A Blast and Burn Hand Injury Caused by an Exploding Vaping Device in a Pediatric Patient: A Case Report.

In this report, we present an injury to the hand caused by an exploding vaping device. This report summarizes the burn, blast and chemical injury, and discusses best practice for treatment. This case provides a warning to healthcare professionals and the public about the potential for and the seriousness of this injury. We hope to emphasize the rising incidence of vaping among children, the injuries that may occur, and the methods for treatment.

Iron contact burns and the path to the diagnosis of child abuse.

Burns are a common injury in both abused and non-abused children, and the accurate diagnosis of abusive burns is important to ensure protection. In the particular case of a three year old child with a second degree burn on her face and neck caused by an alleged contact with a hot iron, the correct analysis of the injury and the dynamics of what was reported as a domestic accident allowed the recognition of a different scenario and a diagnosis of child abuse due to the pressure of the flat part of the iron on the skin, thus uniformly involving the cheek and the upper part of the neck. The involvement of parts of the body placed on different anatomical planes (thus indicating pressure and not mere contact) should be considered as a further element of differential diagnosis. This demonstrates and underlines the importance of a thorough multidisciplinary assessment for this type of injury which is described as an accidental event but rarely as an outcome of child abuse.

Acute Burn Care.

LEARNING OBJECTIVES: After studying this article and viewing the videos, the participant should be able to: 1. Describe the current epidemiology of burn injuries. 2. Understand burn pathophysiology and perform a wound assessment. 3. Summarize the initial emergency management of a burn patient. 4. Calculate the anticipated fluid resuscitation requirements for a burn injury, and diagnose the complications of overresuscitation. 5. Describe the diagnosis and management of inhalation injury. 6. List the goals of wound care for superficial and deep burns, and describe the closed dressing technique. 7. Perform excision of a burn wound. 8. Compare various wound closure techniques using autografts and skin substitutes. SUMMARY: Plastic surgeons are essential members of the multidisciplinary burn team. Burn injuries remain common, and plastic surgeons have an opportunity to develop and innovate the field of acute burn care in light of workforce shortages. Burn pathophysiology is complex and dynamic, which informs the challenges encountered during the perioperative phase. Accurate burn wound assessment remains difficult, with implications for diagnosis and management. A systematic approach is required when stabilizing a major burn and/or inhalation injury with newly updated fluid resuscitation and triage guidelines. Wound care continues to evolve, with an emphasis on a closed dressing technique. For deeper burns, new surgical techniques are emerging for surgical débridement, along with improvements to traditional methods of tangential excision. Following excision, a number of established and novel techniques are available to close the wound with either autografts or skin substitutes.

Never events in plastic surgery: An analysis of surgical burns and medical malpractice litigation.

INTRODUCTION: Burns and fires in the operating room are a known risk and their prevention has contributed to many additional safety measures. Despite these safeguards, burn injuries contribute significantly to the medical malpractice landscape. The aim of the present study is to analyze malpractice litigation related to burn and fire injuries in plastic and reconstructive surgery, identify mechanisms of injury, and develop strategies for prevention. METHODS: The Westlaw and LexisNexis databases were queried for jury verdicts and settlements in malpractice lawsuits related to burn and fire injuries that occurred during plastic surgery procedures. The Boolean terms included "burn & injury & plastic", "fire & injury & "plastic surg!"" in Westlaw, and "burn & injury & "plastic surg!"", "fire & injury & "plastic surg!"" in LexisNexis. RESULTS: A total of 46 cases met the inclusion criteria for this study. Overheated surgical instruments and cautery devices were the most common mechanisms for litigation. Plastic surgeons were defendants in 40 (87%) cases. Of the included cases, 43% were ruled in favor of the defendant, while 33% were ruled in favor of the plaintiff. Mishandling of cautery devices 6 (13%), heated surgical instruments 6 (13%), and topical acids 2 (4%) were the most common types of errors encountered. CONCLUSION: Never events causing burn injury in plastic and reconstructive surgery are ultimately caused by human error or neglect. The misuse of overheated surgical instruments and cauterizing devices should be the focus for improving patient safety and reducing the risk of medical malpractice. Forcing functions and additional safeguards should be considered to minimize the risk of costly litigation and unnecessary severe harm to patients.

