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1.
J Surg Res ; 245: 45-50, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31401246

RESUMEN

BACKGROUND: Dermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors to develop a preventive algorithm. METHODS: An 18-question survey was sent to all US and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results. RESULTS: Fifty-six responses (42% response rate) were received from the burn unit directors. They reported an estimated 133 lacerations over the past 5 y. The overall incidence of dermatome-induced lacerations was approximately 0.1% per year (1.3 per 1000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010- to 0.015-inch thickness (78.4%), and 30°-45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech or nurse (48.6%), whereas the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%). CONCLUSIONS: Our study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes.


Asunto(s)
Quemaduras/cirugía , Laceraciones/epidemiología , Complicaciones Posoperatorias/epidemiología , Recolección de Tejidos y Órganos/instrumentación , Sitio Donante de Trasplante/patología , Unidades de Quemados/estadística & datos numéricos , Canadá/epidemiología , Estudios Transversales , Humanos , Incidencia , Laceraciones/etiología , Laceraciones/patología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Medición de Riesgo , Factores de Riesgo , Trasplante de Piel/efectos adversos , Trasplante de Piel/instrumentación , Trasplante de Piel/métodos , Encuestas y Cuestionarios/estadística & datos numéricos , Recolección de Tejidos y Órganos/efectos adversos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/instrumentación , Trasplante Autólogo/métodos , Estados Unidos/epidemiología , Cicatrización de Heridas
2.
Rev. bras. cir. plást ; 34(4): 504-508, oct.-dec. 2019. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047913

RESUMEN

Introdução: Lesões geradas por queimaduras representam um importante problema de saúde pública, constituindo a quarta causa de morte na infância no Brasil e Estados Unidos. Além disso, poucas são as doenças que trazem prejuízos tão importantes, com considerável morbidade pelo desenvolvimento de sequelas físicas e psicossociais. Diante disso, o objetivo deste estudo é traçar o perfil epidemiológico de crianças de 0-18 anos atendidas em um hospital escola de Curitiba, Paraná. Métodos: Estudo transversal e retrospectivo realizado através da análise de 625 prontuários de internação de crianças de 0-18 anos vítimas de queimaduras, entre janeiro de 2010 a dezembro de 2017. Foram coletadas informações sobre idade, sexo, tempo de internação, óbito, região corporal atingida, extensão da superfície corporal, grau de profundidade, agente etiológico e abordagem terapêutica. Resultados: A maior parte da amostra era composta por lactentes (43%), com média de idade de 12,6 anos. O sexo mais afetado foi o masculino e os pacientes permaneceram cerca de 14,5 dias internados. No estudo, 98% das queimaduras apresentaram como etiologia o agente térmico, principalmente por líquido quente. Em relação ao grau de profundidade, a maioria das queimaduras foram de 2º grau (61,3%), atingindo até 25% de superfície corporal queimada (SCQ), sendo o tronco o mais afetado. Dentre as modalidades de tratamento, 44% dos pacientes necessitaram de intervenção cirúrgica com debridamento e enxertia. Conclusão: Crianças mais novas são mais propensas a sofrerem queimaduras principalmente no ambiente domiciliar e, além disso, uma equipe preparada e capacitada é de crucial importância no prognóstico destes doentes.


