Facial Burn Injury Research Articles

764 Burn Advanced Practice Provider Fluorescein Dye Staining Reduces Ophthalmology Consults

Abstract Introduction Facial burn injury patients typically receive ophthalmology consultations irrespective of the severity of their peri-ocular or ocular involvement. Minor facial burns without significant eye involvement or ocular complaints often do not require in-patient ophthalmologist assessment. We sought to assess ocular fluorescein dye staining by burn unit Advanced Practice Providers (APP; Physician Assistants and Nurse Practitioners) to decrease unnecessary ophthalmology consults. Methods A prospective evaluation was performed at our ABA-verified burn center for all facial burn injury patients admitted between January 1 through August 31, 2023. Patients who presented with full-thickness injuries to their eyelids or peri-ocular area, those exhibiting tense eyelids raising concern for ocular compartment syndrome, those with severe eye pain and anyone with acute vision loss were excluded from staining and received an immediate ophthalmology consult. For patients with facial burns who did not meet the aforementioned criteria, fluorescein dye stains were administered upon admission by APPs, if available. Ophthalmology consults were only ordered for patients with positive stains. Results 83 patients were admitted with facial burns between January 1 and August 31, 2023. Of these, 42 patients received fluorescein dye stains by APPs. Among those stained, 79% were male and 21% female. The average age was 49 years old (range 19 to 82). The average TBSA affected was 8.46% (range 0.1% to 38.5%). The majority of patients (83%) had flame/flash burns, 7% had scald burns, 2% had chemical burns, 2% had sun burns and the remainder had unclear etiology. 34 patient dye stains (80%) yielded negative results, obviating the need for an ophthalmology consult. The remaining 8 had positive results, necessitating a consult. Among these, 4 were false positives with no ocular injury found by ophthalmology. The remaining 4 exhibited ocular chemosis, trace punctate epithelial erosions, thermal keratopathy and chronic central epithelial defects from prior Lasik surgery. Ophthalmology was consulted in 37 out of 83 patients, with only 8 consults resulting from APP staining. This signifies a 48% overall reduction in consults placed during this 8-month time frame, and an 80% reduction of consults in whom qualified for the pathway. Conclusions Fluorescein dye staining by burn unit APPs minimizes unnecessary ophthalmology consults, likely reducing healthcare costs for patients and healthcare facilities. Applicability of Research to Practice Burn centers should consider fluorescein dye stain screening as part of routine practice for burn patients.

Plastic Surgery in Burn Care: A Call for Enhanced Burn Surgery Training Within Plastic Surgery Residency Programs.

A 10 year cohort of patients admitted to a verified burn unit were analyzed to assess the role of plastic surgeons in the operative management of those patients. All 3843patients were admitted during this study period. Of these, 1509 of those patients underwent surgical procedures. Plastic surgeons performed 658 operations on these patients, including acute and delayed reconstruction of hand and facial burn injuries. In this population, plastic surgeons played a critical role in acute and reconstructive burn injuries in anatomically complex areas. This series illustrates the need for plastic surgery training in burn care.

The epidemiology of alcohol burns at a major burn centre in North China

This study was designed to explore the epidemiological characteristics and potential preventive strategies of alcohol burns. In this five-year, retrospective study, 163 patients with alcohol burns (admitted from 1 January 2015 to 31 May 2020 were included. There was a male-to-female ratio of 1.1:1, a mean age of 34.1±16.8 years, and a mean burn size of 13.3±13.7% total body surface area (TBSA). The number of patients with alcohol burns was similar year by year during the five-year period. Just over half of patients (n=84, 51.5%) sustained a third-degree burn injury, which was significantly associated with a longer hospital stay and the need for surgery. The most prevalent aetiology was cupping (n=49, 29.5%), followed by cooking hotpot (n=37, 22.7%). Of the patients, seven (4.29%) sustained injuries during experiments at school and one patient sustained injury when using alcohol spray for disinfection against COVID-19. The incidence of facial burn injury (n=105, 64.4%) was significantly higher than previously reported data (33.2%). The result of the study showed that cupping and hotpot were the main causes of alcohol burns in Beijing, which should be taken into consideration for prevention. It is necessary to strengthen safety management of classes at school where experiments are undertaken and to educate the general public on the proper means of disinfecting against COVID-19.