Cold burn injuries in the United Kingdom: retain-->A 5-year cohort study of patients presenting to a regional burn unit.

AIMS: To assess the aetiology, management and outcomes of cold burn injuries presenting to a regional burn unit in the United Kingdom. METHODS: Retrospective cohort study of consecutive patients over a 5-year period (2018-2022). RESULTS: Sixty-two patients (M:F 34:38; median age 23.5 years) were identified. The most common aetiology was aerosol (n = 28, 45.2%). Seven (11.5%) injuries were sustained during a social media or peer 'challenge' and 19 (31.2%) were self-harm, of whom 5 (26.3%) were inpatients on a mental health ward at the time of injury. All 'challenge' and self-harm injuries were caused by aerosol. Patients with 'challenge' injury were younger than those with self-harm (p = .007) and non-intentional injuries (p < .001). A greater proportion of self-harm injuries were in female patients compared with non-intentional injuries (p < .001). Median total body surface area (TBSA) was 0.35% (IQR: 0.3). Most burns were superficial partial thickness (n = 35, 56.5%), followed by deep dermal (n = 18, 29.0%), full-thickness (n = 8, 12.9%), and superficial (n = 1, 1.6%). The upper limb was most frequently affected (n = 35, 56.5%). Aetiology and a non-intentional, 'challenge' or self-harm injury did not affect TBSA (p = 0.776 and p = 0.364) or depth (p = 0.353 and p = 0.381). Five (8.1%) patients underwent autografting. The median time to healing was 17 days (range: 7-45, IQR: 22.75). Follow-up ranged from 1 to 173 weeks. CONCLUSIONS: The incidence of cold burns has increased when compared with previous literature. A disproportionate number of cold burns are self-inflicted using aerosols, either as self-harm or because of social media or peer 'challenges'. Other emerging aetiologies include non-intentional skin contact with nitrous oxide containers during its recreational use.

Suspected Burn From a 9-Voltage Battery.

Advancements in technology allow for the utilization of low-voltage battery-powered devices for patients admitted to the hospital. There have been rare cases of burns due to leakage of the internal contents from low-voltage batteries, but to date, there have been no reports of electrical burns caused by low-voltage batteries. We present the case of an 89-year-old female who presented to the general surgery service with a suspected electrical burn from laying on a 9-volt battery. The patient underwent operative debridement with no evidence of a deeper injury. The patient continues to follow up with an outpatient wound clinic and is healing well. This case highlights the importance of teaching and raising awareness of all small devices that may become entangled or lost in patients' linens, such as 9-volt telemetry batteries, to prevent harm.

Factors associated with thermal injury of abdominal skin in focused ultrasound ablation of uterine fibroids.

