Case Of Burn Injury Research Articles

Delineating Gastrointestinal Dysfunction Variants in Severe Burn Injury Cases: A Retrospective Case Series with Literature Review

Background: Severe burns can significantly impact various organ systems, including the gastrointestinal (GI) system. GI complications are frequently observed in patients with over 20% total body surface area (TBSA) burn. Objectives: This case series delves into the intricate phenomenology of post-burn GI dysfunction, challenging conventional cause-and-effect paradigms. Our aim is to discern, comprehend, and explore variables influencing positive and negative outcomes, laying the foundation for further research given the current heterogeneity in the literature. Methods: Severe burn patients with GI dysfunction identified between April 1, 2022, and July 31, 2022, from the institutional database are included in this retrospective case-series, and comparisons were made across baseline and treatment conditions across participants. Data were collected on demographics, burn characteristics, complications, and treatment outcomes. Results: We analysed 12 patients with severe burns and GI dysfunction and categorized them into two patterns: Pattern A, characterised by early onset symptoms, gastric and small bowel dilatation, and a relatively benign course with high recovery rates was observed in 6 patients; and Pattern B, characterised by late-onset symptoms, colonic dilatation, shock, and a high mortality rate due to megacolon was seen in 6 patients. Conclusion: The post-burn GI dysfunction observed in our study is a complex interplay of multiple factors. Adequate fluid resuscitation, timely excision of necrotic tissue, staged food ingestion, specific nutrient administration, and appropriate use of antibiotics and judicious use of selective digestive decontamination (SDD) are essential strategies to prevent and treat this syndrome.

High rate of negligence induced burns in children: A rising cause for concern of the world's burn community

One of the most important causes of death in burn patients is burn [1-10]. Accurate evaluation, timely diagnosis, and proper treatment of burn patients can reduce their mortality rate [11-21]. On the other hand, one of the most important causes of injury among children aged 1 to 15 is burns [22]. Usually, children and teenagers are more vulnerable in burn injuries than other age groups [23]. Severe burns can affect children's health both in the acute stage of burns and in the later stages of their lives [24]. Burns in children often occur due to injuries caused by hot liquids. The mechanism of burns among children can be due to exploratory behaviors without understanding the dangers in the environment [25]. Most burn injuries are due to accidental causes, but in some cases, it can be due to negligence in children [22]. It is difficult to distinguish whether the burn was accidental or caused by negligence [24]. Burn hospitalizations and deaths due to negligent burns are more than accidental burns. The interesting point is that some cases of children's burn injuries can be due to misbehavior and negligence that were not diagnosed at the time of admission. Identifying these people is important because preventive efforts by health care teams for children are necessary [22]. Hence, most negligence induced burns in children are preventable because negligence and carelessness are the main causes of burns in them [24]. The consequences of negligence induced burns in children can have physical, mental, and emotional effects on children and their families [23]. Burn scars often persist after healing and lead to functional and aesthetic problems [24]. On the other hand, psychological care after burns should be considered; because, children experience a high level of acute stress, anxiety, and depression after burns, and hospitalization can be scary for children [23]. The negative consequences of negligence induced burns in children in the long term can lead to chronic diseases in childhood and even adulthood. Therefore, special attention should be paid to the timely prevention, diagnosis, and treatment of negligence induced burns in children [22]. However, previous evidence regarding negligence induced burns in children is very limited. Hence, one study showed that 56% of burns in children were due to negligence [24].