A Novel Adjunct for Treatment of Orofacial Contractures After a Facial Burn Injury

Purpose: Surgical management of scar tissue and contractures from facial burns has systematic approaches, yet nonsurgical management continues to lack consensus regarding therapeutic approaches capable of providing stretching of the facial skin and muscles for both treating and preventing microstomia and orofacial contractures. This exploratory study introduces an intraoral splinting system designed to provide low-load, prolonged stretching of orofacial skin and musculature to treat contractures following a facial burn injury. The treatment adjunct described here has potential application across disciplines treating microstomia and orofacial contractures. Method: An 18-year-old man with full-thickness head and neck burns participated in a 5-week trial using intraoral splints to provide stretch to areas of contracture in the mid and lower face. The trial commenced 4 and a half months after his burn injury. Prescriptive placement, sizing, and time for use of the splints were provided. Changes in distance between facial landmarks were identified for 13 measurements taken for nine facial expressions. Results: Lengthening or shortening of the distances between two landmarks indicated the potential benefit from intraoral splints. For the expression “open mouth wide,” increased distance between two end points was noted in 11 of 13 measurements, ranging from 1.6 to 10.8 mm. This represents a lengthening of tissue, allowing for wider oral opening. Negative measurements between two end points occurred in two of 13 measurements, demonstrating elevation of the left and right nostrils. Visual data also demonstrated the appearance of change. Conclusions: When treating microstomia and orofacial contractures, consideration should be given to the use and further exploration of a more targeted intraoral methodology that uses a low-load, prolonged stretch to improve functional and aesthetic deficits. Oral splinting using an intraoral methodology is underutilized in the burn patient population and has application in both the acute care and chronic phases of recovery.

Outcome of Facial Burn Injuries Treated by a Nanofibrous Temporary Epidermal Layer.

The face is commonly affected in thermal injuries, with a demand for proper recognition and the correct choice of treatment to guarantee optimal aesthetic and functional outcomes. It is highly vascularized and often heals conservatively, highlighting the particular relevance of conservative treatment modalities, many of which require daily re-applications or dressing changes, which can be painful and tedious for both the patient and the healthcare providers. Motivated by encouraging results of a novel temporary nanofibrous epidermal layer, we herein present a case series of this technology in a case series of patients suffering from facial burns and treated in our Burn Center. Patients with superficial partial-thickness facial burns and mixed pattern burns, which were treated with SpinCare™, an electrospun nanofibrous temporary epidermal layer, between 2019 and 2021, at our institution were analyzed retrospectively. The Manchester scar scale (MSS) and numeric rating scale (NRS) were used for scar, pain, and outcome evaluation at different time points by five independent board-certified plastic surgeons with profound experience in burn surgery. Ten patients (m = 9; f = 1) were treated and evaluated retrospectively. The mean age was 38.8 ± years (SD ± 17.85). The mean healing time was 6.4 days (SD ± 1.56). The mean follow-up was 16.4 months (SD ± 11.33). The mean MSS score was 5.06 (SD ± 1.31), and the mean NRS Score for pain was significantly reduced from initially 7 to 0.875 upon application (mean (pre-application) 7 ± 0.7 and (application) 0.875 ± 1.26; p ≤ 0.0001). Patients reported a NRS score of 10 in terms of functional and cosmetic outcomes at their final follow-up appointment. No adverse effects were observed. The application of a nanofibrous temporary epidermal layer such as SpinCare™ represents a relatively easy-to-use, well-tolerated, and effective alternative for the treatment of partial-thickness facial burns.

