Challenges and new horizons in the management of advanced basal cell carcinoma: a UK perspective.

Basal cell carcinoma (BCC) is a common malignancy with a good prognosis in the majority of cases. However, some BCC patients develop a more advanced disease that poses significant management challenges. Such cases include locally advanced, recurrent or metastatic BCC, or tumours that occur in anatomical sites where surgical treatment would result in significant deformity. Until recently, treatment options for these patients have been limited, but increased understanding of the molecular basis of BCC has enabled potential therapies, such as hedgehog signalling pathway inhibitors, to be developed. A clear definition of advanced BCC as a distinct disease entity and formal management guidelines have not previously been published, presumably because of the rarity, heterogeneity and lack of treatment options available for the disease. Here we provide a UK perspective from a multidisciplinary group of experts involved in the treatment of complex cases of BCC, addressing the key challenges associated with the perceived definition and management of the disease. With new treatments on the horizon, we further propose a definition for advanced BCC that may be used as a guide for healthcare professionals involved in disease diagnosis and management.

Management of purpura fulminans skin loss at a regional burns centre: Sixteen-year experience.

INTRODUCTION: Purpura fulminans (PF) is a rare syndrome of cutaneous purpura which is the consequence of severe circulatory shock causing intravascular thrombosis, haemorrhagic necrosis, and consequent tissue loss. The aim of this study was to present our 16-year experience of managing PF in a regional burns centre. METHODS: We performed a single-centre retrospective case series of all patients admitted to the St Andrews Burns Centre at Broomfield Hospital, Chelmsford, Essex, UK, between June 2006 and July 2022 with a diagnosis of PF. Data were extracted by retrospectively searching hospital case notes. RESULTS: Thirteen individuals were identified [five children (mean age 5, range 1-14) and eight adults (mean age 39, range 24-54)]. The total body surface area of cutaneous necrosis ranged from 5% to 80%, with a mean of 27.2%. Patients were treated with an established surgical sequence of total wound debridement and immediate coverage with a cadaveric allograft, followed by staged wound autografting. The mean time from disease onset to wound autografting was 37.3 days (range 20-64 days). Eight individuals (61.6%) required major amputation of at least one limb (proximal to the ankle or wrist joint). Only one mortality (of 80% total body surface area skin loss) was observed in the identified cohort. CONCLUSIONS: The large body surface areas often involved in PF cases make management of these wounds well suited for burns centres, wherein established facilities and multidisciplinary teams exist that are familiar with managing large cutaneous burns. We provide a suggested algorithm to aid the management of PF.

Why is priority setting important for global burn care research?

The use of robust evidence is a key component of providing high quality care to patients. Synthesised evidence to support clinical decision-making is lacking for many aspects of clinical burn care. Identifying the most important areas of care that lack high quality evidence and requires research is necessary, as funding for primary research is limited. Priority setting research studies are a joint endeavour between patients, carers and clinicians to identify and rank topics for research in a healthcare area in order to reduce research waste. Such an exercise has yet to be undertaken in burns. The aim of this paper is to outline the importance of research prioritisation in burn care, to discuss how it facilitates the maximum benefit from limited research funding and to explain the methodologies used.

The Use Of Dermal Regeneration Templates For Primary Burns Surgery In A UK Regional Burns Centre.

The gold standard of treatment for major burns is early burn excision and autografting. In major burns this is complicated by a lack of donor site availability. Another challenge after burn injury is achieving optimal cosmetic and functional outcomes. Dermal regeneration templates (DRT) are biomatrices that help to address these problems. Within our centre the most commonly used are two-stage Integra® and single-stage Matriderm®. We review the use and outcomes of DRT in primary burns reconstruction within our regional burns centre. All patients undergoing primary burn reconstruction using Integra® (n=59) or Matriderm® (n=35) over a 13-year period were included. Integra® was used in patients with significantly larger burns (20.4% TBSA vs 1.7% TBSA). Comparable levels of graft take were seen in both groups. Major infections were significantly higher in the Integra® group (11/35 compared to 3/59). There was no significant difference in haematoma development, hypertrophic scarring or the need for secondary reconstructive surgery. Burn contractures developed in 15 patients treated with Matriderm® and 21 with Integra®. DRT have been used safely and effectively and have played an increasingly important role in our service over the last 13 years. Integra® is used primarily in large burns with limited donor sites and Matriderm® in smaller burns in cosmetically sensitive areas.

