Facial Burns Research Articles

One Pedicled Superficial Temporal Artery Hair-bearing Flap to Reconstruct Three Different Anatomical Areas of the Burnt Face: A Personal Technique.

Reconstruction of the burnt face is a challenge. In men, the best option to hide facial scars and get rid of the grafted facial appearance is to use the superficial temporal artery hair-bearing flap. In the literature, the superficial temporal artery flap hair-bearing flap has been used to reconstruct one facial anatomical area in men such the eyebrows, the beard, or the mustache area. In this communication, the author describes a personal technique that allows the use of one pedicled superficial temporal artery hair-bearing flap to reconstruct both eyebrows and improve the grafted appearance of the upper/lower lips post the release and graft of burn contractures. The technique will be demonstrated by a case presentation.

Early experiences using bromelain-based enzymatic debridement in a tertiary burns centre in the United Kingdom: A retrospective case series review

The modern ethos of burn care requires a holistic approach that helps patients to not only survive but also maintain a good quality of life. Bromelain-based enzymatic debridement with Nexobrid™ (NXB) has been shown to selectively debride burnt tissue and allow dermal preservation, which has the potential to reduce surgical burden and improve scarring. In this study, early experience with the use of Nexobrid™ at a tertiary burns centre between July 2016 and December 2019 is presented. In particular, the study assessed whether NXB had changed the acute care delivered to this cohort. A retrospective analysis of the patients' records was performed. Results were analysed and presented in the context of current literature. Twenty adult patients (17 male, 3 female) underwent enzymatic debridement with NXB. Median age was 42.5 years. Mean total burn surface area (TBSA) on admission was 20%. Twelve patients were admitted to the intensive care unit, and eight were admitted to the adult burns ward. Mean TBSA treated with NXB was 8.2%, usually within 24 h of admission (mean). All patients had anaesthetist-led analgesia. NXB debridement was successful in 55% of patients, obviating the need for escharotomy in some patients. Sixty percent of all patients required further surgery, and 80% of facial burns treated with NXB required further surgery. Inotrope support was associated with NXB failure (p = 0.015). Mean length of stay was 29 days. Current evidence, including our own findings, cannot justify replacing the current surgical standard of care with NXB, but it certainly solidifies enzymatic debridement as a useful adjunct that should form part of the modern burn surgeon's armamentarium.

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.

Gender differences in quality of life and psychological impact of facial burn scars in a tertiary care center

AimTo compare the quality of life and psychological impact of cases of facial burn scar between male and female patients. Study typeAn observational cross sectional study done in a tertiary care university level teaching hospital, on a hospital based sample over a period ranging from January 2018 to July 2019. MethodologyThe study was carried out on 32 patients of facial burn scar, who were screened for psychiatric diagnoses by MINI International Neuropsychiatric Interview; severity of depression and anxiety assessed by HDRS and HAM A; assessed for QoL and scar ratings of both patient and observer. QoL was assessed using the WHO QOL BREF questionnaire. The scar assessment was done with the help of POSAS by interviewing the patient and examination of the scar. ResultsNone of other socio-demographic variables patient showed any significant association with the number of psychiatric diagnoses of the patient or QoL domains; barring years of schooling, which had a significant positive correlation with the psychological domain score of QoL. Being male or female also did not show any significant differences with the anxiety or depression severity. No burn or scar related variable could reach significant association, except scar itching, stiffness scores of POSAS P and overall scar opinion score of POSAS O, with the number of psychiatric diagnoses of the patient. Extent of scar had significant negative associations with the physical and psychological domains of QoL. Significant negative correlations were found between scar variables like stiffness, pigmentation, relief, pliability, and overall opinion and QoL domain scores. The total observer score of POSAS and the overall opinion of observer had much stronger negative correlation than the patient score; the latter having a significant association with the depression severity as well. ConclusionNo statistically significant gender difference in QoL and psychological impact of patients with facial burn scar were found. However educational level was found to positively influence the psychological well-being of the patients; whereas scar extent was found to negatively affect the physical and psychological domains of QoL.

Skin Burns of the Head and Neck

Burns of the face and neck are devastating injuries with significant psychological and functional morbidity. A detailed understanding of the severity of head and neck burns is key to effective acute management of these injuries and prevention of long-term complications. This article focuses on acute management of burns of the face and skin both in the inpatient setting and managing the sequelae of facial burns including hypertrophic scarring, contractures, and functional issues such as microstomia and ectropion.