715 Ocular Complications of Facial Burns in the Pediatric Population

Abstract Introduction Pediatric burns commonly involve the face and periocular areas, with a risk of impairing vision. The aim of this study is to characterize ocular injuries in burn patients and identify the patients at most risk of ocular complications. Methods This study is a retrospective review within a single academic, urban pediatric burn center. All burn patients under 18 years of age admitted from January 2010 to December 2020 with periorbital or ocular involvement were included. Variables analyzed included patient demographics, burn characteristics, presence of ophthalmology consultation, ocular exam findings, follow up time period, and early and late ocular complications. Results In the study period, 2,781 patients were admitted to our burn center, 300 of whom had facial burns involving the eyes and/or eyelids. Etiologies of burn injuries were as follows: 112 (37.5%) scald, 80 (26.8%) flame, 35 (11.7%) contact, 31 (10.4%) chemical, 28 (9.4%) grease, and 13 (4.3%) friction. Overall, 70.9% of patients with ocular burns received an ophthalmology consult. Of these patients, 61.5% had periorbital swelling and 39.8% had corneal injuries. Of the 207 patients who were followed as inpatients by ophthalmology, only 61 (29.5%) presented for a follow-up visit, as recommended, 6 of which had serious ocular sequelae including ectropion, entropion, symblepharon, and corneal decompensation, and 4 of whom had a firework-related injury. Conclusions While burns involving the ocular surface and eyelid margins are infrequent overall, they can lead to long-term sequelae. Ophthalmology consultation is critical, particularly in the setting of chemical and firework-related injury. As ocular and periocular burns can cause immediate as well as delayed sequelae, ophthalmologic evaluation is a key component of assessment. Applicability of Research to Practice This paper characterizes ocular injuries in pediatric patients with facial burn injuries and identifies patients most at risk for ocular complications. We believe this will be valuable for many burn researchers and clinicians in order to better identify patients who could benefit from ophthalmologic evaluation and those at risk for both immediate as well as delayed sequelae from periocular burns.

An unusual mode of facial thermal burn injury by an oxygen mask caught fire while smoking in a patient with COPD: A case report

An unusual mode of facial thermal burn injury by an oxygen mask caught fire while smoking in a patient with COPD: A case report

Speech-Language Pathology's Role in Management of Orofacial Contractures After a Facial Burn

Purpose: Care of the burn patient continues to advance and requires a comprehensive interdisciplinary team. With advances in medical sciences, mortality has declined for patients with large total body surface area burns, and this has resulted in the need for more hands-on clinical judgment and skill from the speech-language pathologist working with burn survivors. Patients with a facial burn injury pose a special challenge for intervention by the speech-language pathologist. This population calls upon the therapist to be able to assess and treat the limiting effects of orofacial scarring and contractures, as well as speech, language, voice, cognitive, and swallowing disorders. Traditionally, occupational and physical therapists have managed orofacial contractures in this population with methods such as pressure garments, silicone masks, and oral splints. Research and data on cutaneous functional units have shown that occupational and physical therapists require significant time to address the whole body needs of the burn care patient, calling for increased involvement from all professionals especially in larger total body surface area burns. Microstomia and orofacial contractures are a treatment need for the facial burn population and present a collaborative treatment opportunity for the speech-language pathologist. Conclusions: This article will cover the mechanism of a facial burn injury and how it may cause functional impairments that can be directly impacted through early intervention utilizing speech-language pathology services. Best practice in the care of a patient with dermal or full thickness facial burns should include a referral to the speech-language pathologist. There is an opportunity to expand service delivery by the speech-language pathologist in the acute care and outpatient arenas of burn care.

