causes with free sensory instep flap, three causes with scapular flap. Twelve causes were treated by groin flap, 14 with posterior interosseous flap, 6 with fasciocutaneous ulnar flap, 4 with abdominal flap, 4 with forearm flap and 3 with side-finger flap.
S20
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Patients were evaluated for sensibility, firm binding, skin thickness, glabrous skin, color, ulcers, texture and donor-site morbidity. We have followed up for 5 years. Conclusion: The goals in hand reconstruction is to provide sensibility in the working surfaces of the hand. Optimal function, aesthetic and anatomic reconstruction of the palm with acceptable donor site morbidity are important. We can conclude that an innervated fasciocutaneous free instep flap provides normal contour, texture, glabrous skin and color and thus on optimal functional, aesthetic, and anatomic reconstruction of the palm with acceptable donor-site morbidity. doi:10.1016/j.burns.2006.10.050 Children and their burned limbs Simply VAC® it and foam it? Fette A. a,b a
Children’s Hospital, Lucerne, Switzerland Children’s Hospital, Germany E-mail address: [email protected].
b
Due to their adventurous and exploring behaviour, hands and feets are one of the most common locations for burns in our children. Mostly, these lesions are complex, showing different grades and extensions while at the same time compromising important functional and cosmetic areas. Our challenge therefore, is to manage all these issues parallel and simultaneously, and of course successfully. To date, modern wound management is capable of reducing edema, increasing tissue perfusion, managing wound exsudate, promoting epithelisation and protecting the wound surface at the same time. As well as this, the dressings should allow longterm painless changes, and has to be cost-effective. For children especially, dressings should be “child-adapted, child-accepted and child-proofed” to allow children to play and romp. Since the majority of these requirements are within the proposed mode of action of the topical negative pressure (TNP) treatment philosophy of wounds, VAC® boots or gloves were applied to 10 children with all kind of burns on their hands and feets. Briefly, after meticulous debridement or dermabrasion the foam (black or white as appropriate) was applied, sealed with foil, moulded into a boot or glove before suction was applied. TNP performed well in all cases either for wound bed preparation, wound protection until complete epithelisation has occured or as a prerequisite in preparation for skin or artificial dermis transplants, and even for their after care. Wound healing in general was excellent. Dressing changes could be reduced, and their intervals prolonged. No dressing-related wound infection occured. Even under full mobilisation without any restriction in daily activities of the children, no dressing failures were detected. Due to progressive Swiss health care settlement modalities, TNP therapy is cost-effective and useable in our home and hospital care environments. In conclusion, overall treatment of these burns was convincing, successful, cost-effective and “child-convenient”, so that we currently simply recommend to “VAC® it and foam it”. doi:10.1016/j.burns.2006.10.051 Conservative management of unusual wounds in children Pancani S. a,b , Pinzauti E. a,b , Messineo A. a,b a
Burn Unit “Anna Meyer” Children Hospital, Florence, Italy Smith & Nephew, Italy E-mail address: [email protected] (S. Pancani).
b
Severe congenital malformations, neoplastic and peculiar surgical conditions may be associated with extensive tissue loss. This paper describes the use of Acticoat* and Acticoat 7* in the management of infection in areas lacking skin protection. Case 1 Myelomeningocele Female newborn with severe cerebrospinal malformations who, one month after neurosurgical procedure of dorsal myelomeningocele closure, developed a wide area of skin necrosis, extended over two thirds of her back, involving subcutaneous tissues with leakage of cerebrospinal fluid and subsequent high risk of local and systemic infection. Antibiotic therapy was administered. Local management of the wound included the application of Acticoat. Complete healing was achieved in 30 days. Case 2 Juvenile fibrosarcoma Male newborn affected by a pelvic juvenile fibrosarcoma extending to thigh with involvement of intervertebral foramina. 6/10/2005: Extra peritoneal debulking of the mass was performed. On day 13 post-op, a greyish area of necrotic tissue could be seen. Femoral vessels were exposed: surgical debridement was performed. Parenteral antibiotics were continued in association with Acticoat until wound closure was achieved on 2 December.