Case Series: Novel Use of a Erector Spinae Plane Block At A Lumbar Spinal Level For Coverage Of Sacral Dermatomes

The erector spinae plane (ESP) block is a recent and novel regional anesthesia procedure used primarily for the thoracic region. There is limited use of this block for the lumbar and sacral regions. Here we investigate the use of lumbar ESP blocks for three cases; hip disarticulation, penile burn, and perineal injury. For each case, an 18-gauge Tuohy needle was inserted into the paraspinous region at the L4 level and caudally directed towards the interfacial plane posterior to the transverse process via ultrasound. Once in place, 20-30 mL of 0.5% bupivacaine was injected. Opioid consumption was measured before and after block placement to evaluate for pain control. The ESP block yielded a significant reduction in opioid use for the penile burn and perineal injury cases, while a non-significant reduction was observed in the hip disarticulation case. The use of lumbar ESP block has shown the feasibility and effectiveness for sacral innervated injuries. This nerve block technique has strong potential to improve patient satisfaction and pain control while minimizing opioid reliance in the postoperative and traumatic injury recovery periods for lumbar and perineal injury patients.

An Unusual Case of Cold Burn Injury in a Tropical Country

An Unusual Case of Cold Burn Injury in a Tropical Country

Critically ill patients: Histopathological evidence of thyroid dysfunction

PurposeCritical illness is characterized by severe biphasic physical and metabolic stress as result of systemic inflammatory response syndrome and/or multiple organ dysfunction syndrome, and is frequently associated with non-thyroidal illness. Purpose of this study is to better understand the cytomorphological basis of NTI by performing histopathological examinations of thyroid gland on autopsies of patients who died from critical illness. MethodsHistopathological examination of thyroid gland of 58 critically ill patients was performed in our hospital. The cases included 24 cases of burn injury, 24 cases of traumatic brain injury, and 10 cases of cerebral stroke. Thyroid samples obtained during autopsy were preserved in formol saline and stained with hematoxylin and eosin. The sections were visualized under light microscopy. ResultsOut of 58 cases examined, 21 patients showed normal thyroid findings, and rest of the cases had unusual thyroid findings in the histopathological study. The principal finding was distortion of thyroid follicular architecture. Other findings include mononuclear cell infiltration, clumping of thyroglobulin, and exhaustion of thyroid follicles. ConclusionCritical illness produces metabolically damaging effects on thyroid gland, which functionally corresponds to a state of low T3 syndrome. These changes are more pronounced in BI and cerebral stroke than in TBI.

Knowledge and Practice of Burn Management Among Physicians Using Burn Manikin in Ha'il, Kingdom of Saudi Arabia.

Background Burn is a skin injury that results in the death of the impacted cells. Burn injuries are frequently unintentional and very avoidable. With proper management, the outcome is improved, and the need for surgical intervention is reduced. This article discusses healthcare providers' knowledge and practice of burn first aid and management to highlight the need for the enhanced practice of burn management and first-aid skills. Objective This study aims to assess the knowledge and practice of burn injuries management among healthcare workers in different specialties in Hail city. Methods A cross-sectional study was conducted via an interviewer-administrated face-to-face questionnaire and video recording of a simulated case of burn injury collected from our skill lab at Hail University and evaluated by a board-certified plastic surgeon. Result The study analyzed 119 physicians (mean age = 36.3 years, SD = 6.7) managing burn cases. Of these, 59.7% were male, and 40.3% were female. The mean evaluation score was 7.71 (SD = 2.84). None of the factors studied, including gender (p = 0.353), age (p = 0.970), education level (p = 0.127), specialty (p = 0.871), professional experience (p = 0.118), working sector (p = 0.178), nationality (p = 0.742), or participation in burn management course (p = 0.131), had a significant effect on burn management skills of physicians. However, some groups had higher mean evaluation scores than others. Further research is needed to explore potential reasons for the observed differences in mean evaluation scores among different groups of physicians. Conclusion We discovered that most physicians were found to have poor practical knowledge of proper burn management, and most of them had not engaged in a burn first aid training, therefore more courses targeting physicians who may meet burn patients are required.

Impact of Virtual Resources and Effect of COVID-19 Pandemic on Plastic Surgery Residency and Training among Residents in Southern Nigeria.