Le traitement de référence des brûlures graves est l'excision précoce et la greffe autologue. Dans ces brûlures graves, ce traitement peut s'avérer difficile par le manque de disponibilité de sites donneurs. De plus, l'obtention de résultats satisfaisants tant sur le plan cosmétique que fonctionnel est un véritable challenge dans les suites de brûlures. Les matrices dermiques (DRT) sont des biomatériaux qui peuvent aider à résoudre ces problèmes. Dans notre centre, les matrices le plus souvent utilisées sont Integra® double couche et Matriderm ®. Nous avons étudié l'utilisation des matrices dermiques et leurs résultats dans la chirurgie primaire des brûlures dans notre centre de traitement des brûlures de province. Tous les patients ayant bénéficié d'une chirurgie primaire pour brûlure par Integra® (n=59) et par Matriderm® (n=35) dans les 13 dernières années ont été inclus. Integra® a été utilisé pour des patients présentant des brûlures significativement plus étendues (20,4% TBSA vs 1,7% TBSA). Le taux de prise des greffes est comparable dans les deux groupes. Les infections sévères sont plus élevées de façon significative dans le groupe traité par Integra® (11/59 contre 3/35). Il n'y a pas de différence significative en ce qui concerne les hématomes, l'évolution hypertrophique des cicatrices ou la nécessité de chirurgie secondaire. Des rétractions cicatricielles sont apparues chez 15 patients traités par Matriderm® et chez 21 patients traités par Integra®. L'utilisation des matrices dermiques nous semble sûre et utile et a été largement développée ces 13 dernières années dans notre centre. Integra® est utilisé en chirurgie primaire pour les brûlures très étendues où les sites donneurs font défaut alors que Matriderm® est utilisé pour les brûlures de petite surface à enjeu fonctionnel et cosmétique.

The diagnosis and management of inhalation injury: An evidence based approach.

INTRODUCTION: Smoke inhalation injury (II) is an independent risk factor for mortality in burns and its management is inherently complex. We aim to make recommendations for best practice in managing II and its sequelae by reviewing all available current evidence in order to provide an evidence-based approach. METHODS: We conducted a systematic search of the Cochrane database and Embase using PRISMA guidelines with no patient population exclusion criteria. Published work was reviewed and evidence levels graded. RESULTS: We identified 521 abstracts for inclusion. Of the 84 articles identified for secondary review, 28 papers were excluded leaving 56 papers suitable for final inclusion. CONCLUSIONS: We are able to identify a number of strategies in both diagnosis and treatment of II that have support in the published literature, including the role of bronchoscopy, permissive hypercapnia, nebulized heparin and hydroxycobalamin. Other strategies have not been shown to be harmful, but their efficacy is also not firmly established, such as high frequency oscillatory ventilation and exogenous surfactant. Prophylactic antibiotics and corticosteroids are not recommended. In general, published evidence for II is mostly Level 3 or below, due to a noticeable lack of large-scale human studies. This represents a challenge for evidence-based burns practice as a whole.

The ten-year experience of firework injuries treated at a uk regional burns & plastic surgery unit.