S19
The liquid alcohol in Brazilian current context ˜ F.S.V. a,b , Kroeff M.S. a,b , Pereima M.J.L. a,b Tibola J. a,b , Barbosa E. a,b , Renck L.I. a,b , Guimaraes a
Universidade Do Estado De Santa Catarina, Brazil ˜ Brazil Hospital Infantil Joana De Gumsao, E-mail address: [email protected] (J. Tibola).
b
In Brazil about 150,000 peoples/year suffer burns with liquid alcohol. The Congress representatives analyze the Project of Law 4664/04 that prohibits the sailing of this product. To prevent accidents, it was proposed the commercialization in gel only. In 2002, through resolution of the ANVISA, there was the prohibition of liquid alcohol sailing with substitution for gel version, which was allowed to show reduction of cases in burnings with the product. In detriment, preliminary one was granted in favor of a group of manufacturers, that allowed to its sale, provoking retrocession and, consequently, increasing the number of accidents. Bibliographical research made in database and government websites that objective to ratify the liquid alcohol as causal agent of burnings and, therefore, the relevance of mechanisms that control its sale. It shows that sale prohibition of liquid alcohol will cause enormous impact in the health Brazilian system. Besides to avoid the suffering, the absence of accidents with liquid alcohol will reduce expends for SUS. In the few months that the measure of the ANVISA was working, it has registered fall of 60% in the occurrences of burnings and reduction of the number of deaths. The results are excellent and they should not be ignored by the society nor for the responsible agencies. doi:10.1016/j.burns.2006.10.048 Use of collagen-elastin matrix (matriderm) for dermal reparation: 12 months experiences in the treatment of severe hand burn injuries Kamolz L.P., Frey M., Meissl G., Nathschlaeger G., Haslik W. Division of Plastic and Reconstructive Surgery, Austria E-mail address: [email protected] (L.P. Kamolz). Introduction: More and more patients survive also severe burn injuries. Thereby the focus of interest lies not only in high survival rates, but also the regained quality of life becomes more important. A major part of life quality in burn injuries is restoring full hand function and a satisfying aesthetic appearance of the hand. Thereby one of the main objects is to achieve an earliest possible, but durable and mechanical stable coverage to minimize scar formations and to restore pliability of the skin to maintain full range of motion. Method: Matriderm is an absorbable collagen-elastin matrix used for dermal reparation. The collagen is of bovine origine, all donor animals are tested for bse. Until now six patients with deep dermal and full thickness dorsal hand burns were treated with matriderm on our department. After early debridement of the burned hand was performed matriderm was applied to the wound bed and immediately grafted with skin grafts. All patients were evaluated within the first two weeks and after 12 months. Result: All grafts were adherent to the wound bed during the observation period. An excellent take rate of the matrix and the split skin graft could be observed. No haematoma occurred under the matriderm-matrix and there was no need for further grafting. No signs of topical or systemic allergic reactions were observed. All patients showed a very satisfying cosmetic and functional result after 12 months. The mean VSS was 2.5. There was no need for secondary procedures, the range of motion of the hand was unlimited in each case. No unstable scar formations or blisters could be observed. Conclusion: Matriderm can be used successfully for dermal reparation in hand burn injuries. Our first experiences show promising results, but further studies are necessary to confirm these results. doi:10.1016/j.burns.2006.10.049 Treatment of the palmar of the burned hand with flaps Hosseinian M.A. Beheshty University Faculty of Medicine, 20, North, East Vanak SQ, 19699 Tehran, Iran E-mail address: [email protected]. Introduction: Contractured of the palmar of the crushed or burned hand, and acute hand injuries with significant loss of soft tissue exposing deep structures such as tendons, nerves, bones and joints, covering by flap should be performed. The goals in hand reconstruction are optimal functional, aesthetic and anatomic reconstruction of the palm. We evaluated different methods for 5 years. Material and methods: Fifty palmar of the burned hand since 1993 have treated with different methods of these total, eight causes with free sensory instep flap, three causes with scapular flap. Twelve causes were treated by groin flap, 14 with posterior interosseous flap, 6 with fasciocutaneous ulnar flap, 4 with abdominal flap, 4 with forearm flap and 3 with side-finger flap.