Despite the increased usage of virtual, nonphysical resources for medical education during the coronavirus disease-2019 (COVID-19) pandemic, plastic surgical training still suffered adversely in some aspects. The aim of this study was to explore the overall impact of virtual resources and effect of the COVID-19 pandemic on plastic surgery training among residents in Southern Nigeria. This was a cross-sectional study conducted among senior plastic surgery residents in southern Nigeria using a well-structured online questionnaire carried out over a 3-month period. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. Measures were taken to significantly minimise response, answer order, and other survey research errors/bias. A pilot study was done. Consent was obtained from all participants. A total of 29 plastic surgery residents completed the questionnaire. Mean age was 35.15 years with standard deviation of 6.31. The response rate was 72.5%. According to a majority of the residents, there were no significant changes in the frequency of burn, hand, and facial injury cases during the pandemic; training courses on plastic surgery (44.3%) and operative cases decreased (48.3%), whereas there was a significant increase in intraoperative teaching (27.6%) as well as simulations and conferences (41.4%). Majority of the respondents also alluded to the significant financial and psychological impacts of the pandemic on residents and a significant decline in cases with general anaesthesia as compared with cases with local anaesthesia. The COVID-19 pandemic has caused a mixture of significant positive and negative changes in the plastic surgery training of residents.

A Case of Crushing Burn Injury: A Case Report

A Case of Crushing Burn Injury: A Case Report

Частота и исходы ожоговой травмы органа зрения

Purpose. Study of the structure, functional outcomes of burn injuries of the organ of vision in patients receiving inpatient treatment in an ophthalmological clinic. Material and methods. A continuous sample of patients with burns of the eyes and its appendages hospitalized in the ophthalmological department for 2017 and 2019. Results. 42 patients were hospitalized in the ophthalmology department, including 12 children under 18 years of age. The largest proportion was the age group from 30 to 50 years (51 %). Men predominated – 30 people (72 %). Thermal burns were in 5 patients (12 %). 37 patients (88 %) had chemical burns. All patients had corneal burns, in particular I degree in 19 people, II degree in 16 people, III degree in 7 people. The burn of the conjunctiva of the eyeball and the conjunctiva of the eyelids was noted in all eyes. Treatment of severe burns was carried out in accordance with the stages of burn injury. Conclusion. During the study period, there were 42 cases of eye burn injuries among residents of Khabarovsk and the Khabarovsk Territory, of which 12 were children under 18 years of age. All of them required hospital treatment. Keywords: thermal, chemical burns of the eye, severity of burn injury to the eyes.

Pediatric flame burn injuries from adulterated kerosene explosion – A public health alert from Southern Nigeria

Childhood burns injuries remain an important cause of morbidity and mortality in Nigeria. Scald injuries had previously been noted to be the predominant aetiologic factor. Burns from kerosene explosions were virtually absent from early epidemiologic studies on burns in Nigeria but have been on a steady rise in the last few years mirroring the rise in kerosene costs. This study aims to highlight the rising incidence of burns from adulterated kerosene explosions among children in Uyo.This was a retrospective study of children aged 3 months – 17 years admitted with burn injuries to the University of Uyo Teaching Hospital over the three-year period between November 2018 and October 2021. The demographic characteristics, aetiologic factors, and treatment outcomes were documented using Microsoft Excel. Data was analysed using IBM SPSS version 25.Sixty-seven cases of pediatric burn injuries were recorded in the period under review accounting for 2.7% of all pediatric emergency admissions. Fifty-eight case records were available for review. Flame burn injuries accounted for 71% of all burn injuries. Kerosene explosions accounted for about 90% of all flame injuries and 64% of all burn injuries. Overall mortality rate was 31% and mortality rate from kerosene explosion burns was 40.5% (p = 0.97). Kerosene was mostly purchased from neighborhood sellers.Flame burn injuries from kerosene explosion have become increasingly prevalent in our society. Factors involved include adulteration of kerosene by sellers with the now cheaper petrol to increase profits, poverty and child neglect. Legislation to punish offenders responsible for adulterating petroleum products and enforcing the child rights act is recommended.

