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Various creams are available for superficial second-degree burns (SSDB) of the face.We evaluated provitamin pantothenic acid versus β-glucan for SSDB of the face using the O2C laser Doppler system and digital photo analysis. Out of 20 patients (January to December 2012) with facial burns, 7 with SSDB of both cheeks were included to our study. Burned cheek wounds were treated using pantothenic acid or β-glucan. Digital photos of marked regions were taken daily from predefined distances. Microcirculation wasmeasured atmarked regions for 7 days at scheduled time points using the O2C laser Doppler. Data were evaluated using the SPSS program (SPSS Inc., Chicago, IL). Wounds treated with β-glucan showed faster reepithelialization. O2C laser Doppler measurements showed faster increase in SO2, microvascular perfusion, hemoglobin content, and blood flow. This correlated good with clinical Vancouver Scar Scale results. Although not statistically significant, β-glucan cream therapy of SSDB results in aesthetically superior outcome and faster reepithelialization. [ABSTRACT FROM AUTHOR]

Abstract: Facial burns are very common and have significant clinical impact. However, the treatment regimen for superficial to deep facial burns is not well defined. The purpose of this study was to investigate the effects of cadaver skin grafting in deep partial thickness facial burns in comparison to standard care. In a prospective open study design severely injured patients with superficial and deep partial thickness burns were randomized into the group receiving open treatment with silversulfadiazine (standard n =5) or into the group receiving early superficial debridement followed by coverage with glycerolized cadaver skin (n =5). The outcome measures were time and quality of wound healing, and incidence of hypertrophic scarring at 3 and 6 months post burn. There were no significant differences in demographics between groups. In the group treated with the allogenic material time to reepithelialization was 10.5 days, while it was 12.4 days in the silversulfadiazine group (p <0.05). Scar quality was found to be significantly improved in the allogenic treatment group. Three and 6 months postburn there were no patients with significant hypertrophic scarring in the allogenic group while there were two patients who developed hypertrophic scars in the silversulfadiazine group (p <0.05). In this study, we demonstrated that glyzerolized cadaver allograft skin represents a superior biological dressing for shallow and deep partial thickness facial burns. This is in concordance with other reports on scalds. It would be worthwhile to perform more clinical studies with a larger number of patients to further evaluate the effect and function of allogenic skin for facial burns. [Copyright &y& Elsevier]

Abstract: Erbium:YAG lasers are successfully used to treat a variety of epidermal and dermal lesions, including rhytides, dyschromias, and certain types of scars. To date, however, no report has focused on the experiences with this laser in reconstructive burn surgery. Since 2001, the Erbium:YAG laser has become an integral part of the treatment of postburn scars at the Berlin Burn Center. This paper presents the techniques applied and clinical experiences obtained. In addition, a new stripe technique is introduced, which avoids healing disturbances in scars following deep burns. In conclusion, the Erbium:YAG laser has proven to be a valuable supplementary tool for the improvement of cosmetically disturbing mild postburn scars. It is particularly handy in areas difficult to treat, such as the eyes, nose, lips, and fingers. The individual advantages of the Erbium:YAG laser, other laser systems, and dermabrasion for the treatment of burn scars are compared in a brief survey. [Copyright &y& Elsevier]

The relationship between clinical course and changes of laboratory findings in patients with high-voltage electrical burns with regard to creatinine kinase activity was analyzed in order to determine the value of this prognostic parameter with regard to patients survival and risk of limb amputation. In a retrospective study 42 patients with electrical burns were reviewed. CK serum levels were determined every day during the first 10 days following submission. Analysis of data revealed a relation between strongly elevated CK levels and patients risk of limb amputation and mortality. Although further research is necessary, there is strong evidence that the amount of burned body surface area does not directly correlate with the true extent of tissue damage caused by high tension injuries. Our data suggest that the degree of muscle tissue violation corresponds with the initial excess of creatinine kinase levels in blood serum. This may be an additional factor to support the decision for early surgical decompression of electrically burned extremities and aggressive surgical management of the high-voltage burn victim. Furthermore, it may provide a prognostic parameter for the clinical outcome of these patients. [Copyright &y& Elsevier]

Digital finger amputation with soft tissue injury is a frequent accident in Reconstructive Surgery. Several techniques about reconstruction of digital finger amputation are described in literature. However replantation is difficult when large segments of the arteries are missing. This is especially true for distal finger phalanx amputations, where replantation is done in selected patients such as artists or musicians. In this article a microsurgical replantation techniques of a distal artery and proximal vein anastomosis is presented in a distal phalanx amputation, which successfully solved the problem of venous reflux without venous anastomosis. [ABSTRACT FROM AUTHOR]

