IntroductionExperiences of seeing an altered appearance for the first time can have an important influence on an individual's psychological wellbeing, their body image and their adjustment. Existing research has explored this experience in individuals with breast cancer and facial burns, but limited research has been conducted in other appearance altering conditions. The aim of this study was to explore patient's initial experiences viewing themselves after acquiring an appearance altering condition, including distress, preparedness and social support.MethodsParticipants (n = 64) with a surgical scar, burn injury or amputation completed a mixed methods online survey. This survey included questions about practical elements of the experience, the support they received, their expectations, distress, and preparedness; as well as open questions regarding participant's feelings, fears, support and suggested improvements to the experience. Data analysis included statistical analysis and inductive content analysis.DiscussionParticipants reported a variety of initial experiences. Some felt adequately prepared and supported, whilst others felt this could have improved. A strong correlation was found between perceived support and distress (rs = −.66, p = <.001) and preparedness and distress (rs = −.66, p = <.001). No significant differences in preparedness, distress or support were found according to gender, age, or condition.ConclusionsWhilst many participants reported satisfaction with viewing their appearance for the first time, some participants reported significant distress and a need for further support around this experience. This suggests an important role for healthcare providers in discussing expectations and providing appropriate patient support following injury or treatment.

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IntroductionBurns are a major global health issue, causing approximately 180,000 deaths annually and leading to high morbidity rates. The Japan Trauma Data Bank Report 2022 recorded 1749 burn cases, with a mortality rate of 17.6%. However, comprehensive national data regarding non-fatal burns and regional differences in Japan are lacking. This study aimed to analyze the distribution of small-area burns among patients across Japanese prefectures using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).MethodsWe utilized NDB Open Data from fiscal years 2014 to 2021 to investigate medical claims for small-area burns. The number of claims was normalized to the population of each prefecture using demographic data obtained from eStat, and the correlation between the number of claims and per capita income in each prefecture was assessed.ResultsThe highest number of small-area burn claims was observed among children aged 0–5 years and individuals aged >65 years. Women aged 15–64 years submit approximately twice as many claims as men in the same age group. Significant geographic variations were observed, with more claims in Kochi, Saga, Kumamoto, and Kagoshima and fewer claims in Okinawa, Hokkaido, and Chiba. The number of claims decreased annually, with Saga Prefecture exhibiting the most substantial reduction. There is a significant negative correlation between the number of claims and per capita income.ConclusionThe annual decrease in claims corresponds with previous reports of a decreased incidence of burn injuries. Regional differences suggest an influence of local factors on burn incidence. Further research is necessary to explore these regional disparities and to identify effective burn prevention strategies.Lay summaryBurns are a major global health problem, causing many injuries and deaths each year. In Japan, severe burns are well-documented, but there is little information about small-area burns that do not require hospitalization. Understanding how often and where these small-area burns occur can help create better prevention strategies. This study aims to understand the frequency and distribution of small-area burns across different regions in Japan and among various age and gender groups. We want to identify which areas have higher or lower rates of small-area burns and observe any trends over time. We used data from Japan's National Database of Health Insurance Claims, covering 2014 to 2021. This database includes information on medical treatments paid for by health insurance. We calculated the number of small-area burns per 1000 people for each prefecture (region) in Japan and analyzed differences based on age and gender. We found small-area burns are most common among young children (aged 0–5) and older adults (over 65). Women aged 15–64 had about twice as many small-area burns as men in the same age group. There were significant regional differences: some areas, like Kochi and Saga, had higher rates of small-area burns, while others, like Okinawa and Hokkaido, had lower rates. Over the years, small-area burns decreased, with Saga showing the most notable reduction.Our study provides valuable insights into the patterns of small-area burns in Japan, which can help in designing targeted prevention efforts. However, we did not investigate the specific reasons behind the regional differences or the decrease in burn cases over time. This underscores the need for further research to understand these factors better and potentially make more significant contributions to public health.

