Deep Partial-thickness Burn Wounds Research Articles

The optimal temperature of first aid treatment for partial thickness burn injuries

Using our porcine model of deep dermal partial thickness burn injury, various cooling techniques (15 degrees C running water, 2 degrees C running water, ice) of first aid were applied for 20 minutes compared with a control (ambient temperature). The subdermal temperatures were monitored during the treatment and wounds observed and photographed weekly for 6 weeks, observing reepithelialization, wound surface area and cosmetic appearance. Tissue histology and scar tensile strength were examined 6 weeks after burn. The 2 degrees C and ice treatments decreased the subdermal temperature the fastest and lowest, however, generally the 15 and 2 degrees C treated wounds had better outcomes in terms of reepithelialization, scar histology, and scar appearance. These findings provide evidence to support the current first aid guidelines of cold tap water (approximately 15 degrees C) for 20 minutes as being beneficial in helping to heal the burn wound. Colder water at 2 degrees C is also beneficial. Ice should not be used.

Differentiation of superficial-partial vs. deep-partial thickness burn injuries in vivo by confocal-laser-scanning microscopy

Objective The current determination of burn depth is based both on a visual and clinical assessment. Confocal-laser-scanning microscopy (CLSM) enables in vivo histomorphological images. We hypothesized that CLSM can differentiate superficial-partial vs. deep-partial thickness burns on a histomorphological level. Methods Thirty-eight burn wounds in 14 patients were clinically divided in three groups from superficial (group 1), superficial-partial (group 2) to deep-partial (group 3) thickness burns. CLSM was performed with the Vivascope1500 (Lucid Inc., Rochester, NY, USA) 24 h after burn. The following parameters were assessed: cell size of the granular-layer, thickness of the basal-layer, minimal thickness of the epidermis and number of perfused dermal papillae. Results Superficial burns resulted in a significant increase of the cell size of the granular-layer and a higher increase of the minimal thickness of the epidermis as in superficial-partial thickness burns. The granular-layer in partial thickness burns was destroyed. Superficial burns had an increased thickness of the basal-layer; in superficial-partial thickness burns the basal-layer was partly destroyed with complete destruction in deep-partial thickness burns. In superficial burns the perfused dermal papillae were increased significantly, while decreased in superficial-partial thickness, and completely destroyed in deep-partial thickness burns up to a depth of 350 μm. Conclusions In vivo confocal-laser-scanning microscopy can differentiate superficial-partial vs. deep-partial thickness burns on a histomorphological level.

109 Near Infrared Spectroscopy of Partial Thickness Burns

Introduction: This study examines the capacity of near infrared spectroscopy (NIR) to differentiate partial thickness burns. Methods: Adult burn patients (n = 19) presenting within 72 hours of injury and body surface area < 20% were studied. An independent observer classified the burn injuries as either superficial (SPT, n = 5) or deep partial (DPT, n = 14) thickness. NIR data, oxygen saturation and total hemoglobin, were collected from the burn site and adjacent nonburned control site. NIR data for burn sites were compared to respective control sites to adjust for between subject variability. Skin biopsies for histologic analysis were performed at the time of surgery. Results: NIR spectroscopy was able to detect a slight increase (3.65%, p < 0.05) in oxygen saturation with SPT burns when compared to control sites. In contrast, DPT burns displayed a drop in oxygen saturation (17.65%, p < 0.05) in comparison to the control site. An increase in total hemoglobin was observed for both the SPT (15.83%, p < 0.05) and DPT (5.07%, p < 0.05) injuries in comparison to control sites. SPT and DPT burns are discernible (p < 0.01) based on oxygen saturation values but not total hemoglobin (p > 0.4). Histologic and clinical correlation with the NIR spectroscopic data will be presented at the conference. Conclusions: NIR spectroscopy can distinguish between superficial and deep partial thickness burn injuries in the first 3 days post burn injury. PSI grant

Efficiency of controlled topical delivery of silver sulfadiazine in infected burn wounds