OBJECTIVE: To investigate the factors which may cause thermal injury of abdominal skin in patients with uterine fibroids (UFs) who underwent ultrasound-guided focused ultrasound ablation surgery (FUAS). METHOD: A total of 123 patients were enrolled in the injury group. In contrast, 246 patients without thermal injury were assigned to the non-injury group. The relationship between patient and treatment parameters and injury were explored using univariate analysis and multiple logistic regression analyses. In addition, the factors influencing the degree of thermal injury were analyzed using Kruskal-Wallis H. RESULTS: (1) Abdominal scars (p = .007, OR = 2.187, 95% CI: 1.242-3.849), abdominal wall thickness (p < .001, OR = 1.042, 95% CI: 1.019-1.067), fundus fibroids (p = .038, OR = 1.790, 95% CI: 1.033-3.100), UFs with hyperintense/mixed T2-weighted imaging (T2WI) signals (p = .022, OR = 1.843, 95% CI: 1.091-3.115), average sonication power (AP) (p = .025, OR = 1.021, 95% CI: 1.003-1.039), and treatment time (TT) (p < .001, OR = 1.017, 95% CI: 1.011-1.023) were independent risk factors for thermal injury, while treatment volume (TV) (p = .002, OR = 0.775, 95% CI: 0.661-0.909) was a protective factor for injury. (2) Four groups were subdivided according to the degree of thermal injury(Group A: without skin injury. Group B: with changed T2WI signal in the abdominal wall, Group C: mild skin injury, Group D: severe skin injury), comparison of each with every other showed that the abdominal wall in Groups A and D was thinner than Groups B and C, with statistically significant differences (PAB<0.05, PAC<0.01, PDC<0.05, PDB<0.05); Group A was slightly thicker than D, however, without statistical difference. The ratio of sonication time (ST) to TV in Group A was the lowest of all (PAB, PAC, PAD all < 0.05). And as the level of thermal injury rose, the ratio gradually increased, however, without statistical difference. CONCLUSIONS: Based on our limited results, the following conclusion was made. (1) Abdominal scars, abdominal wall thickness, fundus fibroids, UFs with T2WI hyperintense/mixed signals, AP and TT were independent risk factor. (2) Neither too thick nor too thin abdominal walls would be recommended, as both might increase the risk of skin injury. (3) Noticeably, the risk of skin injury might increase considerably when the ST was longer and the sonication area was more fixed.

Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries.

Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning. The mortality rate in LMICs is twice that of High-Income Countries (HICs) irrespective of injury severity adjustment. The reasons for inadequate care include lack of facilities, transportation problems, lack of prehospital care, lack of resources and trained manpower to handle pediatric trauma. To overcome these challenges, attention to protocolized care and treatment adaptation based on resource availability is critical. Training in management of trauma helps to reduce the mortality and morbidity in pediatric polytrauma cases. There is also a need for more collaborative research to develop preventative measures to childhood trauma.

The epidemiology of alcohol burns at a major burn centre in North China.

This study was designed to explore the epidemiological characteristics and potential preventive strategies of alcohol burns. In this five-year, retrospective study, 163 patients with alcohol burns (admitted from 1 January 2015 to 31 May 2020 were included. There was a male-to-female ratio of 1.1:1, a mean age of 34.1±16.8 years, and a mean burn size of 13.3±13.7% total body surface area (TBSA). The number of patients with alcohol burns was similar year by year during the five-year period. Just over half of patients (n=84, 51.5%) sustained a third-degree burn injury, which was significantly associated with a longer hospital stay and the need for surgery. The most prevalent aetiology was cupping (n=49, 29.5%), followed by cooking hotpot (n=37, 22.7%). Of the patients, seven (4.29%) sustained injuries during experiments at school and one patient sustained injury when using alcohol spray for disinfection against COVID-19. The incidence of facial burn injury (n=105, 64.4%) was significantly higher than previously reported data (33.2%). The result of the study showed that cupping and hotpot were the main causes of alcohol burns in Beijing, which should be taken into consideration for prevention. It is necessary to strengthen safety management of classes at school where experiments are undertaken and to educate the general public on the proper means of disinfecting against COVID-19.

Estimación de factores de riesgo del retardo en la cicatrización en pacientes quemados / Estimation of Risk Factors for Delayed Healing in Burn Patients