Mesenchymal stem cells (MSCs) have shown significant potential in a variety of clinical applications for repairing and regenerating damaged tissues. MSCs can stimulate cellular processes such as fibroblast proliferation, migration, and endothelial angiogenesis, as well as modulate the host's immune response to favor more optimal wound healing. Therefore, the application of mesenchymal stem cell (MSC) therapy to severe burn wounds holds promise as a potential avenue for improved outcomes, especially in cases where alternative therapies may be limited. We present the results of a specific case excluded from our previously reported phase I Clinical Trial, examining the safety of allogeneic bone marrow-derived stem cell therapy for deep 2nd-degree burn wounds. This patient had been discontinued from the trial as a clinical decision was made that the patient would best be served by subsequent split-thickness skin grafting, an exclusion criterion for the trial. We report the benefits of local allogenic MSC therapy followed by an early split-thickness skin graft. We observed a reduction in scar formation with improved sensation to touch using MSC therapy. No adverse events or evidence of rejection were seen. Our case report provides evidence supporting the notion that employing stem cell therapy preceding grafting represents a promising and synergistic therapeutic strategy for effectively treating burn injuries. Hypertrophic scarring is a common issue in burn wounds, despite surgery or non-surgical treatments, and it often leads to tight, restrictive scars that can cause significant discomfort and complications for patients. This report explores the safety of using bone marrow-derived mesenchymal stem cells (BM-MSCs) as a potential treatment for burn wounds, applied either directly to the skin or beneath the surface.To date, no adverse side effects have been reported with these methods. The report details the case of a patient who first received stem cells under the skin, followed by a topical application, and later had a skin graft to treat a large, deep second-degree burn. The stem cells used were from a young healthy adult donor. The patient's progress was monitored for six months.The findings suggest that combining donor stem cells with skin grafting could be a helpful way to treat burn injuries, particularly in cases of deep second-degree burns. This approach appears to enhance wound healing, facilitate faster recovery, and reduce complications like infections, which could lead to shorter hospital stays.

IntroductionScrotal burns resulting from wound care are a rare but preventable injury compared to the wide spectrum of post-circumcisions related complications documented. We report an inadvertent cetrimide-chlorhexidine antiseptic scrotal burns due to post-circumcision dressing and review the literature on genital chemical burns.Case PresentationA 6-week-old baby presented with a 3-days history of worsening scrotal burns following smearing of undiluted cetrimide-chlorhexidine as dressing post-circumcision. Examination revealed a healthy baby with non-tender non-specific multiple ulcers and pan-erythematous scrotum. Wound swab isolated Klebsiella and Pseudomonas spp.DiscussionsAlthough there was no clinical complication during procedure, the wrongful post-operative care resulted in scrotal burns. The isolated uropathogens did not result in sepsis or Fournier’s gangrene, we believe this preventable burn was eventually reported due to the worsening progression over the period, albeit with minor adverse effects.ConclusionPost-circumcision instruction for cetrimide-chlorhexidine use by caregiver must be understood to avoid scrotal burns.Lay SummaryScrotal skin burns from chemical agent: Isolated scrotal skin burns are not common and even rarer when they are caused by prescribed medical solution. A neonate was brought in by the parents with complain of developing watery containing swellings on the scrotum that later bust and leads to peeling of the scrotal skin. The mother noticed this after applying dressing solution as part of the measures to prevent circumcision wound infection. Even though the child looked well, the large scrotal surface without skin cover could become a common point for bacteria entry into the body and its consequences. Even though our test isolated 2 different types of disease-causing bacteria from the scrotal wound, this child was managed well and the wounds healed without any further problem. The lessons: 1. circumcision is the commonest surgical procedure performed. 2. This incidence may only be the tip of the iceberg. 3. The parents brought him because it was getting worse. 4. It is a preventable injury by just using the agent in accordance with recommendations.