Patients with sternum osteomyelitis are transferred to plastic surgery departments for wound coverage. Several options of flap coverage are known; however, various wound diameters need different flaps. In a retrospective study, 135 patients from 2006-2010 with deep sternal wound infections were evaluated. From 2006-2009 various flaps were used for wound coverage, as described in published reports. In 2010 a developed algorithm was used for defect coverage based on wound width using pectoralis muscle flaps or the latissimus dorsi muscle flap. Two groups of patients were analyzed, from 2006-2009 and 2010, and in a matched pair analysis patients with small wound width less than 6 cm, medium wounds widths between 6-12 cm, and large wound width larger than 12 cm. End-point was wound dehiscence larger than 1 cm. Statistical analysis was done by Mann Whitney U-test using the SPSS program. Forty-eight patients were included in the match from a total of 130 study patients. Statistical analysis did not show significant difference in patient population of the two groups. In the group with wound sizes less than 6 cm a significant difference was found when using the algorithm. In the other groups no statistically significant difference was seen; however lesser numbers in wound dehiscence were found. In addition, a significantly lesser length of stay was found in the ICU and length of the hospital stay for all groups treated according to the algorithm. A reduction of costs may be achieved when using the algorithm based on wound size. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the impact of methicillin resistance in Staphylococcus aureus bacteremia (SAB) on mortality and length of stay in burn patients. Design: Retrospective cohort study. Setting: A 750-bed tertiary care university hospital in Cologne, Germany. Patients: Patients registered in the database of the burn intensive care unit (BICU) between 1989 and 2009 with complete data sets (n =1688). Results: Over the 21-year study period, 74 patients with SAB were identified; 33 patients had methicillin-resistant S. aureus (MRSA) and 41 methicillin-susceptible S. aureus (MSSA). Comparing the MRSA with the MSSA population the following parameters were significantly different in the univariate analysis: BMI (27.2kg/m2 vs. 23.6kg/m2; P =0.05), extent of deep partial thickness burns (17.8% vs. 9.0% of total body surface area; P =0.007), antibiotic requirement on admission (45.5% vs. 22.0%; P =0.046), median length of hospitalization prior SAB (24 days vs. 7 days; P <0.001), packed red blood cells administration (47.6 units vs. 26.1 units; P =0.003), intubation requirement (100% vs. 80.5%; P =0.007), intubation period (43.5 days vs. 26.8 days; P =0.008), catecholamine requirement (90.9% vs. 61.0%; P =0.004), sepsis (60.6% vs. 34.1%; P =0.035) and organ failures (81.8% vs. 39.0%; P <0.001). Regarding outcome parameters, methicillin resistance was not significantly related with mortality (adjusted OR 1.55, 95% CI 0.56–4.28; P =0.40) and length of BICU stay after SAB (Kaplan–Meier analysis log-rank test P =0.32; Cox''s proportional hazards regression HR 1.22, 95% CI 0.65–2.27, P =0.535) in the univariate and multivariate analyses. Conclusion: Our data suggest that methicillin resistance is not associated with significant increases in mortality and length of BICU stay among burn patients with SAB. [Copyright &y& Elsevier]

Background: Several options are known for treatment of the sternal wounds. However, various wound diameters need various flaps. Patients and Methods: 135 patients with sternum osteomyelitis from 2006 to 2010 of our institution were analyzed in a retrospective study. After using various flaps from 2006 to 2009 we developed an algorithm based on wound width, using pectoralis muscle flaps or the latissimus dorsi muscle flap. Two groups from 2006 - 2009, and 2010 were analyzed. A matched pair analysis was done for groups with small (< 6 cm), medium (6 cm - 12 cm) and large wound width (> 12 cm). Endpoint for each analysis was wound dehiscence larger than 1cm. Factors influencing wound dehiscence were analyzed, such as infectious agents, applied flap for coverage, gender, co-morbidities, number of debridements before closure, ICU length of stay. Statistical analysis was done by Mann Whitney U-Test using the SPSS program. Results: 130 patients were included in the study and 48 in the match. No significant difference in patient population between the two groups was detected. Total number of wound dehiscence in the 2010 group was lesser, however without statistical significance. Groups with wound sizes lesser than 6 cm showed a significant difference in wound dehiscence when using our algorithm. However, significant lesser length of ICU and hospital stay for all groups treated according to our algorithm was seen. Conclusions: ICU and hospital length of stay can be significantly reduced when using our algorithm, reducing costs for treatment of deep sternal osteomyelitis. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Objective: To analyze trends in incidence and treatment of thermal injuries over the last two decades. Methods: We retrospectively reviewed our local single center database of patients with thermal injuries admitted to the burn intensive care unit (BICU) of the Cologne-Merheim Medical Center (University Hospital of Witten/Herdecke). The cohort was divided into two groups according to the decade of admission and the epidemiology and clinical course of the patient sample admitted during the period 1991–2000 (n =911) was compared to that of 2001–2010 (n =695). Results: The following variables were significantly different in the bivariate analysis: mean age (39.8 years vs. 44.0 years), burn size of total body surface area (23.2% vs. 18.0%) and size of 3rd degree burns (9.6% vs. 14.9%). The incidence of inhalation injury was significantly lower in the last decade (33.3% vs. 13.7%) and was associated with a shorter duration of mechanical ventilation (10.8 days vs. 8.5 days). The ABSI-score as an indicator of burn severity declined in the second period (6.3 vs. 6.0) contributing partially to the decline of BICU length of stay (19.1 days vs. 18.8 days) and to the mortality rate decrease (18.6% vs. 15.0%). Conclusion: The severity of burn injuries during the last two decades declined, probably reflecting the success of prevention campaigns. Concerning mortality, the chance of dying for a given severity of injury has decreased. [Copyright &y& Elsevier]