11 A Twenty-one Year Review of Medical Malpractice Cases in Burn Care

IntroductionTraumatic injuries are a common source of medical litigation but no prior studies have reported on the trends of medical malpractice in burn care. As a result, it is unclear what factors increase the likelihood that a medical professional caring for a burn patient will be named in a lawsuit. By understanding what drives patient discontent and the motivations behind their malpractice claims, burn care practitioners can better care for patients and decrease their own risk of involvement in medical litigation.MethodsThe Westlaw legal research database contains state and federal court documents from over 40,000 databases across the United States and was queried for all cases of burn injuries and medical malpractice from 2000 to 2021. All mechanisms-of-injury (e.g. flame, scald, electrical, chemical, Stevens-Johnson, etc.) were included. Case information including injury circumstances, plaintiff/defendant occupation, defendant burn care experience, and burn demographics (TBSA, mechanism) were recorded when available. The primary outcome was the case ruling (plaintiff or defendant), and settlement amounts were recorded when available.ResultsForty of the 1,222 identified cases fit inclusion criteria. Twenty-seven percent (11/40) of cases involved treatment at a burn center and 82% of plaintiffs were men. The two most common mechanisms-of-injury were scald (38%) and flame burns (18%). The court ruled in favor of the plaintiff in 10% (4/40) of cases. When the court/jury ruled in favor of the plaintiff, the settlement amount ranged from $25,000 to $20,000,000. The most frequently sued medical specialty was Family Medicine (35%) and mid-level practitioners like physician assistants and nurse practitioners (35%). Physicians with a burn fellowship were named in only 5% (2/40) of cases. The most common claims were for burn depth misdiagnoses (7/40), deliberate indifference/treatments below standard-of-care (7/40), and delayed referrals to a burn specialist (6/40). All cases met American Burn Association transfer criteria. Patient mortality was the reason for litigation in 10% (4/40) of cases.ConclusionsThis study showed that most burn-specialized practitioners are not the subject of litigation. In fact, many patients filed malpractice claims because they were not referred to burn specialists. Based on case text analysis, all of the patients’ injuries fit American Burn Association transfer criteria and some lawsuits may have been avoidable.

Severity of thermal burn injury is associated with systemic neutrophil activation

Burn injuries elicit a unique and dynamic stress response which can lead to burn injury progression. Though neutrophils represent crucial players in the burn-induced immunological events, the dynamic secretion pattern and systemic levels of neutrophil-derived factors have not been investigated in detail so far. Serum levels of neutrophil elastase (NE), myeloperoxidase (MPO), citrullinated histone H3 (CitH3), and complement factor C3a were quantified in burn victims over 4 weeks post injury. Furthermore, the potential association with mortality, degree of burn injury, and inhalation trauma was evaluated. In addition, leukocyte, platelet, neutrophil, and lymphocyte counts were assessed. Lastly, we analyzed the association of neutrophil-derived factors with clinical severity scoring systems. Serum levels of NE, MPO, CitH3, and C3a were remarkably elevated in burn victims compared to healthy controls. Leukocyte and neutrophil counts were significantly increased on admission day and day 1, while relative lymphocytes were decreased in the first 7 days post burn trauma. Though neutrophil-derived factors did not predict mortality, patients suffering from 3rd degree burn injuries displayed increased CitH3 and NE levels. Accordingly, CitH3 and NE were elevated in cases with higher abbreviated burn severity indices (ABSI). Taken together, our data suggest a role for neutrophil activation and NETosis in burn injuries and burn injury progression. Targeting exacerbated neutrophil activation might represent a new therapeutic option for severe cases of burn injury.