Keloids are elevated, painful scars that extend beyond the original wound's boundaries and can cause significant emotional distress for patients. While combining surgical excision with radiation therapy has shown potential in treating these scars, its effectiveness in local populations remains unclear. The study was conducted from January 2015 to December 2019 in the Plastic Surgery Department at a tertiary care hospital in Karachi, Pakistan. Twenty-five patients who were treated at the hospital were recruited, while 17 out of 25 fulfilling the inclusion criteria were selected. Patients were treated according to a defined treatment protocol and evaluated after a 2-year follow-up. A survey questionnaire was administered after obtaining consent from the patients via telephonic interviews at a 2-year follow-up. Out of 25 patients, 17 (68%) met eligibility criteria, eight (32%) were excluded due to lack of follow-up. The patients that presented with keloids, were seven (41%) males and 10 (59%) females. Six (35%) had a family history of keloids. Etiological factors included injury/trauma (n=9, 53%), spontaneous growth (n=6, 35%), and wound site growth (n=2, 12%). Recurrence post-surgery and radiation therapy occurred in 11 (65%) cases, while seven (35%) remained recurrence-free over 24 months. Recurrence frequency was noted in six (55%) patients within six months, three (27%) within 12 months, and two (18%) within 24 months. Keloid management is a complex field requiring ongoing research to optimize treatment strategies, reduce recurrence rates, and improve patient outcomes through evidence-based protocols in the Pakistani population. In a recent study conducted at a tertiary care hospital in Karachi, Pakistan researchers investigated the frequency of keloid recurrence following surgical removal and radiation therapy over a period of two years.Keloids are a type of raised scar that can form after an injury or surgery, often causing discomfort and aesthetic concerns for patients.The study aimed to understand how often keloids come back after treatment, particularly when surgery and radiation therapy are combined. This approach is commonly used to manage keloids, but its effectiveness in preventing recurrence over the long term is not fully understood.Over the two-year follow-up period, the researchers tracked a group of patients who had undergone surgical excision (removal) of their keloids followed by radiation therapy. They observed how many of these patients experienced the return of keloids at the site of the original scar.By analyzing the data, the researchers were able to determine the frequency of keloid recurrence in this specific group of patients. This information is important for healthcare providers and patients considering treatment options for keloids, as it helps to better understand the potential outcomes and risks associated with surgical excision and radiation therapy.Overall, the study provides valuable insights into the management of keloids and contributes to our understanding of the long-term effectiveness of combined surgical and radiation therapy in reducing the recurrence of these troublesome scars.

Burn injuries impose a substantial burden globally, particularly in low- and middle-income countries like Ethiopia, where the impact is pronounced. Despite existing studies on individual patient data, there 's a lack of synthesized evidence on burn injury mortality in Ethiopia. This study aimed to evaluate the combined prevalence of burn-related mortality and its determinants in Ethiopian hospitals. A systematic search of various databases yielded 11 relevant studies, which were included in the analysis. Data extraction and quality assessment were conducted using Microsoft Excel 2021 and the Newcastle-Ottawa Scale, respectively. Statistical analyses were performed using STATA version 17 software. The pooled mortality rate among burn patients in Ethiopian hospitals was determined to be 6.99% (95% CI: 4.8, 9.41). Factors significantly associated with mortality included inadequate resuscitation (Adjusted Odds Ratio (AOR) 3.73, 95% CI: 1.31, 10.58), pre-existing illness (AOR: 5.26, 95% CI: 2.12, 13.07), age <5 or >60 (AOR: 2.22, 95% CI: 1.45, 3.40), and burn injury >20% total body surface area (AOR: 5.17, 95% CI: 2.47, 10.80). The findings underscore a notably high prevalence of burn-related mortality in Ethiopia, with inadequate fluid resuscitation, pre-existing illness, extreme age, and the extent of injury identified as key determinants. Collaboration among healthcare