Introduction: Injuries caused by burns represent a significant public health problem, constituting the fourth leading cause of childhood death in Brazil and the United States. In addition, few diseases carry such substantial losses as burns, with considerable morbidity due to the development of physical and psychosocial sequelae. This study aimed to outline the epidemiological profile of 0­18-year-old children treated for burns at a teaching hospital in Curitiba, Paraná. Methods: This cross-sectional, retrospective study involved analysis of 625 medical records of 0­18-year-old children who were victims of burns from January 2010 to December 2017. Information was collected on age, sex, length of hospitalization, death, body region affected, burned body surface area (BSA), depth, etiologic agent, and therapeutic approach. Results: A plurality of the sample were infants (43%), and the average age of the sample was 12.6 years. Most of the sample was comprised males, and the patients remained hospitalized for an average of 14.5 days. Of the burns, 98% were caused by thermal agents, particularly hot liquids. Most burns were second-degree burns (61.3%), reaching up to 25% of the BSA, and the most affected region was the trunk. Among the treatment modalities, 44% of the patients needed surgical intervention with debridement and grafting. Conclusion: Younger children are more prone to burns, especially in the home environment. A prepared and qualified team is of crucial importance for optimizing outcomes in these patients.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Historia del Siglo XXI , Cirugía Plástica , Perfil de Salud , Quemaduras , Traumatismo Múltiple , Encuestas Epidemiológicas , Cirugía Plástica/métodos , Cirugía Plástica/estadística & datos numéricos , Quemaduras/cirugía , Quemaduras/terapia , Traumatismo Múltiple/cirugía , Traumatismo Múltiple/terapia , Encuestas Epidemiológicas/métodos , Encuestas Epidemiológicas/estadística & datos numéricos
3.
Zhonghua Shao Shang Za Zhi ; 35(11): 769-771, 2019 Nov 20.
Artículo en Chino | MEDLINE | ID: mdl-31775463

RESUMEN

At the beginning of 2009, the 38th principle of the Administrative Measures for Clinical Application of Medical Technology, issued by the former Ministry of Health, clearly pointed out that medical institutions should establish a hierarchical management system for surgery. Then the Trial of Administrative Measures for Surgical Classification of Medical Institutions was published and implemented in 2012, but the official introduction of surgical classification catalogue in the national level has not been seen. Therefore, the writing group of this expert consensus has organized numerous well-known experts and scholars in China, taking the three elements of the 38th principle of the Administrative Measures for Clinical Application of Medical Technology issued by the Ministry of Health--risk coefficient, complexity, and technical difficulty as the basic norm to grade scientifically through the four indicators of burn index, surgical area, surgical repair method, and anesthesia risk (each indicator with 4 grades and scores). The total score is then accumulated to divide four grades of operations. The Expert Consensus on Classification Evaluation Methods of Burn Surgery in China (2019 Version) is strategized together expecting to provide academic reference for the government departments to issue or further improve and perfect surgical classification catalogue in the national level as soon as possible, and lay a foundation for the stable development of burn discipline with the significance of national strategic reserve.


Asunto(s)
Quemaduras/cirugía , Guías de Práctica Clínica como Asunto/normas , China , Consenso , Humanos
4.
Zhonghua Shao Shang Za Zhi ; 35(11): 811-813, 2019 Nov 20.
Artículo en Chino | MEDLINE | ID: mdl-31775470

RESUMEN

Objective: To explore the effect of tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall in emergency treatment of laryngeal edema in patients with burns. Methods: From November 2000 to August 2018, 22 patients with severe burn or extremely severe burn combined with acute laryngeal edema were rescued in the author's unit, including 18 males and 4 females, aged 17 to 68 years. All patients were complicated with mild inhalation injury or above and more than deep partial-thickness burn to head, face, and neck. From November 2000 to October 2012, simple emergency tracheotomy was performed for 12 cases. From May 2013 to August 2018, tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall was performed for 10 cases. Rescue effect and complication of the two kinds of tracheotomy were recorded. Data were processed with Fisher's exact probability test. Results: Among the 12 patients treated with simple emergency tracheotomy, 5 cases survived and 7 cases died of suffocation during tracheotomy. Among the 10 patients treated with tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall, 9 cases survived and 1 case died of cardiac arrest caused by arrhythmia. There was statistically significant difference in successful rescue effect between the two kinds of tracheotomy (P<0.05). Among the 14 patients who were successfully rescued, symptoms of insomnia and post-traumatic stress disorder occurred in 12 cases, which were relieved after symptomatic treatment for 14 to 45 d without permanent hypoxic brain damage. Conclusions: In case of loss of the condition of preventive tracheotomy, first aid of acute laryngeal edema of burn patient is very difficult. Tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall is simple and rapid with high successful rate and amelioration of hypoxia, which is an ideal plan for laryngeal edema.