Initial assessment of mortality rates of burn patients in a tertiary care hospital by total body surface area, depth and facial burns, and its correlation with serial total leucocyte count

Background: The pattern of burns in victims varies with the manner of infliction of burns. Age plays an important role in deciding the mortality and morbidity of burn victims. Other factors that decide the prognosis of burn victims are the total body surface area (TBSA), Depth of burns, and inhalational injury as evidenced by facial burns. Assessment of these epidemiological factors and inhalational injury can be done as a part of the initial evaluation. Such an assessment aid in resuscitation including emergent airway and decision making regarding the need for skin grafts or escharotomy. Serial measurement of total leucocyte count also helps in identifying the onset of infection and progress to septicaemia and increased mortality rates.Methods: As a part of the initial evaluation, we attempt to study the relation between TBSA, Depth of burns, facial burns, and total WBC count with mortality. A background of septicaemia was also noticed in the majority of patients.Results: For analysis, patients were divided into two groups- Survivors and Non-survivors. A fall in total WBC count coincided with the onset of sepsis and mortality. The other three factors also had a direct correlation with mortality rates.Conclusions: A scoring system constituting all the factors is essential as an initial diagnostic step and it will help in deciding early intubation, escharotomy, and aggressive fluid resuscitation.

Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria.

To characterize serious inhalation injuries seen during recent military operations, and assess whether bronchoscopic severity findings were associated with clinical presentation and outcomes. Service members who suffered inhalation injuries while deployed to Iraq, Afghanistan, or Syria from 2001-2018 were identified using ICD-9 and 10 codes from the Expeditionary Medical Encounter Database (EMED), which is abstracted from patient records in forward-deployed medical facilities. Further information including demographics, mechanism of injury, mortality, total burn surface area (TBSA), degree of facial burn, total Injury Severity Score (ISS), and first post-injury bronchoscopy notes were collected. Patients were excluded with ISS less than 16 or without sufficient details regarding bronchoscopy. Injuries were grouped based on bronchoscopic Abbreviated Injury Scores (AIS) into low-grade (AIS of 1), moderate-grade (AIS of 2), or high-grade (AIS of 3 or 4). 91 patients met inclusion criteria, with no significant differences in age, gender, paygrade, or service branch between degrees of injury. There were no statistical correlations between grade of injury and battle versus non-battle injury, blast versus non-blast mechanism, TBSA, or degree of facial burn. High-grade injuries had significantly higher ISS than low or moderate-grade injuries. After adjusting for ISS, the odds ratio of death was 10.4 (95% CI 1.47 to 74.53) for those with high-grade and 3.7 (95% CI 0.45 to 32.30) for those with moderate-grade compared to low-grade injuries. In this cohort of deployed military members with inhalation injuries, initial bronchoscopic severity findings are strongly associated with mortality even after adjusting for ISS. The AIS may be an important prognostic tool in all of those with serious inhalation injuries.

To intubate or not to intubate? Predictors of inhalation injury in burn-injured patients before arrival at the burn centre.

Inhalation injury occurs in approximately 10-20% of burn patients and is associated with increased mortality. There is no clear method of identifying patients at risk of inhalation injury or requiring intubation in the pre-hospital setting. Our objective was to identify pre-burn centre factors associated with inhalation injury confirmed on bronchoscopy, and to develop a prognostic model for inhalation injury. We analysed acute admissions from the Victorian Adult Burns Service and Ambulance Victoria electronic patient care records for 1 July 2009 to 30 June 2016. We defined inhalation injury as an Abbreviated Injury Scale of >1 on bronchoscopy. A multivariable logistic regression prediction model was developed based on pre-burn centre factors. Emergency medical services transported 1148 patients who were admitted to the burn centre. The median age of patients was 39 years and most patients had <10% total body surface area (%TBSA) burned. The prevalence of confirmed inhalation injury was 11%. Increasing %TBSA burned, flame, enclosed space, face burns, hoarse voice, soot in mouth and shortness of breath were predictive of inhalation injury. The model provided excellent discrimination (area under curve 0.87, 95% confidence interval 0.84-0.91). A lower proportion of patients intubated at a non-burn centre had an inhalation injury (33%) compared to patients intubated by emergency medical services (54%) and in the burn centre (58%). A model to predict inhalation injury in burn-injured patients was developed with excellent discrimination. This model requires prospective testing but could form an integral part of clinician decision-making.