Short- and long term hyposmia, hypogeusia, dysphagia and dysphonia after facial burn injury – A prospective matched cohort study

BackgroundFacial burns frequently occur in occupational or household accidents. While dysphagia and dysphonia are known sequelae, little is known about impaired smell and taste after facial burns. MethodsIn a prospective observational controlled study, we evaluated hyposmia via the Sniffin’ Stick Test (SnS), hypogeusia via a taste strip test, and dysphonia and dysphagia via validated questionnaires acutely and one-year after burn, respectively. A matched control group consisting of a convenience sample of healthy volunteers underwent the same assessments. ResultsFifty-five facial burn patients (FB) and 55 healthy controls (CTR) were enrolled. Mean burn size was 11 (IQR: 29) % total body surface area (TBSA); CTR and FB were comparable regarding age, sex and smoking status. Acutely, hyposmia was present in 29% of the FB group (CTR: 9%, p = 0.014) and burn patients scored worse on the SnS than CTR (FB: 10; CTR: 11; IQR: 2; p = 0.013). Hyposmia per SnS correlated with subjective self-assessment. Hyposmia and SnS scores improved over time (FB acute: 10.5 IQR: 2; FB one year: 11; IQR: 2; p = 0.042) and returned to normal at one-year post burn in most patients who completed the study (lost to follow-up: 21 patients). Taste strip scores were comparable between FB and CTR, as was the acute prevalence of dysphagia and dysphonia. ConclusionHyposmia acutely after facial thermal trauma appeared frequently in this study, especially when complicated by inhalation trauma or large TBSA involvement. Of all complete assessments, a fraction of burn patients retained hyposmia after one year while most improved over time to normal. Prevalence of dysphonia, dysphagia and hypogeusia was comparable to healthy controls in this study, perhaps due to overall minor burn severity.

787 Two Year Follow Up of Microblading in Patients with a Facial Burn Injury

IntroductionRecovery from a facial burn injury can be challenging. Excessive reconstructive interventions and the emotional devastation can be taxing. Microblading, semi-permanent eyebrow tattooing, is a potential non-invasive alternative treatment. Little research exists on microblading’s longevity and durability over burn scar or its impact on self-esteem. A single case study showed positive impact on patient perceived body image and maintenance of shape and color. Two years post microblading new data supports its efficacy as a potential treatment for patients with a facial burn.MethodsSingle case study two years post microblading of a 22-year-old female who sustained a 30% total body surface area burn injury to bilateral upper extremities, hands and face at age one. Based on referral from her plastic surgeon, she underwent first microblading treatment March 2019 with a standard touch up session May 2019. Patient has not undergone any additional sessions since. Photos obtained two years post treatment were compared to before/after photos immediately following microblading to assess longevity and durability on scar tissue. Self-reported patient outcomes obtained two years after microblading assessed impact on self-esteem and body image.ResultsPhotos were taken pre/post microblading, at nine months, and 2.5 years post. Comparison of photos over time showed some expected fading but maintenance of overall shape. Patient self-reports using an eyebrow pencil to darken when she desires brows that are more vibrant and trims hair as needed to maintain shape. Patient reports positive impact to her self-esteem post-microblading. “I most definitely did notice some changes in my self-esteem.” She notes feeling happier and more confident, especially in social situations with peers. Comparison of responses immediately post-microblading with 2.5 years later show focus on improved self-esteem versus satisfaction with appearance of the eyebrow.ConclusionsComparison of follow up photos obtained 2.5 years after initial microblading shows maintenance of eyebrow shape with some fading of color. Further research is needed to determine if color fading is as expected or more pronounced in patients with scarred skin. Also important is the impact of characteristic dryness of scars on fading rate. To maintain adequate color, additional treatments would be recommended. Better understanding of factors affecting fading would help determine frequency and timing of maintenance sessions. Patient report indicates increasingly improved self-esteem over time as evidenced by focus on confidence versus appearance. Despite some fading, data supports microblading as an effective non-surgical treatment in establishing eyebrow appearance and function over burn scar.

