An eighteen-year review of intensive care requirements for paediatric burns in a regional burns service.

INTRODUCTION: Advances in burns management have reduced mortality. Consequently, efficient resource management plays an increasingly important role in improving paediatric burns care. This study aims to assess the support requirements and outcomes of paediatric burns patients admitted to a burns centre intensive care unit in comparison to established benchmarks in burns care. METHOD: A retrospective review of burns patients under the age of 16 years old, admitted to a regional burns service intensive care unit between March 1998 and March 2016 was conducted. RESULTS: Our analysis included 234 patients, with the percentage of TBSA affected by burn injury ranging from 1.5% to 95.0%. The median (IQR) %TBSA was 20.0% (11.0-30.0), and the observed mortality rate was 2.6% (6/234). The median (IQR) length of stay was 0.7 days/%TBSA burn (0.4-1.2), 17.9% (41/229) required circulatory support and 2.6% (6/234) required renal replacement. Mortality correlated with smoke inhalation injury (P < 0.001), %TBSA burn (P = 0.049) and complications (P = 0.004) including infections (P = 0.013). CONCLUSIONS: Among children with burn injuries who require intensive care, the presence of inhalational injury and the diagnosis of infection are positively correlated with mortality. Understanding the requirements for organ support can facilitate a more effective allocation of resources within a burns service.

Experiences of frostbite injury from recreational use of nitrous oxide canisters in a UK burns center: Not a laughing matter.

Nitrous oxide is used as a recreational drug. Contact frostbite injury from compressed gas canisters has previously been described in the literature, but an increased number of such cases has been noted in our busy regional burns center in the UK. A single-center prospective case series of all patients referred and treated for frostbite injury secondary to misuse of nitrous oxide compressed gas canisters between January and December 2022 is presented. Data collection was performed through a referral database and patient case notes. Sixteen patients, of which 7 were male and 9 were female, satisfied the inclusion criteria. Mean patient age was 22.5 years. The median TBSA was 1%. In total, 50% of patients in the cohort had a delayed initial presentation to A&E of greater than 5 days. Eleven patients were reviewed at our burns center for further assessment and management. In total, 11 patients had bilateral inner thigh frostbite injuries, of which 8 had necrotic full-thickness injury, including subcutaneous fat. Seven patients were reviewed at our burns center and offered excision and split-thickness skin graft. Four patients presented with contact frostbite injury to the hand and one patient to the lower lip. This subgroup was managed successfully with conservative management alone. The reproducible pattern of frostbite injury secondary to the abuse of nitrous oxide compressed gas canisters is demonstrated in our case series. The distinct pattern of injury, patient cohort, and anatomical area affected presents an opportunity for targeted public health intervention in this group.

Microvascular free tissue transfer in acute and secondary burn reconstruction.

INTRODUCTION: The mainstay of operative treatment in burns is split skin grafting with free tissue transfer being indicated in a minority of cases. However, free tissue transfer faces a number of challenges in the burns patient. These include; overall cardiovascular and respiratory stability of the patient, availability of suitable vessels for anastomosis, sufficient debridement of devitalised tissue and a potentially increased risk of infection. We carried out a retrospective study in order to determine the indications, timing, principles of flap selection, complications, outcomes and methods of promoting flap survival when free tissue transfer was utilised for burn reconstruction in our unit. MATERIALS AND METHODS: All patients who underwent soft tissue reconstruction for burn injuries with microvascular free tissue transfer between May 2002 and September 2014 were identified from our burns database. The records of these patients were then retrospectively reviewed. Data extracted included, age, gender, type of injury, total body surface area involved, indications for free tissue transfer, anatomical location, timing of reconstruction, complications and flap survival. RESULTS: Out of a total of 8776 patients admitted for operative treatment over a 12-year period, 23 patients required 26 free flaps for reconstruction. Out of 26 free flaps, 23 were utilised for acute burn reconstruction while only 3 free flaps were utilised for secondary burn reconstruction. All 26 free flaps survived regardless of timing or burn injury mechanism. Complications included haematomas in 2 flaps and tip necrosis in 4 flaps. Two flaps required debridement and drainage of pus, 1 flap required redo of the venous anastomosis while 1 required redo of the arterial anastomosis with a vein graft. CONCLUSIONS: Free tissue transfer has a small but definite role within acute and secondary burn reconstruction surgery. Despite the complexity of the burn defects involved, free flaps appear to have a high success rate within this cohort of patients. This appears to be the case as long as the appropriate patient and flap is selected, care is taken to debride all devitalised tissue and due diligence paid to the vascular anastomosis by performing it away from the zone of injury.