Application of an oral appliance for endotracheal tube fixation in facial burn patients

Application of an oral appliance for endotracheal tube fixation in facial burn patients

Social factors and injury characteristics associated with the development of perceived injury stigma among burn survivors

Improvement in burn survival has shifted the focus of burn care from beyond merely preserving life to improving the quality of life for burn survivors. Healthy psychosocial function is critical to the development of sustained elevations in quality of life after injury, with social and community integration serving a crucial role. Accordingly, the experience of social stigma could pose a significant hindrance to the process of recovery. In this retrospective analysis of patient-reported outcomes following burn injury as captured in the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Model Systems database, we examined the patient and injury characteristics associated with the subsequent experience of social stigma by burn survivors. Using multivariable regression analysis, we found that facial burns and amputations are independent risk factors for experiencing social stigma, while male sex and increased community integration were protective. Taken together, these findings suggest a role for targeted counseling for patients who sustain facial burns and/or amputations, as well as the continued investment in burn-survivor outreach programs aimed at improving social support for survivors.

FUNGSI OLAH TEMPAT KEJADIAN PERKARA (TKP) GUNA MENGUNGKAPKAN KASUS PENGANIAYAAN BERAT DITINJAU DARI SUDUT HUKUM ACARA PIDANA

This study aims at revealing cases of severe maltreatment through crime scene crime scenes. One of the investigation processes can convince the investigator in determining the suspect in handling the crime scene (TKP) where it is divided into 2 namely the First Actions at the crime scene (TPTKP) and processing of the crime scene (olah TKP) from the legislation. As for the results obtained are the methods used by public observations, sketches and photographs, handling victims, handling witnesses and suspects and handling evidence through CCTV footage. In cases of severe maltreatment from the crime scene results can be used through other tools- others such as watering the face with Lombok water, acidic substances, sulfur, saltpeter, vinegar, so that the skin on the face burns, or inserting poisons in food. Not only can it be proven analytically or through autopsy, but it depends on the performance of criminal investigators at the crime scene and eyewitness examination.

Topical treatment for facial burns.

Background Burn injuries are an important health problem. They occur frequently in the head and neck region - the area central to a person's identity, that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of partial-thickness burns to the face. Objectives To assess the effects of topical interventions on wound healing in people with facial burns of any depth. Search methods We searched the Cochrane Wounds Group Specialised Register (searched 12 November 2012); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (1950 to November Week 1 2012); Ovid MEDLINE - In-process & Other Non-Indexed Citations (searched November 12, 2012); Ovid EMBASE (1980 to 2012 Week 45); and EBSCO CINAHL (1982 to 9 November 2012) for relevant trials. We did not apply date or language restrictions. Selection criteria Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review. Data collection and analysis Two review authors independently assessed and included the references identified by the search strategy. Included trials were assessed using a risk of bias form, and data were extracted using a standardised data extraction sheet. For dichotomous and continuous outcomes, we calculated risk ratios and mean differences, respectively, both with 95% confidence intervals (CI). Main results We included five RCTs, comprising a total of 119 participants. Two studies compared two different antimicrobial agents and three compared a biological or bioengineered skin substitute with an antimicrobial agent. All studies had small sample sizes and were at high risk of bias. Heterogeneity of interventions and outcomes prevented pooling of data. In three studies time to complete wound healing was significantly shorter for those using a skin substitute than for those using an antibacterial agent, but the quality of the evidence was low. Pain was significantly reduced with the use of skin substitutes in both studies that reported this outcome in all groups, range mean differences -2.00 (95% CI -3.82 to -0.18) to -4.00 (95% CI -5.05 to -2.95) on a 10-point scale. Authors' conclusions There is insufficient high quality research and evidence to enable conclusions to be drawn about the effects of topical interventions on wound healing in people with facial burns.

Periocular Facial Scald Burns in Children: Is Ophthalmology Consultation Necessary?

Criteria that predict the need for ocular injury treatment in children who suffer periocular facial scald burns are not known. The purpose of this study was to evaluate the incidence and management of ocular injuries among children sustaining facial scald burns and to determine predictors of injuries requiring additional treatment. Children treated at a burn center with periocular facial scald burns were analyzed. Patient and injury profiles were compared between those evaluated and not evaluated by an ophthalmologist. Factors associated with an ocular injury requiring treatment were determined, and treatment differences before and after ophthalmology consultation were evaluated. Seventy-three children with facial scald burns were identified, none with a full-thickness injury. Thirteen children had ocular findings on examination including corneal abrasion, conjunctivitis, scleral burn, and chemosis of the conjunctiva. Twenty-three patients received erythromycin ointment, only 8 of whom had a documented ocular injury. Children seen by an ophthalmologist (n = 24) more often had a positive finding on examination (37.5% vs 8.2%, P = 0.007) and received treatment (66.7% vs 14.3%, P < 0.001). Only 4 patients had modification in their treatment plan after consultation, 3 of whom were started on treatment despite not having a positive finding on examination. Ocular injury after periocular facial scald burns is an infrequent finding. Among children with partial-thickness periocular facial scald burns, initial evaluation and treatment without ophthalmology consultation are appropriate. Ophthalmic antibiotic ointment is an appropriate initial treatment in most symptomatic patients, with ophthalmologic consultation being limited to children without symptomatic improvement.