stakeholders and policymakers is imperative to improve burn care services and mitigate the impact of these injuries. This study was registered with PROSPERO (CRD42023494159), providing a comprehensive overview of burn injury mortality in Ethiopia. Burn injuries are a significant health concern globally, particularly in low- and middle-income countries like Ethiopia. Despite the existing studies on burn injuries, there's a lack of synthesized evidence on burn injury mortality in Ethiopia. This study aimed to evaluate the combined prevalence of burn-related mortality and its determinants in Ethiopian hospitals.The study systematically reviewed 11 relevant studies and conducted a meta-analysis to determine the prevalence of burn injury mortality and associated factors. The pooled mortality rate among burn patients in Ethiopian hospitals was found to be 6.99%. Factors significantly associated with mortality included inadequate resuscitation, pre-existing illness, age <5 or >60, and burn injury >20% total body surface area.The findings underscore a notably high prevalence of burn-related mortality in Ethiopia, highlighting the need for comprehensive and effective treatment approaches. Inadequate fluid resuscitation, pre-existing illness, extreme age, and the extent of injury were identified as key determinants of mortality. Addressing these factors is crucial for improving burn care outcomes and reducing the burden of burn injuries in Ethiopian hospitals.This study provides valuable insights for healthcare professionals, policymakers, and researchers working towards improving burn injury outcomes in Ethiopia. By understanding the factors influencing treatment outcomes, healthcare stakeholders can refine treatment protocols, enhance resource allocation, and implement preventive measures to reduce the burden of burn injuries in Ethiopian hospitals.

Maggot debridement therapy is an effective and widely used biodebridement method in chronic or non-healing wounds but is infrequently documented in burn injuries. Many burn patients wish to avoid surgical intervention, and in an ageing population with increasing comorbidities surgery may not always be preferable. Here we describe its successful use in an elderly and comorbid patient. The larvae were applied to a 0.5% full thickness burn wound on the thigh using two treatments of BioMonde Biobags, and he achieved healing within eight weeks. Maggot debridement therapy has been documented to shorten healing time, increase the likelihood of healing, and reduce antibiotics use in other chronic wounds. Maggots may be more selective in debriding wounds than sharp surgical debridement, preserving more healthy tissue. There is evidence to suggest that maggots clear biofilms created by Staphylococcus aureus and Pseudomonas aeruginosa, which are common organisms cultured in burn wounds. The patient was enthusiastic about the therapy and would recommend it to other patients. More formal evidence is required to compare outcomes between maggot debridement therapy and surgical intervention in such patient subgroups, as this may become a workhorse therapy for successful burns debridement and treatment. Burn injuries are common and increasingly so in the elderly. Full-thickness injuries are those which involve all the layers of skin and are at risk of becoming long-term wounds if left to heal on their own. These types of wounds will often develop a hard covering layer, called eschar, which protects the regenerating skin underneath but can slow down how fast the wound heals. Often patients with full thickness injuries will need the eschar removed, the wound surgically cleaned (known as debriding) and a skin graft to reduce the healing time. However, in elderly patients with medical issues such as diabetes and heart problems (as in this case), surgery may not be advisable due to the risks of having anaesthetics, as well as the medical problems possibly impacting on how well the skin graft will work. Maggots are immature green-bottle fly larvae which feed on dead tissue and release enzymes to break it down to digest. They have been used in wound care for centuries but are less frequently considered an option for burns. In this case report, an elderly and comorbid patient sustained a deep burn injury to his thigh. He declined surgery and maggots were used instead, which were highly safe and effective. He did not require skin grafting. We suggest more studies are required to compare how effective this treatment is within the elderly population as means of avoiding surgery.