The present study is designed to assess the potential benefits of controlled delivery of silver sulfadiazine from collagen scaffold (SSDM-CS) in infected deep partial thickness burn wounds in which epidermis is lost completely and the entire papillary dermis and most of the recticular layer of the dermis is lost. Infection induced by inoculating 10(7) colony forming units (cfu) of Pseudomonas aeruginosa caused significant increase in wound size (20%) till day 15, which decreased significantly from day 9 by SSDM-CS treatment, showing complete healing by day 27 (control > or = 37 days). Early subsidence of infection (<10(2) cfu, day 9) by SSDM-CS resulted in faster epidermal resurfacing and fibroplasia, whereas heavy microbial load (>10(7) cfu, day 9) in controls caused severe inflammatory cellular infiltration. Persistent infection triggered early expression of proinflammatory cytokines intereukin-6, intereukin 1-beta, and tumor necrosis factor-alpha, lasting until day 9, whereas cytokine level decreased in SSDM-CS-treated group by day 6. Infection exacerbated expression of active matrix metalloproteinases (MMPs)-2 and -9 in controls (day 15), while SSDM-CS positively modulated MMP-2 and -9 with faster decline in their levels (day 12). Inherent nature of the dressing to maintain drug level at equilibrium therapeutic concentration (51.2 microg/mL) for prolonged time (72 h), below systemic toxic limits (20 microg/dL, serum level), accelerated the magnitude and sequence of reparative events.

Treatment of deep partial thickness and indeterminate depth facial burn wounds with water–jet debridement and a biosynthetic dressing

Debriding deep thermal injury to face and neck can be particularly challenging with cold knife techniques. Timely healing, a precondition for minimal scarring, is dependant upon optimal wound bed preparation. A new water-jet surgical tool (Versajet) (Smith & Nephew, Hull, UK) has been designed for wound debridement. Ex vivo histologic analysis of depth of debridement on human skin confirmed that predictable and controlled depth of debridement could be obtained by adjusting apparatus settings. We prospectively studied the versatility of this instrument for the treatment of deep and indeterminate depth face and neck burns. Wounds were then covered with either a biosynthetic (Biobrane) (Bertek Pharmaceuticals Inc) or cultured biosynthetic dressing (TransCyte). Patient follow-up demonstrated no adverse effects. Placement of biosynthetic dressings was compatible with water-jet debridement. Median healing time for wounds covered with biosynthetic dressings was 14 days, and 12 days for those which received the cultured biosynthetic dressing. We have found the water-jet system to be a versatile instrument for surgical burn debridement with particular advantage in addressing the challenging and delicate contoured regions found in the face and neck. Accurate control of debridement depth facilitates wound bed preparation for simultaneous treatment with growth promoting biosynthetic dressings.

An Undescribed Scalding, “Çökelek” Burns in Turkish Children: Is Acidic Effect the Reason of High Mortality and Double-Hit Injury?

This retrospective review was aimed to evaluate for the first time the risk factors in addition to the demographic and epidemiological features of immersion scalds by hot çökelek in 23 preschool-aged Turkish children younger than 7 years of age, who were admitted to the burn unit of Erciyes University Medical Faculty between January 1996 and August 2006. This retrospective study consisted of 23 hospitalized scalded children by hot çökelek. Hot çökelek burns were studied in terms of age, sex, length of hospital stay, seasonal variation, regions of involvement, the time between burn and admission to our burn unit, extent of burn injury, mortality, morbidity, and treatment modalities. The study consisted of 17 male (74%) and 6 female (26%) pediatric burns with a male-to-female ratio of 2.83:1, which was more frequent in boys. The mean age distribution, extent of burn injury, length of hospital stay, and mean transport time were 3.47 +/- 1.41 (range, 2-6 years), 36.60 +/- 16.60% (range, 12-79%), 26.00 +/- 10.88 (range, 13-38 days), and 8.69 +/- 3.73 (range, 2-15 hours), respectively. The overall mortality rate of the study population was 47.8% (11 of 23 children died). All patients suffered deep partial and full thickness burn injuries and received surgical treatment. Hot çökelek burns with acidic component should be considered important because of its high morbidity and mortality. We emphasize the admittance criteria of patients into burn units need to be reviewed in countries where çökelek is being widely consumed.