67 Transient Dysphagia After Burn Injury in Children: An Under-identified Problem

IntroductionSeverely burn injured pediatric patients are at risk of dysphagia (difficulty swallowing) due to prolonged intubation or tracheostomy placement. To improve the early identification and treatment of dysphagia, we implemented a swallowing assessment protocol. We hypothesized that the swallowing assessment protocol is effective for identifying and treating dysphagia after prolonged intubation.MethodsBetween October 2016 and December 2020, pediatric burn patients with facial burn injuries, prolonged mechanical ventilation, tracheostomy, inhalation injury and/or anoxic events were placed on the swallowing protocol. The protocol included a Transitional Swallow Screen (TSS) performed within 24 hours after extubation or decanulation by an advanced practice swallow occupational therapist. If signs of dysphagia were noted, recommendations on diet consistency and treatment for positioning and feeding were implemented. Regular reassessments continued until the patient was determined to have regained premorbid swallowing function. Data on patient demographics, burn characteristics, dysphagia, treatment and outcome were collected. Descriptive statistics were used to describe the population, treatments and outcome.ResultsA total of 33 pediatric burn patients were included. Mean age was 8.1±5.9 years and TBSA was 48.1±26.8%. Median time from injury to swallow assessment was 45 (21-81) days. The majority of patients suffered from flame burns (70%). Almost all of the patients were intubated (97%) and 85% underwent a tracheostomy. Patients had a facial burn (73%), inhalation injury (24%) or anoxic injury (15%). Transient dysphagia was diagnosed in 79% of patients. Subsequent therapeutic procedures as a result of the TSS included: neurologic re-education (30%), swallow therapy exercises (55%), desensitization (42%), and patient/ family training and supervision (79%). All patients eventually returned to normal swallow and regular diet. This occurred at an average of 72.5+46.7 days post injury and 8.2+18.0 days post swallow assessment.ConclusionsPediatric patients with substantial burn injury may not only be at risk for aspiration but also have other forms of dysphasia that require intervention. Implementation of a swallowing protocol can identify patients who required further therapeutic intervention and can guide the recovery of safe swallowing and functional oral intake.

815 Translational Research in Skin of Color Spontaneous Repigmentation of Post-Chemical Burn Leucoderma

IntroductionAfter facial burn injuries to skin of color (SOC) patients, repigmentation plays a critical role in post-burn quality of life, given the acquired contrast between preserved skin and achromic scars, and that daily concealment may be difficult. While leucoderma is a well-known side-effect of deep chemabrasion with phenol, phenol-croton oil, and high concentration trichloroacetic acid, mechanisms of repigmentation are still not fully understood, and the observation of spontaneous repigmentation of a deep chemical injury in SOC has not previously been described in the literature. In our study, we present the dynamics of long-term spontaneous facial repigmentation of a Fitzpatrick V chemical burn patient, with microscopic findings of a deep chemical peel SOC animal model.MethodsWe demonstrate spontaneous repigmentation in a 37-year-old female who initially presented with depigmented areas, erosions and eschars on the face, 7 days after accidental deep chemical burn, due to self-application of 70% glycolic acid to improve acne. This is juxtaposed with a SOC porcine experiment, performed with 35% phenol, 1.6% croton-oil, to evaluate depth-of-injury, neocollagenesis band thickness in 21 days, and skin pigmentary safety. A 6mm punch biopsy taken at 21 days underwent Herovici staining to reveal the thickness of collagen type III neocollagenesis, confirm the presence of melanin in the epidermis, and evaluate the presence of melanophages.ResultsOn patient presentation, epidermolysis and areas of deep dermal burns were observed over the forehead and cheeks. At 14 days, multiple leucoderma scars persisted and initial perifollicular repigmentation was noticeable. At 28 days, most of the skin was repigmented; however, many areas had only perifollicular repigmentation and still very severe leucoderma. At 6 months, the skin still had small areas of leucoderma with folicular repigmentation. At 11 months the skin color was fully recovered, with minimal post-inflammatory hyperpigmentation (PIH) over the cheeks.As for the SOC animal model, at 7 days the eschar was detached, and the skin was achromic. At 21 days, skin pigmentation was completely restored without macroscopic signs of PIH. Dermatopathology evaluation revealed microscopic areas of melanophages, a fully recovered epidermal melanin, and a band of over 500 micra of collagen type III.Overall, on follicle-dense areas after chemical burn, we observed progressive full repigmentation over the course of 11 months on the patient, and by day 21 in the porcine SOC model.ConclusionsSpontaneous repigmentation occurred both after accidental deep chemical ablation to the face of a SOC patient, and on the porcine SOC model after deep chemical peel formula application.