Fireworks are used worldwide to celebrate national, religious, cultural festivals and holidays. However the use of fireworks is associated with preventable injuries. We aim to review cases of burns and trauma caused by fireworks presenting to a regional burns and plastic surgery unit in the United Kingdom. We hope our findings will help to guide future firework-related safety practices in the UK. A retrospective review was performed of all patients presenting to our tertiary burns and plastic surgery unit with burns and/or trauma sustained from fireworks over a ten-year period from October 2004 to October 2014. A total of 93 patients were identified. Medical case notes were reviewed, patient demographics, aetiology of injury, management and patient outcomes were recorded. A cohort of 93 patients with burn injuries caused by fireworks were identified from our database. A total of 74% injuries occurred in October and November. Mechanism of injury included contact, flash, flame burns and injury secondary to blast force. Most injuries sustained were to the hands, followed by head and neck, torso, limbs and perineum in descending order of frequency. A total of 38.7% of patients required surgery for their wounds. Fireworks not only result in significant burn injuries, but also eye injuries, soft tissue defects and fractures requiring a spectrum of plastic surgical interventions. The number and severity of accidents can be minimised by raising awareness regarding safety precautions.

Les feux d'artifices (FA) sont utilisés mondialement, dans des contextes festifs variés (religieux, nationaux, culturels, locaux). Les accidents qui y sont liés sont évitables. Nous avons étudié les brûlures et les traumatismes liés aux FA se présentant dans notre CTB, espérant que ceci permettra la mise en place de mesures de prévention dans l'ensemble du Royaume Uni. Nous avons revu rétrospectivement les dossiers des 93 patients pris en charge dans notre CTB entre octobre 2004 et octobre 2014 après un accident de FA. Les données démographiques, étiologiques, de prise en charge et évolutives ont été colligées. Les ¾ des accidents étaient survenus en octobre et novembre. Les mécanismes vulnérants étaient le contact, le flash, la flamme et le blast. Les mains étaient la région la plus fréquemment touchée, suivies par ordre décroissant par la région cervico-céphalique, le torse, les membres et le périnée. Trente huit virgule sept pour cent des patients pont du être opérés. Les accidents de FA entraînent non seulement des brûlures mais aussi des atteintes oculaires, des pertes de substance cutanées et des fractures pouvant nécessiter des interventions dans un large spectre de la chirurgie reconstructrice. Le nombre et la gravité de ces accidents peut être diminués par une application accrue des mesures de précaution.

Improving mortality outcomes of Stevens Johnson syndrome/toxic epidermal necrolysis: A regional burns centre experience.

INTRODUCTION: Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. METHODS: A retrospective case review was performed for all patients with a clinical diagnosis of TEN or SJS/TEN overlap admitted to our paediatric and adult burns centre between June 2004 and December 2016. Patient demographics, percentage total body surface area (%TBSA), mucosal involvement, causation, severity of illness score (SCORTEN), length of stay and survival were appraised with appropriate statistical analysis performed using Graph Pad Prism 7.02 Software. RESULTS: During the study period, 42 patients (M26; F: 16) with TEN (n=32) and SJS/TEN overlap (n=10) were managed within our burns service. Mean %TBSA of cutaneous involvement was 57% (range 10-100%) and mean length of stay (LOS) was 27 days (range 1-144 days). We observed 4 deaths in our series compared to 16 predicted by SCORTEN giving a standardised mortality ratio (SMR) of 24%. CONCLUSION: Management in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes.

Spectrophotometric intracutaneous analysis for the assessment of burn wounds: A service evaluation of its clinical application in 50 burn wounds.

INTRODUCTION: The assessment of burn depth can be challenging even to the experienced burn clinician. Clinical assessment is most widely used to determine burn depth. Because of this subjective nature, various imaging modalities have been invented. The use of photospectometry as a novel technique in burn wound depth analysis has been previously described but the literature is very limited. METHODOLOGY: We carried out a single blinded non-randomized comparative study of healing potential of 50 burn wounds between tissue spectrophotometry analysis versus clinical evaluation. RESULTS: ScanOSkin™ technology has an overall sensitivity of 75% and specificity of 86% in predicting healing potential of wounds. Analysis of Inter Rater Agreement (IRA) using Kappa calculations showed strengths of agreement varied from fair to moderate in perfusion and burn depth. IRA for assessing pigmentation however, was poor and this was reflected in user feedback. CONCLUSION: There is a potential role for ScanOSkin™ tissue spectrophotometric analysis in burn depth assessment. Future studies comparing several imaging modalities with ScanOSkin®, taking into account costs comparison may be useful for future health resources planning.