Comparison of the Results of Operative and Conservative Treatment of Deep Dermal Partial-Thickness Scalds in Children

Deep dermal partial-thickness scalds remain one of the most common types of injuries in childhood. Local treatment of those wounds, alternatively described as IIb degree, is still very controversial. Some authors advise conservative treatment of such wounds, pointing to their ability to self-reepithelialise, which is possible but significantly prolonged. Other investigators postulate operative treatment, i.e., tangential necrectomy and split-thickness autologous skin grafting, which may shorten the time of wound healing. Arguments call for contra-arguments, and the problem still seems to be unresolved. There is indeed a lack of acceptable standardisation of the local treatment for deep dermal partial-thickness scalds in the paediatric population. The results of both conservative and operative treatment of 114 children aged between 3 months and 17 years, treated for deep dermal partial-thickness scalds from 1997 to 2004 are presented. The treatment of five groups of patients, divided into groups based on the extent of their burn wounds, is evaluated. The patients were treated by tangential necrectomy and skin grafting, mechanical dermabrasion, Granuflex(R) (Convatec) hydrocolloid dressings, Iruxol Mono(R) (Knoll) enzymatic dressings, or Aquacel Ag(R) (Convatec) hydrofibre dressings with silver ions. A number of parameters of wound healing were analysed. The results of this paper encouraged us to present and discuss a proposition for the standardisation of local treatment of deep dermal partial-thickness burn wounds in the paediatric population, according to the extent of injury.

Comparison of Fibrin Sealant and Staples for Attaching Split-Thickness Autologous Sheet Grafts in Patients With Deep Partial- or Full-Thickness Burn Wounds: A Phase 1/2 Clinical Study

We undertook a multicenter, randomized, controlled, phase 1/2 clinical study to investigate the safety and efficacy of a fibrin sealant containing 4 IU/ml thrombin (FS 4IU) for the attachment of autologous sheet grafts in patients with deep partial-thickness or full-thickness burn wounds. Fibrin sealant (FS 4IU) was compared with staples for adherence of sheet grafts in 40 patients. Patients had to have burn wounds measuring 40% TBSA or less with two comparable test sites measuring between 1% and 4% TBSA each. Wound beds were prepared before treatment assignment, which was randomized. Percent area of hematoma/seroma at Day 1 (P = .0138) and questionable viability at Day 5 (P = .0182) were significantly less for FS 4IU-treated sites. Median percent area of graft survival on Day 14 was 100% for both treatments (P = .3525). The percentage of completely closed sites generally was greater for FS 4IU-sites on Days 5 to 91; the maximum difference occurred at Day 28 (79.5% vs 59%; P = .0215). The safety profile of FS 4IU was excellent as indicated by the lack of any related serious adverse experiences. These findings indicate that FS 4IU is safe and effective for fixation of skin grafts, with outcomes similar to or better than staple fixation. The data suggest that FS 4IU is a promising candidate for further clinical studies focusing on skin graft adhesion and burn wound healing.

Clinical significance of leukocyte infiltrative response in deep wound of patients with major burns

Objective To investigate the time course of infiltrated leukocytes and the subpopulations of infiltrated lymphocytes in deep wounds, and their relationship with injury severity in seriously burned patients. Methods Six patients with major burns were enrolled in the study. Specimens were taken from deep partial-thickness burn wounds of all patients at 3 days, 1 week, 2 weeks and 3 weeks after burn. The appearance time and cellular components of infiltrated leukocyte zone in the burn wound were evaluated by histological and immunohistochemistry examination with lymphocyte monoclonal antibodies. Results The infiltrated leukocyte zone of burn wound formed 1–2 weeks after burn. The more severe the degree of injury (including burn area, depth and combined injuries) was, the later the infiltrated leukocyte zone appeared. The infiltrated cells mainly consisted of polymorphonuclear leukocytes (PMN) during the early period after burn while macrophages and lymphocytes appeared later. There were some changes of the T lymphocyte subsets and their activation degree in the burn wound. Conclusion The changes of infiltrated leukocyte zone of wound following burns were closely related to the injury severity, and represented alteration of the anti-infection ability and immune rejection of local wound. These results provide important evidence for appropriate wound treatment and prolonging the survival of skin allograft.

A porcine deep dermal partial thickness burn model with hypertrophic scarring

We developed a reproducible model of deep dermal partial thickness burn injury in juvenile Large White pigs. The contact burn is created using water at 92 °C for 15 s in a bottle with the bottom replaced with plastic wrap. The depth of injury was determined by a histopathologist who examined tissue sections 2 and 6 days after injury in a blinded manner. Upon creation, the circular wound area developed white eschar and a hyperaemic zone around the wound border. Animals were kept for 6 weeks or 99 days to examine the wound healing process. The wounds took between 3 and 5 weeks for complete re-epithelialisation. Most wounds developed contracted, purple, hypertrophic scars. On measurement, the thickness of the burned skin was approximately 1.8 times that of the control skin at week 6 and approximately 2.2 times thicker than control skin at 99 days after injury. We have developed various methods to assess healing wounds, including digital photographic analysis, depth of organising granulation tissue, immunohistochemistry, electron microscopy and tensiometry. Immunohistochemistry and electron microscopy showed that our porcine hypertrophic scar appears similar to human hypertrophic scarring. The development of this model allows us to test and compare different treatments on burn wounds.