Asunto(s)
Obstrucción de las Vías Aéreas , Quemaduras/cirugía , Tratamiento de Urgencia , Edema Laríngeo/cirugía , Traqueotomía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Punciones , Adulto Joven
5.
Zhonghua Shao Shang Za Zhi ; 35(9): 661-667, 2019 Sep 20.
Artículo en Chino | MEDLINE | ID: mdl-31594184

RESUMEN

Objective: To explore the clinical effects and key techniques of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face. Methods: From January 2008 to November 2018, 22 patients with extensive burn scars in the face were admitted to the Department of Plastic Surgery of Dongguan Kanghua Hospital and the Department of Plastic Surgery of Dermatology Hospital of Southern Medical University, with 3 males and 19 females, aged from 4 to 48 years. There were 16 cases of type Ⅱ and 6 cases of type Ⅲ in facial scars. Before the first stage of expansion surgery, Doppler blood flow survey meter or multi-slice CT was used to locate the perforator vessels. One to four expanders with rated capacity ranged from 100 to 600 mL were placed in the patients. We gave 20% to 30% of the rated capacity of expander intro-operation and common injection with 10% to 15% of the rated capacity of expander per week post-operation until the volume reached 1.5 to 2.5 times of the rated capacity of expander during the past 3 to 4 months. At the second stage of surgery, the perforators were located again before surgery with the same method. The size of defects after the excision of facial scars ranged from 6 cm×4 cm to 18 cm×16 cm. With perforators used as nutrient vessels, narrow pedicle flaps or random flaps ranging from 6 cm×6 cm to 22 cm×18 cm were elevated as rotating or advancing to reconstruct the defects. The donor sites were sutured directly. Some of the flaps needed stage Ⅲ operation for cutting the pedicle. The survival of flaps, post-operation complications, and follow-up were assessed. Results: All flaps of 22 patients survived. All the donor sites were closed simultaneously. One patient underwent an additional surgery for 5 cm×4 cm necrosis on distal part of flap caused by subcutaneous hematoma. Two patients with epidermis blister on the flaps were healed by themselves after dressing change. Due to rapid expansion, blood capillary proliferation appeared on the central part of the flap in 3 cases, after slowing down the expansion speed properly, which had no impact on flap transfer. No ischemia or venous congestion phenomenon were observed in the other flaps. During follow-up of 5 to 48 months, the flaps of patients showed no significant bloated appearance, with good complexion and texture, and even could reproduce facial fine-grained expressions naturally. Conclusions: For the reconstruction of extensive burn scars in the face, expanded super-thin perforator flaps can not only acquire large and thin flaps with high matching degree surface skin defect, but also reproduce facial fine-grained expressions. It is a simple and safe method which conforms to the facial aesthetic standard.


Asunto(s)
Quemaduras/cirugía , Cicatriz/cirugía , Traumatismos Faciales/cirugía , Colgajo Perforante/trasplante , Procedimientos Quirúrgicos Reconstructivos , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuello , Hombro , Trasplante de Piel , Tórax , Adulto Joven
6.
Handchir Mikrochir Plast Chir ; 51(5): 347-355, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31574547

RESUMEN

Hand function is crucial for everyday and professional life. Even small burns can have a great impact on hand function, either from the injury itself or from scar contractions. Preservation and restoration of hand function are essential for mental and physical well-being of burn survivors. Reduced hand function can lead to social isolation and occupational invalidity. Even though one hand represents only 3 % of the total body surface area, hand burns are categorized as severe burn injuries and are a primary indication for treatment in a dedicated burn center. Hands are involved in more than 80 % of all severe burn injuries, making them the most affected body part. Independent of the severity of the overall burn, hand injuries need to be treated with highest priority.Novel approaches in acute and long-term care of burned hands should aim for long-term improvement in functional and aesthetic outcomes. All burn patients with hand involvement should be able to be reintegrated into society, perform activities of everyday life and return to their profession. The purpose of this review is to highlight recent advancements in research of the burned hand and to identify areas in which further research is needed. We summarized all relevant and recent original and review articles on hand burns; including acute treatment, aftercare, reconstruction, injuries due to E-cigarettes and methods for assessment of hand function. These findings were put into context of established methods in order to provide an outlook on possible future innovations.