Introducción: La atención al paciente con retardo en la cicatrización parte de la optimización en sus cuidados. La reversión del cuadro requiere del conocimiento de los factores de riesgo. La literatura nacional e internacional describen factores locales o relacionados con la herida y generales o relacionados al estado general del paciente. Objetivo: Estimar los factores de riesgo del retardo en la cicatrización en pacientes quemados. Métodos: Estudio analítico de casos y control en pacientes quemados ingresados en el Servicio de Caumatología del Hospital Universitario Manuel Ascunce Domenech en el período 2017 a 2021. La población objeto de estudio comprendió a 267 pacientes. Se calculó el odds ratio y el intervalo de confianza. Resultados: El desarrollo de retardo en la cicatrización resultó tres veces y media más probable en pacientes quemados con 45 años y más, odds ratio 3,591. Además, fue nueve veces más probable en enfermedades crónicas asociadas, hasta seis veces en quemaduras no accidentales, 163 veces en la complicación local y 89 veces en la complicación sistémica. Conclusiones: Los factores de riesgo del retardo en la cicatrización en pacientes quemados identificados fueron los siguientes: edad de 45 años y más, presencia de comorbilidad, el fuego directo como agente causal, el modo de producción no accidental, la presencia de más de seis zonas anatómicas afectadas, la quemadura hipodérmica, la quemadura de 20 porciento de superficie corporal quemada y más de extensión, el apoyo de la lesión, el índice cubano de pronóstico con riesgo vital, la complicación local y la complicación sistémica(AU)

Introduction: The care for the patient with delayed healing starts from the optimization of their care. Reversing such condition requires knowledge of the risk factors. The national and international literature describes local factors related to the injury and general factors related to the patient's general condition. Objective: To estimate the risk factors for delayed healing in burn patients. Methods: An analytical case-control study was carried out with burn patients admitted to the caumatology service at Hospital Universitario Manuel Ascunce Domenech in the period from 2017 to 2021. The study population consisted of 267 patients. Odds ratio and confidence interval were calculated. Results: The development of delayed healing was three and a half times more likely in burn patients aged 45 years or over (odds ratio: 3.591). In addition, it was nine times more likely for associated chronic diseases, up to six times in nonaccidental burns, 163 times in local complications, and 89 times in systemic complications. Conclusions: The identified risk factors for delayed healing in burn patients were the following: age 45 years or over, presence of comorbidity, direct fire as causative agent, nonaccidental way of production, presence of more than six affected anatomical areas, hypodermic burn, burn extension of 20 percent or over on the burned body surface, injury contact pressure, the Cuban index of prognostic vital risk, as well as the local or the systemic complications(AU)

Research Progress of Photodynamic Therapy in Wound Healing: A Literature Review.

Light is an efficient technique that has a significant influence on contemporary medicine. Photodynamic therapy (PDT), which involves the combined action of photosensitizers (PSs), oxygen, and light, has emerged as a therapeutically promising method for treating a broad variety of solid tumors and infectious diseases. Photodynamic therapy is minimally invasive, has few side effects, lightens scars, and reduces tissue loss while preserving organ structure and function. In particular, PDT has a high healing potential for wounds (PDT stimulates wound healing by enhancing re-epithelialization, promoting angiogenesis as well as modulating skin homeostasis). Wound healing involves interactions between many different processes, including coagulation, inflammation, angiogenesis, cellular migration, and proliferation. Poor wound healing with diabetes or extensive burns remains a difficult challenge. This review emphasizes PDT as a potential research field and summarizes PDT's role in wound healing, including normal wounds, chronic wounds, and aging wounds.

Flammability of Ocular Surface Lubricants.

