[The role of skin substitutes in the surgical treatment of extensive burns covering more than 60 % of total body surface area. A review of patients over a 10-year period at the Tours University Hospital]. / Place des substituts cutanés dans le traitement chirurgical des grands brûlés sur plus de 60 % de la Surface corporelle. Revue de patients sur 11ans dans le centre des brûlés adultes du CHRU de Tours.

INTRODUCTION: Progress in intensive care and surgery has made it possible to significantly improve the survival of victims with burns over 60% of total body surface area (TBSA). Coverage of the excised areas of these patients can be difficult when there is a shortage of skin donor sites; then the role of skin substitutes can be important. MATERIALS AND METHODS: This retrospective study included patients with burns covering more than 60% TBSA and treated at the Tours University Hospital over a period of 10 years. Patients who died during the first week or who presented superficial burns were excluded. The various substitutions means to temporarily or permanently replace the cutaneous barrier are presented. The biological dressings associated with grafts expanded by six according to the sandwich technique, allografts and xenografts, widely expanded postage stamp skin grafts using a modified Meek technique (Humeca(®)), temporary cutaneous substitutes such as Biobrane(®) and skin substitutes colonized by autologous cells (Integra(®)) are presented. RESULTS: Forty-four patients were admitted. Self-immolations represented 52% of the cases. Twenty-one patients were treated with Integra(®), 5 with Biobrane(®), 17 with sandwich grafts and 4 with postage stamp skin grafts. Integra(®) was widely used when donor sites were insufficient. The mean number of surgical procedures per patient was 8.4. The mean duration of hospitalization was 155 days. Twenty-four patients survived until the end of treatment. Eighteen patients died during the first week before any surgery could be performed. Two patients died at the end of treatment. The overall survival rate was 55%. It was 92% for patients who survived the first week. The principal sequel were functional (hand, cervical, thoracic and axillary contractures) and aesthetic (face and hands). Associated treatments were pressotherapy, physical therapy, ergotherapy and thermal water therapy. CONCLUSION: By temporarily replacing the cutaneous barrier in the absence of sufficient donor sites, skin substitutes make it possible to increase the survival of patients with very extensive burns and to optimize their treatment.

[Electrical flash burns, about 33 cases. A 10-year retrospective study. Epidemiology, treatment and prevention]. / Brûlures par flash électrique, à propos de 33 cas. Une étude rétrospective sur 10ans. Épidémiologie, traitement et prévention.

BACKGROUND: The electric flash burns are a common cause of accident at workplace, especially among electricians. The aim of this study is to determine the parts of the body most often burned by the flash, to define the usual course and finally to give some simple rules of care and prevention. MATERIALS AND METHODS: This is a retrospective, observational and descriptive study including all patients treated at the University Hospital of Tours for electrical flash burns between 1 January 2003 and 01 January 2013. A collection of medical and socio-economic data was achieved. We present 3 cases of patients hospitalized in our department. RESULTS: Thirty-three patients were included. In our series, all hospitalized patients were men. The average age was 43.2years (range 18 to 82years). In 81% of cases, the burn was due to a low voltage source, in 19% of cases to a high voltage source. It was an accident at workplace for 71% of patients, of whom 67% were electricians. The average total burned area was 9,52% (from 1.5% to 24%). The main locations included the face (86%), upper limbs (86%) and hands (86%). Medical treatment has healed 95% of patients. A surgical procedure was required in 5% of cases. A post-traumatic stress was found in 41% of patients. Outpatient treatment was performed in 36% of cases. CONCLUSION: Flash burns remain a common cause of hospitalization. Screening for hearing and eye disorders, a post-traumatic stress, as well as the prescription of early physiotherapy for burned hands are important components of their management. Following simple rules of prevention would limit their morbidity.