Changing concept in Burns Management- An Analytical study of Epidemiology, Morbidity, Mortality and Treatment in a period of forty years in the Indian state of Assam

There is an improvement in the morbidity and mortality in burns in the recent past due to better fluid resuscitation, use of better burn wound covers and early excision and skin grafting for full thickness burns. Burn care in the North Eastern Indian state of Assam was disorganized in the eighties, but individual efforts by some surgeons of the state, have improved outcome. This is a retrospective analysis of 8569 cases of burn injuries treated in three hospitals of Assam over a period of 40 years. The study intends to analyze the epidemiological pattern of burn injuries in order to plan preventive strategies and also to compare the results of treatment with and without an organized burn care unit. There were 7071 (82.3%) minor burns and 1518(17.7%) major burns in the series. The period of study was divided into three blocks - Block I- first 14 years of disorganized management, before establishment of Burns Unit, Block II -next 16 years of organized management after establishment of Burns Unit and Block III - last 10 years of advanced care with introduction of newer burn wound covers and early excision of burns. The data were analyzed and compared. The overall incidence of burns was more in males, but a greater number of females were the victims of major burns.77.2% of patients were below 40 years of age. The number of accidental burns remaining constant in the three blocks, there was a significant increase in the suicidal burns in the last two blocks. Flame burns (56.7%) constituted the majority of injuries, while scald (31.3%) and electrical burns (9.3%) followed. Domestic burns (73.1%) were of most common occurrence, followed by Industrial (10.8%), Diwali related (9.6%) and Traffic burns (6.4%). Though the overall mortality in the three blocks were almost same (Block I- 9.4%, Block II- 7.8% Block III-9.4%), mortality in major burns were reduced significantly after introduction of modern methods of management (Block I- 79.7%, Block II-52.0% Block III-38.4%). The quality of wound healing showed improvement in the subsequent years as evident by increase in number of patients with no scar (Block I -10%. Block II-20%, Block III- 37%) and decrease in number of patients with extensive scar (BlockI-18%, Block II- 15%, Block III-5%), measured by Vancouver Scar Scale. This analytical study has given us an understanding of the magnitude of the problem of burns in the region, which will help to plan treatment and preventive strategies. It also concludes that, dedicated individual care and introduction of newer methods of treatment have improved results of burn management. Key words: Epidemiology, treatment, morbidity and mortality

Epidemiological and Clinical Characteristics of Burn Injuries among Hospitalized Patients in Babylon Province

Background: Burns form the fourth most common cause of injury after road traffic injuries, falls, and interpersonal conflicts and are usually correlated with devastating physical, mental, social, and financial harms, particularly in low and middle-income countries like Iraq. Objectives: To investigate the epidemiological and clinical characteristics of burn injury patients, to measure the mortality rate (case fatality rate) for burns, and to explain the main determinants of deaths among hospitalized burn injury patients. Patients and Methods: This was an observational descriptive cross-sectional study conducted on all acute burn injury cases who were admitted to the biggest teaching hospital in Babylon Province, Iraq. Data were collected from patients themselves or their companions and from patients’ hospital records using a pretested questionnaire designed for collecting the requested information that included demographic data, burn characteristics, burn determinants, and burn outcomes. Results: A sample of 120 patients with burn injuries were investigated. The mean age ± standard deviation was 18.9 ± 17.9 years. The mean age of burn death victims was 24.5 ± 17.66 years. The young age group (15–24 years) represented the highest proportion. Male to female ratio was 1:1.4. Most of the patients had low educational and income levels. The case fatality rate was 26.6% (32/120). The majority of cases were from rural areas; 67% of suicidal burn deaths had more than 50% of total body surface area. Intentional burn death victims had significantly severe burns (third-degree burn and high body surface area) as compared to accidental burn death victims. There was a statistically significant difference as regards the mode of burns between the intentional and accidental burn deaths; all intentional death victims were burnt with flame. Conclusions: The case fatality rate of burn injuries was high, females outnumbered males, the majority of the victims had low educational and income levels, and suicidal burn deaths were significantly associated with severe burn as compared to the accidental ones.