Use of Ovine Forestomach Matrix in the Treatment of Facial Thermal Burns

Thermal burn injuries are common, devastating medical emergencies that are challenging to manage. Timely and effective treatment is paramount to both short- and long-term patient outcomes. Currently, medical providers and health care facilities worldwide are emphasizing the need for cost-efficient and accessible treatments; such treatments are particularly vital for vulnerable populations with limited access to advanced medical resources. The use of extracellular matrix (ECM) technologies has become widespread in the management of acute and chronic wounds, including burns. Ovine forestomach matrix (OFM) is an ECM bioscaffold isolated from sheep forestomach tissue and has been shown to be effective in soft tissue reconstruction procedures. The use of OFM in the treatment of 2 facial thermal burn injuries, including in a pediatric patient, is described. Both patients fully recovered from their facial injuries with satisfactory cosmetic outcomes. Although OFM technology is widely used in the management of acute and chronic wounds, the authors believe this to be the first published report of its use to aid healing in burns. Ovine forestomach matrix may provide a valuable additional tool for the management of complex burns.

Facial Burns: A One Year Audit at a Tertiary Hospital in Dar Es Salaam, Tanzania

Abstract Background: Facial burn injuries have plagued mankind since time immemorial and till the present day, they remain among the major public health problems. Since the face carries the identity of an individual, it is the most psychologically significant area of the body. Therefore, any disfigurement to the face such as that caused by burns has potential psychosocial consequences to the victim. The present study aimed at determining the etiology, pattern of occurrence and management of facial burns among patients attended at Muhimbili National Hospital, Dar es Salaam Tanzania. Material and methods: This was a one-year prospective study of all consecutive patients with facial burns who attended treatment at the Muhimbili National Hospital (MNH). The variables examined included socio-demographic characteristics, etiology, clinical features and management of facial burns. The data were analyzed using SPSS software for windows version 23 (IBM Corporation Chicago, IL, USA). Fisher's t-test was used and associations were considered significant when p < 0.05. Results: A total of 112 patients with body burn injuries were attended during the period of this study where by 29.5% of the patients had burn injuries to the facial region. The male to female ratio was 2:1 and patient's age ranged from 17 to 70 years, with a mean age of 30.6 (SD 12.3) years. The etiological factors included open fire that affected (78.8%) of the patients followed by scalding (12.1%) and electricity (9.1%). Majority (81.8%) of the burn injuries were accidental in nature. The most frequently burnt facial aesthetic zones were the zygomatic region followed by the orbits. More than 80% of the participants had complications where by hypo-pigmentation was the commonest (51%) complication of burn injuries encountered. Conclusion: Facial burns affected males twice more than females. Open fire was the most common etiological factor and the zygoma was the most frequently affected facial esthetic zone. Majority of the patients had complications due to burn injury, of which the facial skin hypo-pigmentation was the commonest followed by death.

Nexobrid Treatment for Burn Injuries in Patients With Chronic Obstructive Pulmonary Disease and Home Oxygen Therapy.