Asunto(s)
Quemaduras , Traumatismos de la Mano , Quemaduras/cirugía , Cicatriz , Sistemas Electrónicos de Liberación de Nicotina , Traumatismos de la Mano/cirugía , Humanos , Traumatismos de la Muñeca
7.
Handchir Mikrochir Plast Chir ; 51(5): 356-361, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31574548

RESUMEN

A consistently high proportion of thermal injuries in children are to the hand, and scalds and contact burns are the main causes. While most thermal Injuries to the hand in children can be treated conservatively, deep burns can result in scary contractures and syndactylies that cause functional impairments to the hand. Therefore, thermal injuries to the hand in children should be treated in a specialised centre, thus ensuring a differentiated approach with respect to the localisation and extent of the thermal injury.Besides acute therapy, regular follow-up consultations - including splint and compression treatments -, physiotherapy, ergotherapy and, if necessary, corrective surgical measures are of immense importance. Only adherence to this treatment regime can guarantee optimal functional and aesthetic results and minimise daily restrictions for the young patients. The purpose of this article is to illustrate/outline the essential aspects of this treatment of thermal injuries to the infantile hand.


Asunto(s)
Quemaduras , Traumatismos de la Mano , Traumatismos de la Muñeca , Quemaduras/cirugía , Preescolar , Contractura/cirugía , Femenino , Traumatismos de la Mano/cirugía , Humanos , Lactante , Masculino , Modalidades de Fisioterapia , Procedimientos Quirúrgicos Reconstructivos/métodos , Férulas (Fijadores) , Colgajos Quirúrgicos , Cicatrización de Heridas
8.
Handchir Mikrochir Plast Chir ; 51(5): 362-366, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31574550

RESUMEN

The depth assessment of thermal wounds is subject to many variables. Therefore, technical systems are increasingly being used to determine severity. Particularly hand burns can have clinically relevant consequences in terms of function and aesthetic appearance. Hence, a secure assessment for an adequate treatment is necessary.Technical analyzes such as Hyperspectral Imaging, Laser-Doppler-Imaging or Laser-Speckle-Imaging are intended to simplify and objectify the examination by helping to determine the necessary depth of necrectomy and thus to define the skin transplantation area. Furthermore, the diverse technical devices are to improve the functional result, reduce the severity of scarring and cosmetic complaints, and facilitate the evaluation of inexperienced personnel in the field of burn medicine.Therefore, various technical approaches have been pursued, which are largely based on optical principles. The respective devices are not yet used in the standard diagnosis of burn wounds.In future studies it will be necessary to determine an algorithm for the measurement intervals based on the wound dynamics and to evaluate which methodology is superior to the specificity and sensitivity.


Asunto(s)
Quemaduras , Quemaduras/diagnóstico por imagen , Quemaduras/patología , Quemaduras/cirugía , Cicatriz , Humanos , Flujometría por Láser-Doppler , Piel/diagnóstico por imagen , Trasplante de Piel
9.
Handchir Mikrochir Plast Chir ; 51(5): 367-371, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31574551

RESUMEN

Burn injuries of the hands happens very often. Up to 80 % of all severe burn victims suffer from a participation of their hands. A meticulous reconstruction of these areas is mandatory due to their important properties in form, function and aesthetic outcome. The treatment options actually are impressed by the efforts to reduce invasiveness, to increase the selectivity of necrectomy as well as the natural capacity of tissue regeneration.