Treatment of deep partial thickness burns by a single dressing of porcine acellular dermal matrix

To explore the effect of one dressing of porcine acellular dermal matrix on deep partial thickness burns. From January 1997 to January 2004, sixty-seven cases of deep partial thickness total burned surface area (TBSA) from 50% to 90% burn wound were treated by a single dressing of porcine acellular dermal matrix (the porcine acellular dermal matrix group). Ten cases of deep partial thickness burned patients with the same TBSA treated by exposure method served as the exposure method group. The healing time of the wound was observed. The patients were followed up for 3 months to 2 years, and the scar proliferation was observed. The deep partial-thickness wound would be healed without dressing change in the porcine acellular dermal matrix group, and the average healing time was (12.2 +/- 2.6) days. The average healing time of the exposure method group was (27.4 +/- 3.5) days. Follow up of the patients within 3 months to 2 years showed that scar proliferation in the porcine acellular dermal matrix group was much less than that in the exposure method group, even no scar proliferation was observed in some patients. Without tangential excision, autografting and dressing change, a single dressing of porcine acellular dermal matrix on deep partial thickness burn wound could shorten the healing time and inhibit scar proliferation.

Control of hypertrophic scar from inception by using xenogenic (porcine) acellular dermal matrix (ADM) to cover deep second degree burn

Objective We have spent 7 years to investigate the method of applying porcine acellular dermal matrix (ADM) on deep partial thickness burn wound until the wound heals without dressing change. Known as “Feng's pig skin method” by our hospital, the method appears to encourage rapid re-epithilization with minimum scarring. Method The deep partial thickness burn wound was rinsed cleanly under anesthesia when the patient admitted. ADM was applied on the wound after the detached epidermis was thoroughly removed, wrapped and fixed by sterile gauze and bandages. The dressing was removed within two weeks and the wound completely healed. The outcome of the treatment was analyzed by using the modified Vancouver Burn Scar Assessment Scale. Result All the wounds healed with one dressing within 2 weeks, and the time of wound re-epithelialization shortened to 7–12 days. Scar hyperplasia did not occur, or it was greatly ameliorated compared with traditional treatment after a followed-up period of 3 months to 2 years. The Scar Index was significant lower than that of the traditional exposure method. Conclusion Using ADM to cover deep second degree burn can preserve maximally residual dermal tissue and epithelium, help accelerate the regeneration of epithelial and stem cells, thus shorten the healing time, remodel the skin structure, and consequently has the effect of controlling hypertrophic scar at inception.

Burn injuries associated with the water tank of motorfarming tricycles in China

Burns caused by hot coolant from the reservoir of motorfarming tricycles have not been reported previously. We performed retrospective studies of such cases in 126 patients with complete records in rural areas of China. The majority of victims were unmarried (59.5%), young (<40 years, >20, 55.6%), and male (male to female ratio 9:1). The burn accident occurred mostly during the busy seasons of spring and summer (66.7%). The mechanism of injury was usually the same. The drivers were trapped under the farming tricycle in a traffic accident and then hot coolant leaked from the mouth of the coolant, resulting in long contact with the hot fluid. The burn wounds were located mostly on the areas of the buttocks and lower extremities (especially on the thigh) (64.3%). The generally burned patients had moderate burn areas, about 20–50% total burn surface area (TBSA) of deep partial thickness or full thickness burn wound. For the purpose of decreasing the number of burns presenting, or at least making them less severe, the suggestions include: (1) the design of motorfarming tricycle should be changed; obviously separation of the coolant tank from the seat is the most important factor in reducing such burns. (2) Road conditions should be improved to reduce traffic accidents and loading regulations introduced. (3) Traffic control should be enhanced, especially in rural areas.

A new experimental hypertrophic scar model in guinea pigs.