Conservative treatment of facial burns

Objective: compare the effectiveness of using a moisturizer containing antibacterial drugs of plant origin with a water-soluble ointment that includes the antibiotic chloramphenicol in the treatment of victims with burns of the face II-IIIа degrees.Materials and methods: The results of treatment of 27 victims (12 men and 15 women) with burns of the face and other areas of the body of I – II degree with a total area of 1 to 6 % of the body surface at the age of 18 – 60 years were analyzed. In the main group (13 patients), a cream containing antibacterial drugs of plant origin was used. In the control group (14 patients), bandages with a water-soluble ointment containing an artificial synthesized antibiotic chloramphenicol were used. Visually evaluated the course of the wound process, the nature and volume of exudate, the healing time of burn wounds when using ointments. Seeding of the wound discharge was done on the day of admission, on the 5th and 10th day of treatment. The structure and number of microflora of burn wounds were studied.Results: in the third seeding of the main group, the concentration of bacteria was (2.4 ± 0.04) x103 CFU / g. in the third seeding of the control group, the concentration of microorganisms was (5.9 ± 0.03)×105 CFU / g. the duration of hospitalization in the main group was 18.1 ± 1.5 days, in the control group — 23.8 ± 1.9 days.Conclusions: cream containing antibacterial preparations of plant origin, in comparison with a water-soluble ointment that includes an artificial synthesized antibiotic chloramphenicol, reduces the bacterial contamination of wounds in victims with superficial burns of the face by 2×102 times, the duration of inpatient treatment for 5 days (p &lt; 0.05).

Geoffrey Patrick Ridsdill Smith

Geoffrey Patrick Ridsdill Smith, known as Patrick, chose to follow a medical career in his early thirties having worked as an economist for Fisons plc. He went on to have...

Inhalational Injury Management: From Intubation to Nebulized Heparin

Inhalational injury is common during fire accidents. Upper airway injury occurs due to heat, whereas the lower airway injury is caused by chemical irritation. It causes local damage to the upper, lower airway, and lung parenchyma leading to erythema, bronchorrhea, edema, airway obstruction, and surfactant loss. Plasma leakage occurs due to a storm of pro-inflammatory markers and vascular leak, with fibrin deposition, leading to formation of airway cast and debris increasing the risk of airway obstruction. Systemic complications occur due to anoxia, carbon monoxide, and hydrogen cyanide poisoning. An inhalational injury should be suspected in patients with a history of exposure to flames and in those who are entrapped in a closed compartment during the fire. Facial burns, singed facial or nasal hair, stridor, and carbonaceous sputum should raise suspicion of high index of inhalational injury. Severity of inhalational injury can be graded using 133 Xenon (radioisotope) study, bronchoscopy, computerized tomography findings, or virtual endoscopy. In the management of inhalational injury, keeping airway patent and secured is of vital importance. According to the advanced trauma life support principles, these patients should be intubated early, but as per the recent literature, it may not be necessary to intubate all inhalation injury patients. Adjuvant therapy includes bronchodilators, mucolytics, and beta-agonists. Nebulized heparin is found to be useful as it breaks and prevents new clot formations in the airway without any systemic anticoagulant effects. Inhalational injury is an independent risk factor for increase in mortality in burn patients.