Histopathological Evaluation of Burn Injury

Background: Burns always have posed a threat to the sensitive human body. It is a common catastrophe today as burn injury cases are one of the common emergencies admitted to any hospital. In a medico-legal setting, the main difficulty arises when a burnt body found in unknown circumstances is brought for post-mortem examination. In such a case, a forensic expert has to opine whether the burn injuries sustained are antemortem or post-mortem. It is also of paramount importance to determine the age of burn injuries sustained. Aging of burn injuries by the naked eye is sometimes difficult and unreliable. By histopathological examination of burnt tissue, one can predict whether the victim was alive or dead when the fire was going on and determine the age of burn injuries. Materials and Methods: The present cross-sectional study was carried out in the Department of Forensic Medicine and Toxicology, Pt. B.D.Sharma PGIMS, Rohtak. Total 3033 autopsies were conducted in the mortuary of the Department of Forensic Medicine andToxicology, PGIMS, Rohtak, from November 5, 2011`to November 5, 2013. During that period, out of 486 cases reported burns, randomly 100 cases were selected for this study. Results and Conclusions: In the present study, efforts were made to determine burn wound vitality and age by histopathological evaluation. The study revealed that the inflammatory infiltrate consisted mainly of polymorphonuclear leucocytes in initial stages (up to 3rd-day post-burn) with gradual lymphocytes, macrophages, and fibroblasts forming immature granulation tissue. On the 14th-day post-burn, the burn wound revealed repair by regeneration, increased collagen deposition, fibrosis, and granulation tissue formation. It was infiltrated with fibroblasts, macrophages, and lymphocytes. Our study demonstrated that evaluation of various histopathological changes occurring during the distinctive phases of burn wound healing help in the estimation of its vitality and age.

Alcohol-based hand sanitizer-induced burns: A harsh reality in current times

Due to the recent coronavirus pandemic, there is a steep rise in the use of alcohol-based hand sanitizers (ABHSs) over the past few months. For them to be effective against microorganisms, the minimum recommended concentration of alcohol is 60%. This high alcohol content makes the sanitizers easily flammable. Although, they are extremely convenient to use, they can also prove to be a hazard if used in an improper manner. Guidelines have been published for safe manufacturing and distribution of these sanitizers. There are recommendations for storage and use, which should be adhered to in a strict manner. Their use by children should always be supervised. We report four cases of burn injuries caused by injudicious use of alcohol-based sanitizers. The flammable nature of ABHSs can also be exploited as witnessed in one of our cases. With this report, we wish to emphasize that judicious and correct use of these seemingly benign products is essential.

A Prospective Study of Burn Deaths with Special Reference to Manner of Death and Duration of Survival

Around 0.2 million people are admitted in hospital due to burns, of which about 5000 people die every year.4Extent of Total Body Surface Area involved is an important parameter, that affects the prognosis in case ofburn injury. The majority of fire related deaths are accidental, usually due to carelessness. Suicidal burns aremostly seen in domestic situations and in females. Homicidal burns are rare; mostly accomplished to takerevenge or to conceal crime. So, this study was carried out with the aim to estimate the total body surfacearea affected & duration of survival / hospital stay and to find out the manner of death in burn cases.It was found that 79.00% cases had burn injuries covering 60– 100% of the total body surface area (TBSA).Maximum percentage of burns was seen in females (30.00% cases) with TBSA of 80-90%. 95% cases werehospitalized with 75.00% having the hospitalization period of 1 – 10 days and maximum number of cases(33%) survived for a period of 3 to 5 days. In most of the cases (64.00%), the manner of death was accidentalfollowed by suicidal (34.00%), with only 2% cases of homicidal burns.