There is an increased risk for burn injuries associated with home oxygen therapy of patients with chronic obstructive pulmonary disease (COPD) since 10% to 50% of these patients continue to smoke. Enzymatic eschar removal of facial burns is gaining popularity but intubation of this specific patient group often leads to prolonged weaning and can require tracheostomy. This study dealt with the question if enzymatic debridement in these patients can also be performed in analgosedation. A selective review of the literature regarding burn trauma associated with home oxygen use in patients with COPD was performed, as well as a retrospective analysis of all patients with burn injuries associated with home oxygen use and COPD that were admitted to the study clinic. In the literature, 1746 patients with burns associated with home oxygen use are described, but none of them received enzymatic debridement. In this study, 17 patients were included. All three patients in this study with facial full-thickness burn injuries received enzymatic debridement. The mortality rate in this cohort was 17.6% (3/17). Up to date, there is limited experience performing regional anesthesia debridement in patients with COPD. This is the first manuscript describing the use of enzymatic debridement in patients with COPD and home oxygen therapy. We could confirm other studies that intubation of these patients leads to prolonged ventilation hours and increases the probability for poor prognosis. Therefore, we described the treatment of enzymatic debridement in analgosedation without intubation.

541 72 Facial Burns Treated with Autologous Skin Cell Suspension- A Real World Data Analysis Across 5 U.S. Burn Centers

Abstract Introduction Optimal management of facial burn injuries remains a significant challenge in burn care. Acute surgical intervention is often coupled with delayed reconstructive procedures as an essential option for burn care. Experience with new surgical technologies could challenge historic reconstructive ladders. Our goal was to pragmatically assess the rate of successful intervention with autologous skin cell suspension (ASCS) for the treatment of facial burn injuries from real-world data. Methods A retrospective review from five burn centers over a three-year period was performed from deidentified registry data for facial burn injuries initially treated with ASCS. Cases of non-acute thermal burn and burns not involving the face were excluded. Data collection included: date of surgery, last follow-up date, need for grafting (split or full thickness skin graft, STSG or FTSG, respectively) or reapplication of ASCS within the same hospitalization, and reconstruction not including laser procedures due to scarring during the follow-up period. Descriptive statistics were calculated and data are reported as median with interquartile ranges where appropriate. Results A total of 72 burn injuries were treated with ASCS for facial burn injuries. Two burn centers treated 4 patients each, one treated 18, and the remaining two treated 22 and 24 patients. The median follow-up was 199 days (range 9 -1,150 days). Acute failure requiring a second treatment with ASCS or application of a full-thickness or split-thickness autograft occurred in 12 (16%) of the patients with 5 undergoing re-application of ASCS and 7 undergoing FTSG or STSG. reconstruction secondary to scarring during the follow-up period occurred in 10 (14%) of patients. Reconstruction was required in 1 of 5 patients that underwent a second treatment with ASCS as opposed to 4 of 5 patients treated with FTSG or STSG. Conclusions This study represents the largest experience with the use of ASCS for the management of facial burn injury in the reported literature. Use of ASCS from real-world data indicated that ASCS successfully resulted in definitive wound closure in 90% of the patients treated with facial burn injuries, with 10% requiring secondary intervention. This failure rate is below the previously published rate of 33%, indicating the disruptive potential of this technology for the management of facial burn injuries.

The relationship between psychosocial distress and oral health status in patients with facial burns and mediation by oral health behaviour

BackgroundThere is limited discussion on the influence of psychosocial factors on the oral health of patients with a facial burn injury. This report investigated the relationship between oral health and psychosocial distress in patients with facial burns and the role of oral health behaviour in mediating the relationship.MethodsThe data were part of a cross-sectional study that had systematically and randomly selected patients with > 10% total burn surface area from a burn centre in Pakistan. The oral health status (DMFT, CPI, OHI-S) and severity of facial disfigurement were assessed. Validated instruments in the Urdu language were self-administered and information relating to oral health behaviour (brushing and dental visits), oral health-related quality of life (OHIP-14), satisfaction with appearance, self-esteem, anxiety and depression, resilience, and social support were collected. The statistical analyses included simple linear regression, Pearson correlation, t-test, and ANOVA. Mediation analysis was carried out to examine the indirect effect by oral health behaviour.ResultsFrom a total of 271 participants, the majority had moderate to severe facial disfigurement (89%), low self-esteem (74.5%), and moderate to high levels of social support (95%). The level of satisfaction with appearance was low, whereas anxiety and depression were high. Disfigurement and satisfaction with appearance were associated with lower self-esteem and social support (p < 0.05). Greater severity of disfigurement, higher levels of anxiety and dissatisfaction with appearance, and lower levels of self-esteem and social support were associated with greater DMFT and OHIP-14 scores, worse periodontal and oral hygiene conditions, and less frequent tooth brushing and dental visits (p < 0.05). The main barriers to oral healthcare utilization were psychological and social issues (p < 0.05). The indirect effect by oral health behaviour was not significant for anxiety but was significant for disfigurement, satisfaction with appearance, self-esteem, and social support.ConclusionThere is an association between the psychosocial factors and oral health of patients with facial burns through a direct effect and mediation by oral health behaviour.