SURGICAL ASPECTS OF FULL-THICKNESS SKIN AUTOGRAFT ENGRAFTMENT ON A GRANULATING WOUND

Background. The paper presents the clinical results of treating patients using full-thickness skin autografts for granulating wounds.Objective. To study the surgical aspects of full-thickness skin autograft engraftment on a granulating wound. Material and methods In traumatology and burn research, to achieve the best cosmetic results, transplantation methods of free full-thickness skin autografts are used. In the Regional Clinical Hospital #1, a method of skin grafting with a full-thickness autograft was developed, which allows to close the defect in the conditions of a purulent wound: granulations are excised before skin transplantation, and a vacuum is applied after grafting.Results. Annually, the specialists of the Burn Center of the Scientific Research Institute – Regional Clinical Hospital #1 assist more than 1300 patients. Of these, from 20 to 25 cases are face burns. 132 patients with burns of the face have been admitted to the hospital over the past 10 years. 37 patients underwent plastic surgery with a full-thickness skin autograft. The authors presented the technology for the surgical treatment of deep burns on the face. After cleansing the wound from areas of necrosis and granulations, usually 20 days after the injury, the upper layers of granulation tissue are removed with a dermatome parallel to the skin surface, to a depth of 1–2 mm. Then, plastic surgery with the free full-thickness skin autograft is carried out on the skin of the face with the formation of cuts for the nose, mouth, eyes. The wound is tightly bandaged with 5–7 rounds of a medical bandage or a vacuum-assisted closure is applied.Conclusion. In case of traumatic skin detachment, plastic surgery according to Krasovitov should be performed in the first hours from the moment of injury. Our study allows transplantation of a full-thickness skin graft to granulating wounds as well. After 5 days, the condition of skin autografts is assessed at the first dressing. Their engraftment is observed on the 7th day. In the postoperative period, scar tissue does not form.

Reasons for Initiation of Areca Nut and Related Products in Patients with Oral Submucous Fibrosis within an Endemic Area in Gujarat, India

Background: While the patterns of consumption of areca nut and its by-products (ANBP) vary across South Asia and the rest of the world, all users share the probable severe outcome of oral submucous fibrosis (OSMF), and this is well reported. The role of psychosocial drivers of habit initiation and addiction is reported less. Objective: To reveal the burden of ANBP abuse, exploring the psychosocial relationship between sex, age at first exposure (AFE), the reason for initiation (RFI) with the type of habit (TOH). Methodology: Data came from the prospective hospital-based study conducted at K.M. Shah Dental College and Hospital covering years 2017 and 2018. Patients with oral lesions were assessed with complete history recording demographics, TOH, AFE, RFI, duration of habit, and clinical diagnosis of any oral and systemic diseases. Patients with a history of scleroderma, facial burns, and oral malignancy were excluded. Results: Of the 13,874 patients, 9.89% reported ANBP. We included 1000 OSMF patients. The mean age of the study cohort was 38.97 ± 14.29 years, with a range of 17–75 years. Males constituted the majority (80.1%). The most common TOH reported was regular use of gutkha (60.1%) followed by mawa (31.4%) with tension and stress (30.3%) being the most common RFI among the cohort. TOH was notably different in relation to AFE. Interestingly, mawa chewing (38.69%) was observed more in females. Importance: This study reveals the burden of ANBP abuse and reports the complex psychosocial relationships between sex, AFE, and RFI with TOH in OSMF patients in this high incidence population.

Extensive facial burns: A case for awake fiberoptic intubation

Mask ventilation is the most basic step in airway management. There are certain situations where mask ventilation is difficult,1 but sometimes it may be really impossible as in this 30 year male patient with facial burns. He suffered from burns one and a half month back due to episode of seizure. Burns were present over face, neck, chest and shoulders. On examination, mouth opening was less than one cm. Teeth were loose. Neck movements were restricted. Left nares was only partially patent. Respiratory and cardiovascular systems were unremarkable. Relevant laboratory investigations were within normal limits. Mask ventilation was not feasible. So awake nasal fiberoptic intubation was planned.2,3 The procedure was explained to the patient and consent was taken for the same. He was given alprazolam 0.25 mg and ranitidine 150 mg at night and 2 h before surgery.

Epidemiology of severe trauma patients treated by plastic surgeons: A 7-year study at a single regional trauma center in South Korea.

BackgroundAfter the laws regulating emergency medicine were amended in 2012, regional trauma centers were established in South Korea. Plastic surgeons specialize in the simultaneous surgical care of patients with facial trauma, burns, and complicated wounds. The objective of this study was to evaluate the role of the plastic surgery department in treating severe trauma patients.MethodsFrom January 2012 to December 2018, we enrolled 366 severe trauma patients with an Injury Severity Score (ISS) over 15 who received treatment by specialists in the plastic surgery department. Of these patients, 298 (81.4%) were male, and their mean age was 51.35 years (range, 6–91 years). The average ISS was 22.01 points (range, 16–75 points).ResultsThe most common diagnosis was facial trauma (95.1%), and facial bone fracture (65.9%) was most common injury within this subgroup. Patients were referred to 1.8 departments on average, with the neurosurgery department accounting for a high proportion of collaborations (37.0%). The most common cause of trauma was traffic accidents (62.3%), and the average length of stay in the general ward and intensive care unit was 36.90 and 8.01 days, respectively. Most patients were discharged home (62.0%) without additional transfer or readmission.ConclusionsThrough this study, we scoped out the role of the specialty of plastic surgery in the multidisciplinary team at regional trauma centers. These results may have implications for trauma system planning.