[Unexpected abdominal trauma from a fireworks explosion]. / Onverwacht buiktrauma bij een vuurwerkexplosie.

BACKGROUND: Fireworks injuries are common and often affect children. Such injuries should be considered high energy trauma in the emergency room and taken care of according to the principles of the Advanced Trauma Life Support (ATLS). CASE DESCRIPTION: A 7-year-old boy was a victim of an explosion when he set off illegal fireworks. During evaluation in the emergency department he presented with a superficial laceration on the belly and extensive hand injury. Upon examination he had small-intestinal perforation that required immediate resection. The patient recovered well, but suffered permanent damage to the hand. CONCLUSION: Potentially life threatening injuries may accompany hand injuries after modern illegal fireworks. Hand injuries are serious. Despite prolonged treatment, they often result in permanent disability. The structured approach to trauma according to ATLS was important in detecting an accompanying abdominal trauma in this case.

Dermal substitution in acute burns and reconstructive surgery: a subjective and objective long-term follow-up.

Tissue engineering and dermal substitution are currently prominent topics of wound-healing research. However, no extensive clinical trials with objective evaluation criteria have been published so far that support the clinical effectiveness of dermal equivalents in the long term. The dermal substitute that is discussed here is derived from bovine collagen and elastin-hydrolysate and has been shown to improve skin elasticity during a short-term clinical follow-up of scar reconstructions. In this study we will present the long-term outcome by means of objective and subjective scar assessment tools for dermal substitution in acute burn wounds and scar reconstructions. In a clinical trial, an intraindividual comparison was performed between the conventional split-thickness autograft and a combination of the collagen/elastin substitute with an autograft. After 1 year, scars were evaluated by the Cutometer SEM 474 for objective elasticity measurements and by planimetry to establish scar contraction. An independent observer subjected scars to a generally accepted clinical scar assessment tool: the Vancouver Scar Scale. In addition, patients gave their impression of the outcome. Forty-two paired burn wounds and 44 paired scar reconstructions were included and evaluated 1 year after surgery. Although substituted scar reconstructions demonstrated an elasticity improvement of approximately 20 percent compared with control wounds, no statistically significant differences were found for skin elasticity, scar contraction, Vancouver Scar Scale, and patient's impression in both categories after 1 year. An extensive long-term follow-up shows that the dermal substitute, which was proven effective in a clinical trial on a short-term basis, did not yield statistical evidence for a long-term clinical effectiveness of dermal substitution.

Graft survival and effectiveness of dermal substitution in burns and reconstructive surgery in a one-stage grafting model.

Survival of the autograft and objective parameters for scar elasticity were evaluated after dermal substitution for acute burns and reconstructive surgery. The dermal substitute, which was based on bovine type I collagen and elastin-hydrolysate, was evaluated by intraindividual comparison in a clinical trial. The substitute was applied in a one-step procedure in combination with a split-thickness autograft. This treatment was compared with the conventional treatment, the split-thickness antograft. After 1 week, the percentage of autograft survival was assessed. The Cutometer SEM 474 was used to obtain objective measurements of skin elasticity parameters 3 to 4 months postoperatively. Forty-two pairs of wounds (31 patients, age 32.9 +/- 19.3 years; burned surface area, 19.8 +/- 14.5 percent) were treated because of acute burns. Reconstructive surgery was performed on 44 pairs of wounds (31 patients, age 33.9 +/- 17.5 years). Autograft survival was not altered by the substitute for reconstructive wounds, although a slight but significant reduction (p = 0.015) was established in the burn category for substituted compared with nonsubstituted wounds. However, the necessity for regrafting was not increased by substitution. Cutometer measurements of reconstructive wounds with a dermal substitute demonstrated a significant increase of pliability (50 percent, p < 0.001), elasticity (defined as immediate extension, 33 percent, p = 0.04), maximal extension (33 percent, p = 0.002), and immediate retraction (31 percent, p = 0.01), as compared with nonsubstituted wounds. After burn surgery, no improvement was found for the different elasticity parameters. Dermal substitution in a one-stage grafting model seems feasible with respect to graft survival. Skin elasticity was considerably improved by the collagen/elastin dermal substitute after reconstructive surgery.

Correction of the post-burn malpositioned nipple-areola complex by transposition of two subcutaneous pedicled flaps.

Symmetrical anatomy of the chest wall is the aesthetic goal in any technique for nipple-areola complex positioning in post-burn patients. In 15 patients, a new surgical technique was applied by transposition of two subcutaneously pedicled flaps, one of which carries the malpositioned nipple-areola complex. The long-term results of this procedure were found to be satisfactory in all patients.

The use of allografts in the management of exposed calvarial electrical burn wounds of the skull.

Deep burns of the scalp and skull are often caused by high voltage electrical injuries. In an early stage, protection and preservation of the skull is important. Covering the wound with a full-circulatory skin flap or a myocutaneous free flap is a reasonable selection, but is not our first choice. In our experience, preliminary use of glycerol-preserved allograft wound dressing significantly improved the development of granulation tissue to perform an autograft at a later stage. With these allografts, there is a significantly shortened healing time compared with the results found in the literature.