Civilian blast-related burn injuries.

There is limited English literature describing the experience of a civilian hospital managing blast-related burn injuries. As the largest regional burn unit, we reviewed our cases with the aim of identifying means to improve current management. A 6-year retrospective analysis of all patients coded as sustaining blast-related burns was conducted through the unit's burns database. Medical case notes were reviewed for information on burn demographics, management and outcomes. 42 patients were identified. Male to female ratio was 37:5. Age range was 12-84 years, (mean=33 years). Total body surface area (%TBSA) burn ranged from 0.25% to 60%, (median=1%). The most common burn injury was flame (31/42, 73.8%). Gas explosions were the most common mechanism of injury (19 cases; 45.2%). 7/42 cases (16.7%) had full ATLS management pre-transfer to the burns unit. The Injury Severity Score (ISS) ranged from 0-43 (median=2). 17/42 (40.4%) patients required admission. 37/36 (88.1%) patients were managed conservatively of which 1 patient later required surgery due to deeper burns. 5/42 (11.9%) patients required surgical management at presentation and these were noted to be burns with >15% TBSA requiring resuscitation. One case required emergency escharotomies and finger amputations. All patients survived their burn injuries. Blast-related burn injuries are generally uncommon in the civilian setting. Following proper assessment, most of these cases can be deemed as minor injuries and managed conservatively. Improvement in burns management education and training at local emergency departments would provide efficient patient care and avoid unnecessary referrals to a burns unit.

La littérature anglophone concernant l'expérience des hôpitaux civils dans la prise en charge des brûlés à la suite d'une explosion. En tant que plus grand CTB de la région, nous avons revu nos cas, afin d'identifier des axes d'amélioration de notre prise en charge actuelle. Nous avons pour cela revu les dossiers des patients admis pour brûlure liée à une explosion pendant 6 ans, en nous focalisant sur les données démographiques, la prise en charge et le devenir. Quarante deux patients ont été retrouvés, dont 37 hommes et 5 femmes. L'âge moyen était de 33 ans (12-84), la surface brûlée de 1% (0,25-60), l'agent vulnérant une flamme dans 31 cas (73.8%). Une explosion de gaz était retrouvée 19 fois (45.2%). Presque tous (36 soit 88.1%) les patients étaient passés par le déchoquage avant leur admission en CTB. L'ISS s'étendait de 0 à 43 (médiane 2), 40.4% (17) d'entre eux ont été hospitalisés, presque tous (36) ont cicatrisé spontanément, le dernier ayant été greffé secondairement. Cinq patients (11.9%) ont dû être opérés d'emblée, ils avaient tous une surface brûlée de plus de 15%, nécessitant une réanimation hydro-électrolytique. Un patient a subi des incisions de décharge et une amputation digitale. Aucun décès n'a été observé. Les brûlures liées à une explosion sont rares en pratique civile. La plupart des patients ont des brûlures mineures, cicatrisant spontanément. La formation des urgentistes pourrait permettre les transferts inutiles en CTB.

Self-inflicted Burns: 10 year review and comparison to national guidelines.

