Post-burn Scars Research Articles

Longitudinal changes in plasma Transforming growth factor beta-1 and post-burn scarring in children

Transforming growth factor beta1, a multifunctional growth factor, plays a pivotal role in wound healing and has been shown to accelerate impaired wound healing. However, high systemic levels of Transforming growth factor beta1 have generally been associated with fibrotic disease processes such as myelofibrosis and pulmonary fibrosis. Hypertrophic scarring occurring during childhood interferes with growth, impairs the function and causes immense psychological and aesthetic problems. Burns is the leading cause of hypertrophic scarring. We studied the longitudinal relationship between plasma Transforming growth factor beta-1 and post-burn wound healing and scarring in children. We discovered that the plasma levels of Transforming growth factor beta-1 rapidly increased to significantly higher levels in the first two weeks post-injury and fell thereafter, in patients who healed with good quality scars post-burn. By contrast, the increase in plasma TGFβ 1 levels in the early stages after-burn, was noticeably absent in patients who developed hypertrophic scarring. We propose that this change in the systemic levels of TGFβ 1 early after the burn may be used as an indicator of patients at risk of developing hypertrophic burn scars. This group of patients could then be targeted for early pharmacological/physical interventions to reduce/prevent scar-related morbidity in burn survivors.

Integra Artificial Skin ® for burn scar revision in adolescents and children

Integra Artificial Skin ®, a biosynthetic dermal template, is well established in acute burn surgery. The aim of the study was to determine the role of Integra in the surgical treatment of postburn scars in a younger population. Between March 1998 and November 2004, 17 patients ( n = 17; mean age = 13.15 years) underwent complete excision of hypertrophic scars or keloids (1–4% TBSA; extremities = 47%, head/neck = 35%, trunk = 18%) with subsequent implantation of Integra for defect closure. Split thickness skin grafting (STSG) of the Integra-derived neodermis was performed 3 weeks after the first operation. Scar excision and primary Integra implantation was successful in all but one patient (94%) who (6%) needed reimplantation once. Integra's mean take rate was 99.7% for all primarily successful patients. Complications occurred in three patients (18%), including minor problems without long-term consequences in 12% (seroma formation), and major problems in 6% (hematoma formation). Take rate of STSG ranged from 50% to 100% (mean 94%). Functional and cosmetic long-term outcome showed results scored “excellent” in 53%, “good” in 36%, and “fair” in 11%. Comparison of pre- and postoperative findings revealed a significant functional improvement in all and a considerable cosmetic improvement in all but two patients. These results suggest that Integra is a valid new treatment modality for extensive burn scar revision in younger patients.

Plasties en Z basse tension

Performing a conventional Z-plasty on postburn scar tissue frequently leads to varying degrees of necrosis of the tips of the transposed flaps. In the conventional technique, the flaps are transposed first by anchoring the tips and then by performing the other sutures. In this order, the tips are subjected to a high degree of tension. Again, according to the conventional technique, perpendicular incisions are performed along the tips, which do not ensure the effective vascularisation of the tips in this context of postburn scarring tissue with loss of dermal blood flow. Two technical modifications are proposed: a different approach to the tension by first of all anchoring the base of the flaps and not by classical first suturing of the tips and the performance of oblique incisions away from the tips to ensure a maximum vascularisation of the subdermal fatty tissue. These two elements have allowed us to improve the results of our plasties.

Marjolin ulcer with multifocal origin

Marjolin ulcer developed from a twenty years old post burn scar. The patient presented with chronic ulceration followed by multifocal development of squamous cell carcinoma with different growth pattern. One nodular lesion grew rapidly to produce a large lesion with history of a little bleeding after trauma but without any pain. Excision followed by skin grafting resulted in good cosmetic scar.

Behandlung der Verbrennungswunde in der Praxis – Welche Kriterien dienen der Einschätzung der Wunde?

Burn injuries are a common trauma. Burn injuries to the skin are divided according their depth into erythema, superficial partial thickness, deep partial thickness and full thickness wounds. Superficial partial thickness wounds are characterized by intense pain and a positive blanching test. Superficial partial thickness wounds of up to 10 % total body surface area can be treated as out-patients. Large burns and those at critical areas like hand, face and genitalia should be treated in surgical departments or may require treatment at specialized burn centers. Superficial partial thickness burns are treated topically with antimicrobial ointments or wound dressings. It is of major importance to avoid desiccation of the wound bed. Reepithelialization should be completed by day 14. Infection of the wound or a non-healing wound makes surgical intervention necessary. In the case of postburn scarring silicon dressings and compression garments are necessary.