PURPOSE: Surgical fires pose a substantial risk to patients and can cause significant injury, especially in oculofacial surgery. Ocular surface lubricants can potentially act as fuel for an operating room fire. We present an experimental analysis of the flammability of 9 commonly used ophthalmic lubricants under 4 ignition sources used in oculofacial surgery with and without supplemental oxygen. METHODS: The flammability of 9 ophthalmic lubricants were tested under various operating room conditions. Each lubricant was exposed to 4 different ignition sources: an open flame lighter, monopolar cautery, bipolar cautery, and hand-held high temperature cautery, and the response of the lubricant was recorded. The testing was conducted both in room air and with 6 L/minute of 100% oxygen directed at the lubricant through a nasal cannula. Any reaction in which there was ignition, sparking, smoking, or a transient or permanent change in appearance of the lubricant was deemed notable. RESULTS: Of the 9 lubricants tested, 4 displayed a reaction to the ignition source. Without supplemental oxygen, 100% petrolatum and neomycin-polysporin-bacitracin-hydrocortisone ointment produced some smoke when applied with the high temperature cautery. Notably, under both the conditions of no supplemental oxygen and with the addition of 6 L/minute of 100% oxygen, the carboxymethylcellulose drops and lidocaine jelly both conducted and sparked with the monopolar cautery leaving visible burn marks on the paper. CONCLUSIONS: The overall fire hazard posed by ocular surface lubricants is low. Some topical lubricants can conduct electricity from monopolar cautery, which could increase the risk of inadvertent electrical burns. Certain lubricants could potentially become a fuel source when used in combination with hand-held high temperature battery cautery. Bipolar cautery was not associated with either increased conductivity or flammability with any of the lubricants tested.

Cement Burn of the Skin Following Total Knee Arthroplasty Case Report and Review of the Literature.

INTRODUCTION: Cement burns following arthroplasty pro-cedures are a rare but serious complication. To the authors' knowledge, this report is the first of its kind in total knee arthroplasty. CASE: A 61-year-old female underwent an otherwise rou-tine left total knee arthroplasty. On postoperative day one, a 3 cm by 3 cm cement burn was noted on the distal aspect of the popliteal fossa of the operative leg. The burn was noted to be a full-thickness (third degree) burn that required plastic surgery burn service management and limited the patient's postoperative recovery and function. CONCLUSIONS: Cement burns of the skin following total joint arthroplasty are rare, though when they do occur, they can cause significant pain and distress. Recognizing the depth of the skin involvement is important to determine the burn classification, treatment, and ultimately the prognosis to optimize outcomes.

Assaults by Scalding in British Prisons.

We describe the trends and severity of deliberate scald injuries from assaults within prisons presenting to Pinderfields Hospital in the United Kingdom. Data were obtained using local records of the International Burn Injury Database. Between 2003 and 2019, the hospital's Department of Plastic Surgery and Burns treated 22 cases from at least seven prisons, with 20 cases occurring in the last 4 years. Boiling water was used in most cases. Other substances included syrups of boiling water and sugar, and hot fat. Mean total body surface area was 2.8%, most commonly the face, neck, shoulders, and anterior chest. National data identified 267 cases with a similar rising trend. These injuries increase logistical and financial burdens on our burns service due to the need for added security and police escorts during treatment. "Copycat attacks" within same prisons, sometime on the same day, raise concerns that incidence of these injuries is likely to increase. Outreach nursing and telemedicine facilities may minimize the challenges during the management period.

A Systematic Review of Pediatric Nonaccidental Burns: Protecting the Children Through Knowledge, Vigilance, and Prevention.

BACKGROUND: Inflicted burns on children are a particularly difficult medical and psychosocial issue. Pediatric nonaccidental burns (PNABs) are unfortunately relatively common. In our study, we aim to present the key findings on PNABs with the intention of raising awareness, improving early, and recognizing accurately by identifying red flags, developing triage tools, and establishing prevention strategies for this sensitive issue. METHODS: A computerized literature search was conducted on PubMed, Google Scholar, and Cochrane for articles published until November 2020. The online screening process was performed by 3 independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS: A total of 12 studies were included for analysis. Scald burns via forced immersion accounted for the majority of reported PNABs affecting both feet and hands. Complications included wound infection, sepsis, requiring systemic antibiotics, or intensive care. Abused children's parents had a history of mental illness, unemployment, substance abuse, incarceration, and/or low annual income. CONCLUSIONS: Scalds via forced immersion remain the most common mechanism of PNABs. All health care professionals must remain vigilant, be able to recognize subtle signs of abuse, triage patients appropriately, report to police and/or social services, and ensure no further harm is made to the child or children. Repeated abuse with burns can lead to death. Prevention and education are the cornerstones for addressing this social phenomenon.