Previous studies have assessed the effects of changes in microcirculation on wound healing; however, the influence of microcirculation on tissue histomorphology remains widely unknown. Reflectance-mode-confocal microscopy (RMCM) enables in vivo tissue observation on a cellular level. We present RMCM data evaluating the local microcirculation and assess the influence on histomorphology during burn healing. RMCM was performed in 12 patients (aged; 36.2±14.2 years, maximum-burn-extent: 4% total body surface area) at times 12, 36, and 72 hours after a superficial burn. The following parameters were assessed: quantitative blood-cell-flow (cbf), epidermal thickness (Emin), basal-layer thickness (tbl), and granular cell-size (Agran). Cbf was found to be 54±3.6 cells/minutes (control), increased to 91±3.6 cells/minutes ( p<0.05) 12 hours postburn; decreased to 71±6.1 cells/minutes ( p<0.05) (36 hours), and to 63±2.3 cells/minutes ( p>0.05) 72 hours postburn. Emin was 43.74±3.87 μm (control), increased to 51.67±4.04 μm ( p<0.05) 12 hours, decreased to 48.67±3.51 μm ( p<0.05) 36 hours, and to 45.33±3.21 μm ( p>0.05) at 72 hours postburn. Tbl was 14.17±0.6 μm (control), increased to 16.93±1.15 μm ( p<0.05) 12 hours, decreased to 15.93±1.20 μm ( p<0.05) 32 hours, and to 15.00±0.85 μm ( p>0.05) 72 hours postburn. Agran was 718±56.20 μm2 (control), increased to 901±66.02 μm2 ( p<0.05) 12 hours, decreased to 826±56.86 μm2 36 hours, and 766±65.06 μm2 at 72 hours postburn. RMCM enables in vivo observation of wound microcirculation and allows direct assessment of vascular effects on cutaneous histomorphology during the healing course of superficial burns. [ABSTRACT FROM AUTHOR]

Abstract: The Parkland–Baxter formula is a widely utilized resuscitation guideline for the initial management of fluid deficits in burn victims. Implementation of resuscitation formulas has helped to reduce the incidence of shock and hypovolemic organ failure such as acute renal failure in the setting of burn trauma. However, it has been shown that indiscriminate implementation of these formulas may inappropriately suit individual patient’s requirements. In our experience resuscitation by the Parkland formula often forced corrections in order to reach predefined resuscitation goals. Objective: Given these findings we felt the need to refine formula based resuscitation strategies. Patients and measurements: Reviewing a subset of 81 burn admissions we screened for predictive parameters in addition to total body surface area burned (TBSA burned) and body weight influencing resuscitation volume requirements. Design: Using multivariate linear regression analysis (MRA) various parameters were integrated in a stepwise forward mathematical selection procedure resulting in a modified resuscitation formula. Main results: A new formula including body weight, TBSA burned, inhalation injury (IHI), high blood alcohol level (BAL) and a compensating factor for advanced age was set up. The new formula was compared to the original Parkland formula. Both were assessed for predictive reliability (PR±20%). Using this strategy we were able to improve PR±20% from 28.4% to 51.9%. Conclusions: Optimal fluid resuscitation of severe burn victims is a complex clinical challenge. Rigid-formula based resuscitation schemes often fail to match all subtleties of current clinical practice but need to provide a reliable starting point for fluid resuscitation. We demonstrate a new multifactorial formula resulting in a better guide to initial fluid resuscitation. [Copyright &y& Elsevier]