INTRODUCTION: There is an increasing trend of self-inflicted burns noted in the literature, often seen in patients with complex psychosocial backgrounds. These patients are challenging to manage as the recovery from the acute burn may be compounded by difficult rehabilitation and suboptimal coping strategies. We aimed to review patients presenting to our burns unit with self-inflicted burns, the management strategies and examine the complexities surrounding their management. We assessed patient outcomes with a particular interest in psychosocial support given. METHODS: A retrospective review of all patients presenting with self-inflicted burns over a 10 year period (2005-2014 inclusive) was conducted. Patients were identified through IBID database coded as either 'self-inflicted' or 'suicidal.' We reviewed patient and burn demographics, the clinical management, psychosocial management and patient outcomes such as wound healing, re-admission rates, and survival. RESULTS: We identified 118 self-inflicted burns in total. 50/118 (42%) were admitted. 64 (54%) were male and the total body surface burn area ranged from <0.5% to 99% with a median of 14%. 60/118 (51%) had TBSA <10% and 58/118 (49%) had TBSA >10%. 24 (48%) underwent admission to the Burn Intensive Care Unit (BITU). All patients admitted to BITU had TBSA >10%. Of those admitted to BITU 6 were palliative, 18 had full resuscitation and surgical management. Of those 18 patients who had active treatment, 10/18 (56%) died. Mean total length of stay was 31 days, range 1-130 days. 9% of patients sustained injuries whilst being a current inpatient at a psychiatric institution. Of all patients reviewed, 16% (n=19) had a previous history of deliberate self-harm through burns. Of those patients admitted, 98% of were reviewed by the mental health team during their admission with time to psychological review varying depending on fitness for assessment. The overall mean length of stay for all admitted patients who were actively treated but who subsequently died was 53 days. 84% of admitted patients were managed surgically. CONCLUSION: Self-inflicted burns patients would benefit from a more complex pathway of treatment as their management aims to achieve not only physical health but also psychological health. They would benefit from enhanced care to manage the acute burn but also psychiatric support to ensure patients do not re-offend.

The burning issues of motor vehicle radiator scald injuries revisited - a fresh review and changing prevention strategies.

A preventable subgroup of burn injuries is scalds sustained from motor vehicle radiators. This study was to determine changes in trends in epidemiology of such injuries and to discuss whether current and other prevention efforts proposed previously require reinforcement. We conducted a retrospective study (February 2007-August 2015) of all motor vehicle-related burn referrals to our regional burns service. 68 cases of motor vehicle radiator burns were identified. Male to female ratio was 65:3. Mean age was 35.1 (range = 9-71). Most cases occurred in the summer months (22/68 = 32.4%). 65 cases (95.6%) involved car radiators. 66% of injuries resulted from actively removing the pressure cap of an overheated radiator in the motor vehicle. Mean total burn surface area (%TBSA) was 2.1% (range = 0.5- 11%). The depths of burn injuries were mostly superficial partial thickness. Face, chest and upper limbs were the most common sites of injury. Mean healing time was 14.2 days (range = 4-60). Following the introduction of safety measures by vehicle manufacturers, motor vehicle radiator burns in this era are mostly minor injuries and can be potentially managed conservatively as an outpatient. This contrasts with findings from previous studies over a decade ago of larger, more significant injuries requiring admission and surgery. Whilst manufacturers have installed safety measures into the design of radiator caps, our findings suggest that re-educating the public to allow a period of cooling prior to opening caps should be reinforced.

Les ébouillantements par liquide de refroidissement de voitures (LRV) sont évitables. Cette étude a pour but d'évaluer les changements épidémiologiques de ce type d'accidents et de discuter si les stratégies préventives passées et actuelles nécessitent une mise à jour. Nous avons étudié rétrospectivement tous les patients hospitalisés dans notre CTB entre février 2007 et août 2015 à la suite de brûlures en relation avec un véhicule à moteur. Parmi ceux-ci, 68 (65 hommes, 3 femmes) âgés en moyenne de 35,1 ans (9-71) s'étaient brûlés avec du LRV. La plupart des cas (22 soit 32,4%) étaient observés en été. La grande majorité (66 cas soit 95,6%) mettaient en cause le radiateur avec 2 fois sur 3 l'ouverture de celui-ci en raison d'une surchauffe. La surface brûlée était de 2,1% (0,5-11%) et les brûlures, le plus souvent superficielles (délai de guérison moyen de 14,2 jours (4-60), touchaient principalement la partie haute du corps (visage, thorax, membres supérieurs). Les systèmes de sécurité mis en place par les constructeurs ont permis d'observer des brûlures mineures guérissant spontanément après une prise en charge en externe, contrastant avec les observations précédentes de brûlures plus étendues et plus profondes, nécessitant une hospitalisation et des greffes. Cependant, une prévention passive insistant sur la nécessité de laisser refroidir le moteur avant d'essayer d'ouvrir le radiateur semble nécessaire.