Many aspects of the biology and effective therapy of proliferative scars remain undefined, in part due to a lack of an accurate, practical, reproducible, and economical animal model for systematically studying hypertrophic scars. This study was designed to investigate whether hypertrophic scar formation could be induced in guinea pigs by removal of the panniculus carnosus alone, and by a combination of the removal of the panniculus carnosus with application of coal tar afterwards. Whole thickness skin excision or deep partial thickness injury was used to create the lesions on intact skin. Different anatomic locations were tested in different groups. Scars thus developed were examined morphologically by light microscopy and electron microscopy (TEM and SEM) and biochemically by measuring the activity of glucose-6-phosphate dehydrogenase (G6PD) to check whether these scars had morphological and biochemical properties specific to hypertrophic scars. The albino guinea pigs used in this study were divided into three groups. Removal of the panniculus carnosus was performed from the ventral aspect of the torso in animals in groups I and II. On the skin overlying the area of panniculectomy, circular skin excision was performed in group I, and deep partial thickness burn injury was inflicted in group II, to see whether wounds would heal with hypertrophic scars. In group III, dorsal aspect of the torso were used and wounds were produced by circular skin excisions followed by panniculectomy on both sides but coal tar was applied to only one side. Tissue samples were taken from the scars that were hypertrophic in appearance, and from normal scars and normal skin for comparison. Light and electron microscopic examinations and G6PD activity measurements were performed on these samples. While hypertrophic scar development was not seen in group I and group II, scars with morphological and biochemical properties specific to hypertrophic scars developed in one third of animals in group III after healing of the wounds treated with coal tar. In conclusion, it is shown that it is possible to develop experimental hypertrophic scars in guinea pigs with morphological and biochemical properties similar to those of human proliferative scars. Therefore this model is a new, practical, and economical experimental animal model to study proliferative scars, although improvements are needed to increase yield.

Cryopreserved cultured epidermal allografts achieved early closure of wounds and reduced scar formation in deep partial-thickness burn wounds (DDB) and split-thickness skin donor sites of pediatric patients

Burn treatment in children is associated with several difficulties, e.g. available skin replacement is small, donor area could expand, and subsequent hypertrophic scar and contracture could become larger along with their physical growth. In order to have better clinical results, the authors prepared cryopreserved cultured epidermal allografts from excess epidermal cells of other patients, and applied the epidermal allografts to 55 children, i.e. 43 cases of deep partial-thickness burn wounds (DDB) due to scald burn and 12 cases with split-thickness skin donor sites. In the 43 DDB patients, epithelialization was confirmed 9.1±3.6 days (mean±S.D.) after treatment. In 10 of the 43 patients, epithelialization was comparable between the area which received the epidermal allografts (grafted area) and the area which did not receive the epidermal allografts but was covered with usual wound dressing (non-grafted area). As a result, epithelialization day was 7.9±1.7 in grafted areas and 20.5±2.3 in non-grafted areas. In the 12 patients with split-thickness skin donor sites, epithelialization was confirmed 6.3±0.9 days after treatment. Epithelialization of the grafted and non-grafted areas was comparable in 8 of the 12 patients, and it was 6.5±1.1 days and 14.1±1.6 days, respectively. In these 10 DDB patients and 8 split-thickness skin donor site patients, redness and scar formation were also milder in the grafted area. The 55 patients have been followed up for 1–8 years (mean, 4.75 years), and scar formation was suppressed in both DDB and split-thickness skin donor sites. These findings showed that cryopreserved cultured epidermal allografts achieve early closure of the wounds and good functional outcomes.

Treatment of burn scar depigmentation by carbon dioxide laser-assisted dermabrasion and thin skin grafting.

Permanent depigmentation occasionally develops after deep partial-thickness and full-thickness burn injuries, which heal by secondary intention. This problem can be solved by dermabrasion and thin split-thickness skin grafting. However, mechanical dermabrasion is a bloody procedure that risks exposing medical professionals to infectious diseases transmitted by blood products, and it is difficult to assess the extent of tissue ablation. In this study, dermabrasion of depigmented burn scar area was performed by using flash-scanned carbon dioxide laser treatment, followed by thin split-thickness skin grafting. This method was applied to 13 patients on whom burn scar depigmentation sites were located as follows: two in the facial area, four on the trunk, and seven on the extremities. Skin graft take was excellent in all patients except for one. The follow-up period for these patients ranged from 1 to 12 months, with an average of 8 months. Repigmentation appeared soon after grafting, and no depigmentation occurred again in the treated areas. In conclusion, depigmented burn scar areas can be dermabraded in a short time; depth of tissue ablation can be well controlled; and a bloodless and smooth raw surface can be created by using a flash-scanned carbon dioxide laser. These raw surfaces sustain thin skin grafts well.