Postburn Scars: An Update

Burn wounds give rise to the largest scars we can find in human pathology, influencing patients' quality of life. Despite the improved knowledge on pathophysiology, efficacy of the various treatments remains unsatisfactory. In this short review recent literature is examined with a focus on recent data on postburn pathological scars epidemiology and risk factors, which underline the high prevalence and the long evolution, pointing to identify this illness as a systemic inflammatory one, more frequent in women and in those of younger age, regulated by local factors relevant in wound healing.

Extrinsic post burn peri-anal contracture leading to sub acute intestinal obstruction: A case report

Peri-anal contracture lead to intestinal obstruction whenever there is involvement of anal orifice. In this case anus and peri-anal skin up to two cm was normal; however both gluteal folds were fused because of post burn scar leaving a very small opening which lead to faecal impaction and sub acute intestinal obstruction.

Lower-Extremity Burn Reconstruction in the Child

Lower-extremity burns in a pediatric patient require special consideration. The management of burn reconstruction in pediatric patients is often complex, requiring multiple reconstructive operations, and the primary intention of the surgeon is to prevent burn scar deformities. Timely management of the burn wound and postburn scars has decreased the incidence of burn scar deformities and contractures of the lower extremity in recent years. We present an overview of the principles of reconstruction techniques using skin grafting and biologic skin substitutes to restore the important barrier lost secondary to burns. In addition, we address methods of repairing scar contracture, a common occurrence in burn patients, at specific locations on the lower extremity. Finally, special scenarios such as burns associated with fractures, burn injury in insensate children, and Marjolin ulcer are discussed.

Behandlung der Verbrennungswunde in der Praxis – Welche Kriterien dienen der Einschätzung der Wunde?

Die kutane Verbrennung stellt eine häufige Verletzung dar. Verbrennungen werden bezüglich der Verbrennungstiefe in 1-, 2a-, 2b-, 3- und 4-gradige Verbrennungen eingeteilt. 2a-gradige Verbrennungen, die nur bis in die oberflächlichen Anteile der Dermis reichen und durch erhebliche Schmerzen und positive Rekapilarisierung erkennbar sind, werden konservativ behandelt. Großflächige Verbrennungen (> 15 %-2a-gradig bei Erwachsenen) und Verbrennungen an speziellen Lokalisationen (Gesicht, Hände, Genitale) sind jedoch stationär zu behandeln. Die konservative Behandlung wird mit topischen Salben und Wundauflagen durchgeführt. Ein Austrocknen des Wundgrundes ist zu vermeiden. Die Reepithelisierung sollte nach 14 Tagen abgeschlossen sein. Infizierte Wunden oder eine ausbleibende Heilung machen eine operative Intervention notwendig. Eine Nachbehandlung mit Narbenpflege und Kompression kann auch bei konservativ behandelten zweitgradigen Verbrennungswunden notwendig sein.

Epidemiology and Risk Factors for Pathologic Scarring After Burn Wounds

To describe the clinical characteristics of postburn scars and determine the independent risk factors specific to these patients. While burns may generate widespread and disfiguring scars and have a dramatic influence on patient quality of life, the prevalence of postburn pathologic scarring is not well documented, and the impact of certain risk factors is poorly understood. A retrospective analysis was conducted of the clinical records of 703 patients (2440 anatomic burn sites) treated at the Turin Burn Outpatient Clinic between January 1994 and May 15, 2006. Prevalence and evolution time of postburn pathologic scarring were analyzed with univariate and multivariate risk factor analysis by sex, age, burn surface and full-thickness area, cause of the burn, wound healing time, type of burn treatment, number of surgical procedures, type of surgery, type of skin graft, and excision and graft timing. Pathologic scarring was diagnosed in 540 patients (77%): 310 had hypertrophic scars (44%); 34, contractures (5%); and 196, hypertrophic-contracted scars (28%). The hypertrophic induction was assessed at a median of 23 days after reepithelialization and lasted 15 months (median). A nomogram, based on the multivariate regression model, showed that female sex, young age, burn sites on the neck and/or upper limbs, multiple surgical procedures, and meshed skin grafts were independent risk factors for postburn pathologic scarring (Dxy 0.30). The identification of the principal risk factors for postburn pathologic scarring not only would be a valuable aid in early risk stratification but also might help in assessing outcomes adjusted for patient risk.