A major burn injury in a liver transplant patient.

Immunosuppressive therapy may aggravate the clinical course of a burned patient, primarily affecting wound healing and thus complicating permanent wound coverage. We hereby present the successful management of a 48-year-old female liver transplant recipient with a major burn injury, aiming to elucidate the effects of the patient's immunosuppression on surgical treatment. After admission to the Burns ITU, the patient underwent serial debridement of the burn and coverage with cryopreserved allografts. Despite immunosuppression, no prolonged survival of the allo-epidermis was documented. Nevertheless, a variable degree of vascularized allo-dermis was clinically identified. She subsequently underwent skin autografting and was discharged home with most of the wounds healed. Although there are isolated reports of survival of skin allografts in immunocompromised patients, in our case the allografted skin did not provide permanent wound coverage. However, it permitted a staged surgical management, allowing the immunosuppressive regime to change, the skin donor sites to heal and it also provided a dermal scaffold for successful skin autografting.

Un traitement immunosuppresseur peut obérer l'évolution d'un brûlé, en raison de ses interactions avec la cicatrisation. Nous présentons la prise en charge couronnée de succès d'une patiente de 48 ans transplantée hépatique victime d'une brûlure grave, dans le but de faire le point sur la relation traitement chirurgical/chirurgie du brûlé au stade aigu. Après son admission en réanimation pour brûlés, la patiente a bénéficié de plusieurs séances d'excision/allogreffe. Malgré le traitement immunosuppresseur, les allogreffes ne sont pas restées en place plus longtemps. Cependant, une vascularisation, à un degré variable, de l'alloderme a été cliniquement observée. Elle a pu retourner à son domicile après autogreffes, les brûlures quasiment entièrement cicatrisées. Au contraire de quelques rapports d'intégration d'allogreffes chez des patients immunodéprimés, celles de notre patiente ont été rejetées. Elles ont toutefois tenu suffisamment longtemps pour permettre un changement de l'état immunitaire, la guérison des sites donneurs et le développement d'un sous-sol apte à recevoir les autogreffes.

Prevention and control of carbapenemase-producing organisms at a regional burns centre.

In many parts of the world, carbapenemase-producing organisms (CPOs) are endemic. The transfer of medical patients from such countries to the UK requires us to have control systems in place to avoid onward transmission. This report describes the experience of a regional burns centre challenged by its first four cases of CPO in two separate incidents. Key learning from our experience was the importance of CPOs being considered in empirical antibiotics for any patient from an endemic area. Using contact plates, we demonstrated high bacterial counts after cleaning and we describe a terminal cleaning strategy along with the importance of continuing staff engagement and education.

UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016.

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the diagnosis and management of the full spectrum of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS-TEN overlap in adults during the acute phase of the disease. The document aims to.

Treatment of nasal burns: analysis of 150 cases.