Effect of Bone Cement Thickness on the Risk of Scalded Skin in Joint Surgery.

OBJECTIVE: Bone cement releases a large amount of heat as it polymerizes. Skin burns caused by discarded bone cement are not well understood during arthroplasty. It is important to study the correlates and mechanisms of scalding and to accurately evaluate the severity of burns to guide treatment decisions. METHODS: Standardized burns were created in eight anesthetized rabbits using different thicknesses of bone cement. Bone cement was uniformly stirred to make thicknesses of 1 mm, 4 mm, 8 mm, 12 mm, 16 mm, and 20 mm and a 20 × 40 mm cuboid. Bone cement samples were then placed on the back of a rabbit, and the temperature changes were recorded with an industrial digital thermometer. One hour later, the appearance of scalded skin was observed, and the rabbits were euthanized. The scalded parts were cut to make pathological sections and stained with HE, and the differences in the depth of the scalded skin caused by different thicknesses of bone cement were observed under a light microscope. RESULTS: Damage caused by 1 mm-, 4 mm-, 8 mm-, 12 mm-, 16 mm-, and 20 mm-thick bone cement samples mainly involved the epidermis, the papillary dermis, the reticular dermis layer, and the full thickness of the skin and the subcutaneous tissue. The maximum temperature of 1 mm, 4 mm, 8 mm, and 12 mm bone cementation had a statistically significant difference (p < 0.001), while there was no significant difference between 12 mm, 16 mm, and 20 mm samples (p = 0.856). The time to severe scalding with bone cement at temperatures above 70°C was significantly different between different thicknesses (p < 0.001). CONCLUSION: The heat released by different thicknesses of bone cement leads to different maximum temperatures and the duration of severe burns, resulting in different degrees of skin burns. Attention should be paid to discarded bone cement to prevent this potential complication in knee arthroplasty.

Sauna contact burns in adults in the Helsinki Burn Centre during 2006-2018.

INTRODUCTION: Within Finish culture is a strong tradition of sauna bathing. This special environment predisposes the persons refreshing in the sauna to different kind of burns with varying etiologies. Despite the high prevalence of sauna related burns in Finland, there is paucity on the sauna related burns literature. METHODS: In this 13-year retrospective study, all sauna-related contact burns in the adult population treated at the Helsinki Burn Centre were analyzed. Altogether 216 patients were included in this study. RESULTS: The incidence of sauna-related contact burns was significantly higher in males; they accounted for 71.8% of patients. In addition to male gender, another risk factor was high age, with the elderly also being more prone to have a longer length of stay in hospital and more often receiving operative treatment. Despite most burns being relatively small, they were deep and more than one-third (36.6%) of patients underwent surgery. A strong seasonal variation in the injuries was recorded; over 40% of the burns took place during the summer months. CONCLUSION: Sauna contact burns are common, and despite their small size, they frequently cause deep injuries indicating operative treatment. There is a clear male predominance in the patient population. Most probably the cultural aspects of sauna bathing at summer cottages explain the strong seasonal variation in the incidence of these burns. The long latency between initial injury and presentation at the Helsinki Burn Centre should be highlighted to health care centres and central hospitals.

Oral and Maxillofacial Injuries Associated With E-Cigarette Explosions: A Systematic Review and Management Guidelines Proposal.