Skin flap survival after superficial and deep partial-thickness burn injury.

Whether a flap can be raised successfully in a body region that has been subjected to burn injury remains an issue. The aim of this study was to investigate the survival of skin flaps that were elevated after superficial and deep partial-thickness burn injury in a rat model. Sixty-five rats were divided into five groups: Group 1 (N = 15) was the control group, group 2 (N = 10) included rats with superficial partial-thickness burns that had flaps elevated on day 0, group 3 (N = 15) was comprised up of rats with superficial partial-thickness burns that had flaps elevated on day 4, group 4 (N = 10) included rats with deep partial-thickness burns that had flaps elevated on day 0, and group 5 (N = 15) was comprised of rats with deep partial-thickness burns that had flaps elevated on day 4. Caudally based dorsal flaps consisting of skin and panniculus carnosus were elevated in all groups, and the amount of surviving tissue on each flap was quantified. The surviving areas of flaps elevated on postburn days 0 and 4 in superficial partial-thickness burn zones (groups 2 and 3) were larger than those of flaps that were elevated on postburn days 0 and 4 in deep partial-thickness burn zones (groups 4 and 5). The surviving portions of flaps that were elevated on day 4 in superficial partial-thickness burn zones (group 3) were similar to the surviving areas of flaps in the control group (group 1), and were larger than those of all other groups (groups 2, 4, and 5). In this rat model, flaps were elevated in superficial dermal burn zones with successful outcomes. However, raising flaps in deep dermal burn zones was not a reliable method.

Vitiligo: Treatment by dermabrasion and epithelial sheet grafting—a preliminary report

PUVA therapy and topical steroids are commonly used, nonsurgical treatments for patients with vitiligo. I Unfortunately, some patients fail to respond to these treatments. They seem to be least effective in areas such as the extensor surface of the fingers and hands. Various operative procedures, employed for those patients not responsive to medical therapy, have included the use of tops of suction blisters.' punch grafts, and cultured melanocytes. Varying success has been reported. In 1991, we reported a surgical procedure to successfully repigment skin that had been depigmented by deep partial-thickness burn injuries.5 The purpose of this article is to describe the application of this technique to the treatment of a patient with idiopathic vitiligo that was refractory to medical therapy.

Porcine dermal collagen as a wound dressing for skin donor sites and deep partial skin thickness burns

Collagen was extracted by pepsin digestion from porcine skin, and collagen membrane was prepared by salt precipitation. The porcine collagen membrane was evaluated as a burn wound dressing in deep partial skin thickness burn wounds in rats. Burn wounds, 4 × 4 cm, were inflicted by exposure of skin to 75°C for 15 s followed by de-epithelialization. Wound healing was assessed by planimetry of epithelialization on day 10 after injury. Open wounds exhibited 24 per cent of wound area re-epithelialized. Collagen membrane dressing significantly improved the healing to 69 per cent of wound area (P < 0.0001). In a completely separate experiment, the porcine collagen membrane was applied as a wound dressing to the donor sites of burn patients, and its effect on wound healing was compared with that of a petroleum jelly gauze dressing. The donor sites covered with petroleum jelly gauze had re-epithelialized by an average of 14.5 days (ranging from 13 to 16 days) after wounding. The wounds dressed with collagen membrane demonstrated a significant increase in the healing rate. Complete re-epithelialization was observed by 10.3 days (ranging from 10 to 12 days) after wounding (P < 0.0001).

Treatment for Depigmentation Resulting from Burn Injuries

A new surgical technique to "repigment" skin that has been depigmented by deep partial-thickness burn injuries has been developed and proven to be successful. Partial-thickness burn injuries frequently heal with pigmentary changes. Occasionally, permanent depigmentation is observed, especially in areas such as the hands and fingers. This article reports our surgical technique and our success in using it to treat depigmentation after burn injuries. This new technique consists of superficial dermabrasion of the depigmented region, followed by transplantation of melanocytes via epithelial grafts. With this technique, 15 separate surgical procedures have been performed on 11 patients. The follow-up period for these patients has ranged from 0.5 months to 94 months, with an average of 14 months. The skin-graft take has been excellent in all patients. The color match ranges from good to excellent. No complications have been observed, and this procedure has consistently and reliably improved the disfigurement from depigmentation after these burn injuries.