A systematic review of the applications of free tissue transfer in burns.

INTRODUCTION: Free tissue transfer is a rarely indicated procedure in burns. However, in well selected cases it may play a pivotal role in optimizing outcomes in both primary and secondary burn reconstruction. We undertook a systematic review, based on the PRISMA statement for systematic reviews, of all published literature relating to the use of free flaps in acute burns and in secondary reconstructive procedures. METHODS: Inclusion and exclusion criteria were defined and Medline, Embase, PubMed and Google Scholar databases were searched from 1980 onwards to May 2013 with the search terms: "free flaps", "free tissue transfer", "microvascular", "burns", "acute burns", "primary reconstruction" and "secondary reconstruction". RESULTS: A total of 346 studies were retrieved following the search of which 30 studies met the inclusion criteria and were included in the review. DISCUSSION: We present the indications, timing, complications and failure rates for free flaps in primary and secondary reconstruction based on the available literature. We also provide a list of the various free flap options for the commonest sites undergoing reconstruction following burns. Finally an algorithm to ensure optimal success of free flaps when used in primary and in secondary burn reconstruction is presented.

Skin resurfacing in a circumferential full thickness burn to the penis: lessons learnt.

A circumferential full-thickness burn to the penis is a rarely encountered injury. However, when it does occur, it proves a management challenge to the plastic and burns surgeon in terms of reconstruction. This is due to the need of not only regaining adequate function of the organ, but also because of the need for a pleasing aesthetic outcome. Split-skin grafts have been utilised successfully to resurface full thickness burns of the penis and have given good results. Yet the success of split-skin grafts, especially those applied to an anatomically challenging region of the body such as the penis, depends on a number of carefully thought-out steps. We discuss the case of a circumferential full-thickness burn to the penis which was treated with split-skin grafting and highlight important pitfalls that the plastic and burns surgeon need to be aware of to ensure a successful outcome.

Multiple glomuvenous malformations presenting in a child: follow-up over a period of 8 years.

Multiple glomuvenous malformations (GVMs) are a rare condition which usually present in children with only a handful of cases reported in the literature. It is usually congenital and has an autosomal dominant inheritance pattern. They may be distributed throughout the body in either a localised, segmental or disseminated pattern. Pain, which is a characteristic feature of glomus tumours, is less often associated with GVMs. In addition, unlike glomus tumours which most commonly occur over acral skin surfaces, GVMs may occur throughout the body. A number of treatment options are available including surgical excision, laser treatments and sclerotherapy. We present the case of a 14-year-old boy with multiple GVMs which were treated with surgical excision and followed him up over a period of 8 years.

Burn injuries resulting from hot water bottle use: a retrospective review of cases presenting to a regional burns unit in the United kingdom.

Introduction. Hot water bottles are commonly used to relieve pain and for warmth during the colder months of the year. However, they pose a risk of serious burn injuries. The aim of this study is to retrospectively review all burn injuries caused by hot water bottles presenting to our regional burns unit. Methods. Patients with burns injuries resulting from hot water bottle use were identified from our burns database between the periods of January 2004 and March 2013 and their cases notes reviewed retrospectively. Results. Identified cases involved 39 children (aged 17 years or younger) and 46 adults (aged 18 years or older). The majority of burns were scald injuries. The mean %TBSA was 3.07% (SD ± 3.40). Seven patients (8.24%) required debridement and skin grafting while 3 (3.60%) required debridement and application of Biobrane. One patient (1.18%) required local flap reconstruction. Spontaneous rupture accounted for 48.20% of injuries while accidental spilling and contact accounted for 33% and 18.80% of injuries, respectively. The mean time to heal was 28.87 days (SD ± 21.60). Conclusions. This study highlights the typical distribution of hot water bottle burns and the high rate of spontaneous rupture of hot water bottles, which have the potential for significant burn injuries.