Швидка нейтралізація травмуючих гіпертермічних чинників ушкодження при опіках у дітей на етапах само-, взаємо- та першої долікарської допомоги

Occupying a leading position in the structure of general injuries, burn injuries in children remain an urgent issue of combustiology in particular and medicine in general. At the same time, many issues related to the organization of first aid to such patients still remain unregulated. To this end, a study aimed at conducting a comparative analysis of the clinical effectiveness of emergency care for children with burn injuries, including the use of the suggested algorithm, was conducted. Materials and methods. 153 cases of burn injuries with boiling water of IIab–III degree on the area of 10–40% of the body surface in children aged from 8 months to 16 years, who were treated at the Clinical Center for Thermal Injury and Plastic Surgery of the Municipal Non-profit Enterprise «Vinnytsia Regional Pirogov Clinical Hospital Vinnytsya Regional Council» in the period of 2015–2020 were analyzed. All patients underwent comprehensive diagnosis and treatment including surgery. Depending on the nature of first aid, children were divided into two groups: patients of the main group (n=97) underwent prompt neutralization of the traumatic effects of exogenous hyperthermic factors on the injured areas from the moment the injury was sustained. Childrenin the control group (n=56) sought help on the 5th–14th day after the injury. The duration of prompt neutralization did not exceed 15 minutes or was not performed at all. It was often combined with the irrational use of pharmacological agents and folk remedies. Results. Comparative analysis of the course of the disease in children of the main group and the comparison group reliably confirmed the benefits of prompt neutralization of traumatic effects of hyperthermic exogenous and endogenous damage factors in burn injuries manifested by a more favorable course of the disease, faster improvement, lower local and systemic inflammatory response, shorter hospital stay with less occurrence of various complications, repeated surgical interventions, better aesthetic and functional results. Conclusions. The obtained results objectively confirmed the importance and effectiveness of the suggested system of organization of care for children with burn injuries, especially at the stages of self-help, mutual assistance and first aid. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: burn injuries, children, first aid, traumatic hyperthermic agents, neutralization.

Lessons Learned From Twenty-Eight Cases of Burns Following Breast Reconstruction: An Underestimated Complication Requiring Inclusion in Consent Information.

There has over recent years been a constant increase in annual breast reconstruction figures. Although reports indicate that burns following breast reconstruction are a rare occurrence, there has nevertheless been a relative increase in cases. The key underlying causes of this type of condition remain unknown. The authors launched a new study on the demographic characteristics of burns in the breast reconstruction population with the inclusion of up-to-date data to assess cases and contributing factors. The study was a multicenter retrospective review of patients who underwent any type of breast reconstruction and subsequently sustained burn injuries. Twenty-eight cases of burn injury following breast reconstruction were documented; 6 involved autologous flaps and 22 involved implants. Nine of the 10 implant exposure cases had previous history of radiotherapy, but there was no statistically significant difference between previous radiotherapy history and implant exposure (P = 0.32). Of the 13 cases sustaining full-thickness burns, a large number included implant-based reconstruction (n = 12, 92%), although no statistically significant difference was observed between type of reconstruction and incidence of full-thickness burns (P = 0.17). Each patient undergoing breast reconstruction should be advised of the potential risks and instructed to avoid significant heat exposure and steer clear of dark-colored bathing suits. At the time of writing, this information has yet to be included in the vast majority of surgery-related informed consent documents.

Commentary on: Lessons Learned from Twenty-Eight Cases of Burns Following Breast Reconstruction: An Underestimated Complication Requiring Inclusion in Consent Information.

The authors of this article have reviewed their experience with 28 cases of burn injury following prosthetic (n = 22) and autologous (n = 6) breast reconstruction.1 The data have been summarized and recommendations for prevention are well described. The authors conclude that burn injuries are an often-overlooked complication that should be discussed with all patients prior to breast reconstruction to increase awareness of this untoward event. They also suggest that “innervated” reconstruction would “probably” restore the ability of reconstructed breasts to thermoregulate and minimize burn injury. The authors briefly discuss 2 possible mechanisms that explain why mastectomy skin and autologous flaps are more susceptible to burn injury. The first involves the inability of these tissues to adequately thermoregulate. The second is based on the inability of denervated tissue to detect a heat stimulus, rendering it susceptible to burn. To better understand this mechanism of action, it is important...