In Ethiopian traditional medicine, Rumex nervosus Vahl leaves are used to treat wounds. However, despite traditional claims and supportive in vitro findings, no scientific study has been conducted to evaluate the in vivo wound healing activity of R. nervosus Vahl leaves. To evaluate the wound healing activity of crude extract of the leaves of R. nervosus Vahl and its solvent fractions in mice. R. nervosus Vahl leaves were extracted with 80% methanol, and then the crude extract was fractionated using ethyl acetate, chloroform, and water. Ointments at 5% and 10% strengths were formulated from the crude extract and its fractions. The healing activity of the crude extract was evaluated using linear incision, circular excision, and burn wound models in mice. Additionally, the activity of solvent fractions was assessed using circular excision wounds in mice. Treatment of wounds with ointments containing 5% and 10% crude extract showed significantly increased wound contraction rate, shorter epithelialization period, and higher skin-breaking strength (P < 0.05) compared with the negative control. Both 5% and 10% formulations of the aqueous and ethyl acetate fractions significantly increased wound contraction and decreased the period of epithelialization in the excision wound model (p < 0.05), however, the chloroform fraction showed no significant wound healing effect compared with the negative control. The 80% methanol crude extract as well as the aqueous and ethyl acetate fractions of R. nervosus Vahl leaves possess wound healing activity as evidenced by improved wound contraction rate and tensile strength and decreased epithelialization period.

IntroductionBurns are associated with a high risk of developing comorbidities, including psychiatric disorders such as Post-Traumatic Stress Disorder (PTSD). This study aimed to evaluate the association between PTSD and opioid use, chronic pain syndrome, and other outcomes following burn injuries.MethodsA retrospective case-control analysis was conducted using the TriNetX database, a federated, de-identified national health research network with 92 healthcare organizations across the United States. Burn patients with and without PTSD were identified and matched based on demographics and injury severity. The likelihood of opioid use and other outcomes, including chronic pain, depression, anxiety, and emergency department visits, were compared between cohorts. Our study examined eight cohorts based on the percentage of total body surface area burned (TBSA%) and the presence or absence of PTSD. These cohorts were stratified as follows: patients with or without PTSD with TBSA, 1–19%, 20–39%, 40–59%, and 60+%. This stratification enabled a detailed comparison of outcomes across different levels of burn severity and the presence of PTSD, providing a comprehensive context for the results.ResultsThe mean age of patients with PTSD was slightly higher (46 ± 16 years) than that of those without PTSD (43 ± 23 years). Incidence of PTSD ranged from 4.96 to 12.26%, differing by percentage of total body surface area burned (TBSA%). Significant differences in various complications and comorbidities were observed between patients with and without PTSD within each burn severity cohort. Compared to the patients without PTSD, patients with PTSD had a significantly higher risk of opioid use in all cohorts: TBSA 1–19%, 20–39%, 40–59%, and 60+%.ConclusionPTSD is associated with a significant increased likelihood of adverse outcomes following severe burns, particularly opioid use, chronic pain, psychological disorders, and higher healthcare utilization. These findings underscore the importance of identifying PTSD in burn patient management and highlight the need for further research into postoperative pain management strategies for this vulnerable population. Psychological assessments and cognitive behavioral therapy may be particularly useful.Lay SummaryBurn injuries can cause serious problems like infections and organ failure, and they sometimes lead to death. Severe burns affect about 4.4% of all burn cases and can be deadly in nearly 18% of those cases. They cause inflammation that can lead to long-term heart, metabolism, and thinking problems. These injuries can also cause mental health issues like PTSD (Post-Traumatic Stress Disorder).PTSD means people might relive their trauma through bad memories or nightmares, avoid thinking about it, and feel different emotions for at least a month after it happens. People who survive burns often get PTSD because the injury is so traumatic and takes a long time to heal. Between 2% and 30% of burn survivors might feel very stressed soon after, and up to 40% could have PTSD within six months.People with PTSD from burns often also have depression and anxiety because recovering and going back to normal life is tough. Doctors often give strong painkillers called opioids to burn patients, but they can be very addictive. People with PTSD and opioid problems often also have other mental health issues. A study in 2023 found that 80% of burn patients with opioid problems also had other mental health problems. This shows how important it is to treat pain and mental health carefully in burn survivors.This study looks at how PTSD affects opioid use in people with burns. It uses data from many hospitals to see if PTSD makes pain worse and makes people use more opioids after surgery. Learning about this can help doctors find better treatments and stop people from using opioids too much if they have PTSD from a burn.