Clinical Performance of Hydrogel-based Dressing in Facial Burn Wounds: A Retrospective Observational Study.

Preserving both esthetic and functional outcome remains challenging in facial burn injuries. The major issue is the initial treatment of injury. In this study, we focused on patients with partial-thickness facial burns admitted to the burn unit of Tri-Service General Hospital, Taipei, from November 2016 to November 2018. In 21 included patients, customized mask-style, transparent hydrogel-based dressing was applied to the burns. The mean age of included patients was 37.4 years. The mean area of burn injury was 11.9% of total body surface area, and the mean area of second-degree facial burns was 162.3 cm2. Full reepithelialization took, on average, 10.86 days. Scarring was acceptable in terms of texture and color, and no hypertrophic or keloidal scarring was noted. The mean Vancouver Scar Scale score was 2.07. Use of the hydrogel-based dressing masks seems to be a promising means of reducing pain, providing uninterrupted wound healing, facilitating observation, and positively affecting scarring in patients with second-degree facial burns.

Tratamento ortodôntico em paciente com queimadura facial – relato de caso

Numerous variables are considered in a normal occlusion, one of those is the homeostasis of the facial musculature and its harmony with bones and teeth. Several factors can lead to change in muscle functionality. An example is the facial burn injury in which it is common formation of hypertrophic scars that cause muscle structures dysfunction and impact on facial growth and dentition development. Patient K.R.S, 15-years-old, female, sought treatment at the Center for Attention and Research of Craniofacial Anomalies (CEAPAC) complaining of “crooked teeth”. She reported during anamnesis that when she was a child, she suffered a domestic accident which caused facial, and body burn injury. The patient had Angle Class I malocclusion and upper and lower incisor lingualization. Dental arch atresia and moderate crowding were observed. Rapid maxillary expansion and lower dental expansion were performed with the lip bumper, followed by teeth alignment and leveling with a fixed appliance. n the retainment phase, Hawley plates (upper and lower) were used in addition to a fixed lower retainer. The treatment of arch expansion and alignment proved to be viable and predictable, however, the stability has a dubious prognosis, which led the authors to indicate the use of retainers indefinitely.

Total full-thickness skin grafting for treating patients with extensive facial burn injury: A 10-year experience

IntroductionFacial burns are not only a severe burn injury, but result in psychological disturbance. The improvement of the methods of treating facial burns remains topical. The aim of the study was to evaluate the effectiveness of approach based on full-thickness skin autografting for facial burn injuries. MethodsDuring 2000–2019, ninety seven patients with the facial burn were treated in Burn Center. All patient were divided into two groups. The comparative analysis between groups was done. ResultsGroup A was treated with full-thickness skin grafts (42 patients – 43.3%). Since 2010, total full-thickness skin graft was used in 11 patients from Group A. In group B, 55 patients (56.7%) were treated with split-thickness skin grafts, including 9 patients (16.4%) with total split-thickness skin graft transplantation. Total full-thickness skin graft was performed in case of a deep and extensive facial burn and cicatricial deformities. During the long-term period, a positive cosmetic result and the absence of indications for reconstructive operations were noted. ConclusionThe approach of facial burn treatment based on total full-thickness skin graft allows conditions for engraftment and adaptation of autograft, reduces the risk of scar developing and achieves maximum cosmetic results of treatment.