PURPOSE: E-cigarettes have become increasingly popular devices used to consume nicotine in recent years. There is a growing body of evidence regarding the risk of spontaneous explosion of these devices causing burn and projectile injuries. The primary purpose of this review was to summarize all injuries to the oral and maxillofacial region secondary to explosion of e-cigarettes. The secondary purpose was to propose an initial management algorithm for such injuries based on the findings in the literature. This review also aims to test the hypothesis that e-cigarette explosive injuries to the oral region were associated with an increased risk of intubation and surgery and examine whether any other injury pattern was associated with an increased risk of intubation or surgery. METHODS: A cohort study based on identifying cases in the literature was conducted to summarize injuries to the oral and maxillofacial region and examine the associations between injury types and location and management. A literature search of the major biomedical databases was conducted in September 2022 using terms such as e-cigarette, explosion, blast, trauma, and burn, among others, which yielded 922 studies. Nonclinical studies, review articles, and studies without injuries to the facial region were excluded. Study subjects were recorded for demographics, device characteristics, injury mechanism, injury location, management, and complications. Chi-squared analysis was used to determine if the predictor variables of type of injury (burn or projectile) and its associated location (ocular, facial, or intraoral for burns and facial thirds for projectile) were associated with the outcomes of intubation and surgical management. The collected data were then used as a guide to propose an initial management algorithm for these injuries. RESULTS: Twenty eight studies, including 20 case reports and 8 case series met the inclusion criteria. A total of 32 explosions of e-cigarettes to 32 patients caused 105 recorded injuries to the facial region. Projectile injuries made up 73.3% (n = 77) of all facial injuries, while burn injuries made up of 26.7% (n = 28). There were 14 (43.8%) patients who suffered both projectile and burn injuries. Burn injuries mostly involved the face (64.3%, n = 18), oral cavity (25%, n = 7), and eye (10.7%, n = 7). The majority (81.8%, n = 63) of projectile injuries occurred in the lower facial third. There were 20 (62.5%) patients who suffered a bone or tooth fracture. Management of injuries involved surgery in 62.5% (n = 20) of patients, which included open reduction and internal fixation of fractures, dental extraction, bone and skin grafts, and ocular surgery. A complication rate of 44.4% (n = 8) was observed across studies that reported on follow-up. There was no statistically significant association between explosive injury to the oral region and intubation or surgical management. There was also no other statistically significant association between any other injury type and location with intubation or surgical management. CONCLUSIONS: E-cigarettes are at risk for spontaneous combustion that can cause serious oral and maxillofacial injuries, particularly to the lower facial third and commonly requiring surgical management. Safety of these devices should be improved through increased user education and regulation.

Burn Injury From Smoking Electronic Cigarettes While on Supplemental Oxygen.

Many reports pertaining to burns from e-cigarette battery explosions exist, as do injuries from smoking conventional cigarettes while on home-oxygen therapy. However, literature regarding burn injuries from e-cigarettes while on oxygen therapy is limited. The heating coil of the device can rise to temperatures that facilitates ignition of oxygen. The purpose of this study is to describe and characterize this novel and under-reported mechanism of injury. This study was a descriptive review of 2013-2016 National Burn Repository (NBR) data, with a query for "oxygen," "O2," "electronic cigarettes," and various permutations/abbreviations/misspellings. Demographics, injury characteristics, and outcomes were reported. Also, a Google search for lay-press articles and a PubMed/Scopus search using similar terms was conducted to find literature. Of approximately 60,000 NBR entries, 8 records of injury while smoking e-cigarettes on oxygen were found. Patients were predominantly male, 63 ± 9 years old, with 3.4% ± 4 TBSA burns, and LOS of 5.8 ± 7 days (an LOS O/E ratio of 1.5). Two patients sustained full-thickness burns (0.5% and 11% TBSA). Three were intubated, with mean of 3.33 ventilator-days. Most injuries occurred at home (88%). All patients survived. A google search revealed five lay-press articles. Only three partially relevant scientific articles were found to only mention the phenomenon, without granular data. Although uncommon, smoking e-cigarettes on supplemental oxygen can result in injury without a lithium-ion battery explosion. Limitations in the database may have resulted in underestimation of injuries. A paucity of relevant literature exists, necessitating more research. Patients who receive home-O2 should be warned about this potential danger.