S20
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Patients were evaluated for sensibility, firm binding, skin thickness, glabrous skin, color, ulcers, texture and donor-site morbidity. We have followed up for 5 years. Conclusion: The goals in hand reconstruction is to provide sensibility in the working surfaces of the hand. Optimal function, aesthetic and anatomic reconstruction of the palm with acceptable donor site morbidity are important. We can conclude that an innervated fasciocutaneous free instep flap provides normal contour, texture, glabrous skin and color and thus on optimal functional, aesthetic, and anatomic reconstruction of the palm with acceptable donor-site morbidity. doi:10.1016/j.burns.2006.10.050 Children and their burned limbs Simply VAC® it and foam it? Fette A. a,b a
Children’s Hospital, Lucerne, Switzerland Children’s Hospital, Germany E-mail address: [email protected].
b
Due to their adventurous and exploring behaviour, hands and feets are one of the most common locations for burns in our children. Mostly, these lesions are complex, showing different grades and extensions while at the same time compromising important functional and cosmetic areas. Our challenge therefore, is to manage all these issues parallel and simultaneously, and of course successfully. To date, modern wound management is capable of reducing edema, increasing tissue perfusion, managing wound exsudate, promoting epithelisation and protecting the wound surface at the same time. As well as this, the dressings should allow longterm painless changes, and has to be cost-effective. For children especially, dressings should be “child-adapted, child-accepted and child-proofed” to allow children to play and romp. Since the majority of these requirements are within the proposed mode of action of the topical negative pressure (TNP) treatment philosophy of wounds, VAC® boots or gloves were applied to 10 children with all kind of burns on their hands and feets. Briefly, after meticulous debridement or dermabrasion the foam (black or white as appropriate) was applied, sealed with foil, moulded into a boot or glove before suction was applied. TNP performed well in all cases either for wound bed preparation, wound protection until complete epithelisation has occured or as a prerequisite in preparation for skin or artificial dermis transplants, and even for their after care. Wound healing in general was excellent. Dressing changes could be reduced, and their intervals prolonged. No dressing-related wound infection occured. Even under full mobilisation without any restriction in daily activities of the children, no dressing failures were detected. Due to progressive Swiss health care settlement modalities, TNP therapy is cost-effective and useable in our home and hospital care environments. In conclusion, overall treatment of these burns was convincing, successful, cost-effective and “child-convenient”, so that we currently simply recommend to “VAC® it and foam it”. doi:10.1016/j.burns.2006.10.051 Conservative management of unusual wounds in children Pancani S. a,b , Pinzauti E. a,b , Messineo A. a,b a
Burn Unit “Anna Meyer” Children Hospital, Florence, Italy Smith & Nephew, Italy E-mail address: [email protected] (S. Pancani).
b
Severe congenital malformations, neoplastic and peculiar surgical conditions may be associated with extensive tissue loss. This paper describes the use of Acticoat* and Acticoat 7* in the management of infection in areas lacking skin protection. Case 1 Myelomeningocele Female newborn with severe cerebrospinal malformations who, one month after neurosurgical procedure of dorsal myelomeningocele closure, developed a wide area of skin necrosis, extended over two thirds of her back, involving subcutaneous tissues with leakage of cerebrospinal fluid and subsequent high risk of local and systemic infection. Antibiotic therapy was administered. Local management of the wound included the application of Acticoat. Complete healing was achieved in 30 days. Case 2 Juvenile fibrosarcoma Male newborn affected by a pelvic juvenile fibrosarcoma extending to thigh with involvement of intervertebral foramina. 6/10/2005: Extra peritoneal debulking of the mass was performed. On day 13 post-op, a greyish area of necrotic tissue could be seen. Femoral vessels were exposed: surgical debridement was performed. Parenteral antibiotics were continued in association with Acticoat until wound closure was achieved on 2 December.