Battlefield Acupuncture

Battlefield Acupuncture

Expanded Reverse Abdominoplasty for Reconstruction of Burns in the Epigastric Region and the Inframammary Fold in Female Patients

We report the use of expanded reverse abdominoplasty in three female patients with postburn scars involving the entire epigastric region in which the inframammary folds were effaced, resulting in distortion of breast contour. In two of the patients, tissue expanders were used, and subsequently, reverse abdominoplasty was performed, thus re-creating the inframammary fold. The third patient reported to be pregnant after expanders were placed; therefore, smaller volumes of inflation for tissue expansion were necessary. We believe that this procedure is an optimal solution, both aesthetically and functionally, in respect to other reconstructive techniques in female patients with normal skin inferior to epigastric burns. The surgical technique and results are discussed.

Experience with integra in the management of post-burn hypertropic scars and contractures

Development of hypertropic scars, keloids and contractures is a common outcome affecting burn victims. This induces aesthetic and functional problems. The quality of skin cover after burns is a matter of concern to the patient and to the treating surgeon. This article is meant to discuss our clinical experience, using Integra dermal regeneration templates for the treatment of post-burn contractures and hypertropic scars. We also describe our clinical experience in the management of post-burn complications and add some practical points that we learned using this new technique. From July 2003 to December 2004, Integra was used to cover various parts of the body including trunk, limbs, neck and perineum in 12 patients requiring reconstructive surgery. The Integra was used mainly for the treatment of post-burn contractures and hypertrophic scars, resulting in diffuse tightness causing restriction of movements particularly of the joints along with an unacceptable appearance. After the application of Integra, all the post-burn complications recovered remarkably well and the quality of skin improved significantly in texture, feel, pinching and overall appearance. Function was restored completely to the involved joints and appearance improved to acceptable levels in all concerned.

A-0276 Tissue expansion for post-burn scarring at the upper extremity

A-0276 Tissue expansion for post-burn scarring at the upper extremity

Analysis of Activin A in post-burn pathological scarring

Analysis of Activin A in post-burn pathological scarring

Minor procedures for post burn scarring face

Minor procedures for post burn scarring face

Minor procedures for post burn scarring face

Minor procedures for post burn scarring face

The ‘expansile’ supraclavicular artery flap for release of post-burn neck contractures

Soft tissue defects in the cervico-facial region can result from trauma, tumour excision or post-burn scarring. All rungs of the reconstructive ladder offer possible reconstructive options for these defects. The supraclavicular artery based flap is an extremely reliable local flap for this purpose. It offers thin and pliable skin with good colour match and minimal donor site morbidity. An additional advantage, in our experience, is that this skin can stretch postoperatively to allow further improved neck contour and mobility. Between June 2000 and January 2004, 27 patients underwent reconstruction of neck defects after release of post-burn contractures with the supraclavicular artery based skin flap at our hospital. After discharge the first follow-up visit was on the 10th postoperative day. The patients were advised to wear a custom made Watusi splint for 3 to 4 months. The patients were subsequently followed up at 3 months, 6 months and 1 year. The dimensions of the flap were measured and the patients photographed at the time of discharge and at subsequent visits. All the flaps survived completely. The average operating time for contracture release and flap coverage was 2 h. The hospital stay ranged from 5 to 8 days. Follow-up ranged from 1 to 4 years with an average of 22 months. Complications included epidermolysis (n=2) and delay in donor site healing (n=2). Almost all patients had some widening of the donor site scar. In our experience the width of the flap increased in the postoperative period. At the time of surgery, the width of the flap ranged between 9 and 12 cm. At the 3-month follow-up there was an average increase in width of 24.2%. At 6 months, the average increase in width was 42.8% of the original flap width. At 1 year the average flap expansion was 63% of the original. The length of the flap ranged from 18 to 24 cm and generally remained unaltered during follow-up.

Innowacyjne zastosowanie opatrunku Granuflex Extra Thin w leczeniu blizn pooparzeniowych i pooperacyjnych

Innowacyjne zastosowanie opatrunku Granuflex Extra Thin w leczeniu blizn pooparzeniowych i pooperacyjnych

Erbium:YAG Laser Treatment of Post-burn Scars: Potentials and Limitations

Erbium:YAG Laser Treatment of Post-burn Scars: Potentials and Limitations