Nasal burns present a challenge for the plastic surgeon in terms of immediate management, choice of primary treatment and secondary reconstruction with the goals of good aesthetic and functional outcome. We present a retrospective analysis of the management of 150 patients with nasal burns treated in our center between July 2005 and July 2011. We rationalized our conservative and all surgical treatments of this subset of burns patients and organized them in a simple and structured way. The reconstructive options for most complex full thickness nasal injury is determined by the integrity of adjacent facial tissues which would always be preferred when available. Microsurgical free tissue transfer is dependent upon the fitness of the patient and the availability of unburned skin at the donor site. Secondary nasal reconstruction is based on an assessment of the residual functional and cosmetic problems. Airways narrowing from scar contracture or loss of support are managed using standard plastic surgical and rhinoplasty principles. Cosmetic refinements range from flap debulking to the importation of new tissue on to the nose. Our experience with this challenging group of patients has led us to develop a simple treatment algorithm for the management of nasal burns.

Les brûlures nasales présentent un défi pour le chirurgien plastique en terme de prise en charge immédiate, de traitement primaire ou de reconstruction avec un objectif de bon résultat esthétique et fonctionnel. Nous présentons une analyse rétrospective de 150 patients souffrant de brûlures nasales traités dans notre centre entre Juillet 2005 et Juillet 2011. Nous avons codifié nos traitements chirurgicaux d'une manière simple et structurée. Les options reconstructives dépendent de l'intégrité des tissus faciaux de voisinage qui seront toujours préférés s'ils sont disponibles. Le transfert microchirurgical libre dépend de la condition physique du patient et de la disponibilité d'une zone donneuse. Les reconstructions nasales secondaires dépendent de l'évaluation des séquelles fonctionnelles et esthétiques. Les sténoses en rapport avec le tissu cicatriciel ou la perte de support sous jacent sont soumises aux principes de la chirurgie plastique et de la rhinoplastie .Les améliorations cosmétiques vont du dégraissage des lambeaux au transfert de tissu. Notre expérience avec ce groupe de patients nous a conduit à développer un algorithme de traitement simple pour la prise en charge des brûlures nasales.

Periorbital burns ­ a 6 year review of management and outcome.

INTRODUCTION: Periorbital burns are an infrequent but potentially devastating injury. This study aimed to elucidate the spectrum of such injuries presenting to a UK burns centre and the outcome achieved in the cases requiring periorbital reconstruction for the restoration of function and form. METHODS: Patients admitted to a UK regional burns centre between January 2005 and January 2011 with periorbital burns were identified from the Patient Administration System (PAS), theatre logs and the International Burns Injury database (IBID). Multiple parameters were assessed using patient notes, ITU and hospital image databases. RESULTS: Over 6 years, 167 patients with facial burns requiring surgery were treated, including 103 patients with eyelid burns. The mean burn size was 33% total body surface area. The eyelid burn depth varied; 67% superficial partial thickness, 17% deep dermal and 16% full thickness. Two patients lost complete vision in one eye, one patient underwent amniotic membrane grafting. In total 16 patients required periorbital reconstruction to maintain eye closure, with 1.8 operations on average per patient. Acute surgery was required in 11 patients, whilst late intervention (>3 months) was needed in 5, 2 patients had both acute and delayed surgery. Of the 5 late intervention patients 4 were treated with full thickness skin grafts and 1 with a Z plasty. Average time for final reconstruction with delayed surgery was 4.5 months. CONCLUSION: The goal in management of periorbital burns is preservation of vision, prevention of future complications and restoration of an acceptable aesthetic outcome. Total visual loss is thankfully rare, but early ophthalmology intervention is vital given the evidence of corneal damage as a brief therapeutic window exists.

Burn wound healing: James Ellsworth Laing memorial essay for 1991.

This essay has concentrated on the basic processes, clinical techniques involved in burn wound healing and how the two relate to each other. The achievement of early, sound, durable burn wound healing is one of the fundamental aims of burn care in order to minimize subsequent morbidity and mortality. It must be remembered that all patients with burns are individuals. There is no standard way to treat a burn and treatment must be tailored to suit the needs and requirements of both the patient and the burn wound. Burn wound healing is not the specific domain of any one specialist. It requires input from all disciplines and can be best achieved by the burn team approach.