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Abstract: Despite the changes to the UK fireworks laws and considerable efforts in prevention, children are still being injured by fireworks. The UK is one of many countries that have altered their firework laws in recent years. We reviewed 54 firework-injured children over the last 10 years and assessed the impact of the two recent UK law changes. Our study outlines past British firework legislation and reviews the literature. In November 1996, there were three deaths in England, Wales and Scotland due to fireworks. The British Government introduced the Fireworks (Safety) Regulations of 1996/1997, primarily banning banger fireworks (known as bangers). We have not seen banger injuries in Newcastle since then. The Fireworks Act 2003 and the Fireworks Regulations 2004 limited the sale of fireworks to the 3 weeks surrounding bonfire night, and banned under 18s from purchasing or possessing fireworks. In our series, we noticed that, in 2004, 83% of children''s firework injuries happened in the 3 weeks surrounding Bonfire Night. We conclude that legislation has had an impact, but stricter enforcement of the existing laws and further education of children and the general public into the dangers of fireworks is needed, as children are still being injured. [Copyright &y& Elsevier]

Abstract: The relationship between burn depth, healing time and the development of hypertrophic scarring (HTS) is well recognised by burn surgeons but is seldom mentioned in the published literature. We studied 337 children with scalds whose scars were monitored for up to 5 years. Overall HTS rates were found to be: under 10 days to healing=0%, 10–14 days=8%, 15–21 days=20%, 22–25 days=40%, 26–30 days=68% and over 30 days=92%. In the conservatively treated group the HTS rates are: under 10 days=0%, 10–14 days=2%, 15–21 days=20%, 22–25 days=28%, 26–30 days=75% and over 30 days=94%. If skin grafting is undertaken there is a much higher incidence of HTS in the 10–14 days group: 10–14 days=33%, 15–21 days=19%, 22–25 days=54%, 26–30 days=64% and over 30 days=88%. We conclude that there is a low risk of HTS formation in scalds healed before 21 days, and that surgery should be reserved for scalds likely to take more than 21 days to heal. [Copyright &y& Elsevier]

Abstract: Loss of dermis is one of the principal factors that contributes to poor scar outcome after severe burn. Dermal loss may be due to the primary injury, surgical management or as a result of infection. Strategies for dermal preservation are therefore important to improve scar quality. We report our early experience using the Versajet® hydrosurgery system, to preserve dermal tissues, both directly during surgical debridement and indirectly by reducing infection and optimising the use of biological dressings. In deep partial thickness burns softer necrotic dermis can be removed with the Versajet® sparing the underlying tougher viable dermis. In superficial burns the Versajet® cleans and removes loose epidermal elements providing an optimal wound surface for the application of biological dressings, even a number of days after injury. Versajet® is most useful when the tissue to be removed is softer than that to be left behind. [Copyright &y& Elsevier]

Little evidence has been produced on the best practice for managing paediatric burns. We set out to develop a formal approach based on the finding that hypertrophic scarring is related to healing-time, with durations under 21 days associated with improved scar outcome. Incorporating new advances in burn care, we compared outcomes under the new approach to a cohort treated previously. Our study was a retrospective cross-sectional case note study, with demographic, treatment and outcome information collected. The management and outcome of each case was assessed and compared against another paediatric burns cohort from 2006. 181 burns presenting across a six month period were analysed (2010 cohort) and compared to 337 children from a previous cohort from 2006. Comparison of patients between cohorts showed an overall shift towards shorter healing-times in the 2010 cohort. A lower overall rate of hypertrophic scarring was seen in the 2010 cohort, and for corresponding healing-times after injury, hypertrophic scarring rates were halved in comparison to the 2006 cohort. We demonstrate that the use of a structured approach for paediatric burns has improved outcomes with regards to healing-time and hypertrophic scarring rate. This approach allows maximisation of healing potential and implements aggressive prophylactic measures. [ABSTRACT FROM AUTHOR]