Asunto(s)
Quemaduras , Traumatismos de la Mano , Cicatrización de Heridas/fisiología , Quemaduras/cirugía , Estética , Mano , Traumatismos de la Mano/cirugía , Humanos
10.
Handchir Mikrochir Plast Chir ; 51(5): 377-383, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31574552

RESUMEN

Reconstruction of the burned hand requires detailed knowledge and surgical skills to develop a therapeutic concept for optimal functional outcomes through predictive planning. The key to success is to use a broad spectrum of plastic surgery and hand surgery techniques, individually applied to the patient's situation.In this overview article, we describe basic principles, timing of reconstruction, classification of deformities, and the corresponding techniques for surgical correction.


Asunto(s)
Quemaduras , Traumatismos de la Mano , Procedimientos Quirúrgicos Reconstructivos , Traumatismos de la Muñeca , Quemaduras/cirugía , Traumatismos de la Mano/cirugía , Humanos , Cirugía Plástica , Traumatismos de la Muñeca/cirugía
11.
Zhonghua Shao Shang Za Zhi ; 35(8): 561-564, 2019 Aug 20.
Artículo en Chino | MEDLINE | ID: mdl-31474033

RESUMEN

Under the vigorous support of the Chinese Burn Association, MEEK skin-grafting technique has accumulated abundant experiences during widespread clinical application in burn surgery in a long term, since its import into China over a decade ago. Recently, it has been widely and successfully used in many big rescues of burn casualties. In order to obtain more better gasp on MEEK skin-grafting technique and play its advantage, MEEK Micro-skin Transplantation Technology Collaboration Group of Chinese Burn Association organized domestic experts to complie clinical operation procedure of grafting technique of MEEK micro-skin, including indication, preoperative preparation, operating procedure, postoperative care, and points for attention, for getting more standard application of this technology and better therapeutic outcome.


Asunto(s)
Quemaduras/cirugía , Trasplante de Piel/métodos , China , Humanos , Cuidados Posoperatorios , Piel
12.
Zhonghua Shao Shang Za Zhi ; 35(8): 608-610, 2019 Aug 20.
Artículo en Chino | MEDLINE | ID: mdl-31474042

RESUMEN

Objective: To explore the clinical effects of artificial dermis combined with vacuum sealing drainage (VSD) and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn. Methods: A total of 8 patients with scar hyperplasia and contracture deformity on joint after healing of extensive burn were admitted to our hospital from August 2015 to August 2017. There were 5 females and 3 males aged 8 to 45 years with an average of 23 years. In the first stage operation, scar tissue on contracture site was removed, and the wound was covered by artificial dermis followed by continued VSD treatment. On 10-14 d after the first stage operation, the artificial dermis tissue formed, and the second stage autologous split-thickness skin grafting and continued VSD treatment were performed. Routine anti-scar therapy was carried out after healing of wounds. Time of wound healing after the second stage operation was recorded. Colour and texture of the split-thickness skin graft, scar formation condition of the donor site, and action condition of the operation site during follow-up were observed. Results: The wounds of 8 patients were healed in 10-14 d after the second stage operation. During follow-up of 6-24 months, the split-thickness skin graft was with smooth surface and good elasticity, and the function of joint recovered well. The donor site in head healed well with no scar. Only pigmentation was left in the donor site of thigh, and scar was not obvious. The patients and their family members were satisfied. Conclusions: After application of artificial dermis combined with VSD and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn, the skin grafting area and donor site were with unobvious scar hyperplasia, and the joint function in the operation area was good.


Asunto(s)
Quemaduras/cirugía , Cicatriz/cirugía , Contractura/cirugía , Terapia de Presión Negativa para Heridas , Trasplante de Piel , Piel Artificial , Adolescente , Adulto , Niño , Dermis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos , Cicatrización de Heridas , Adulto Joven
13.
Zhonghua Shao Shang Za Zhi ; 35(8): 611-613, 2019 Aug 20.
Artículo en Chino | MEDLINE | ID: mdl-31474043

RESUMEN

From January 2013 to December 2017, 8 patients with deep burns of upper limbs were admitted to our hospital, including 6 males and 2 females, aged 23-48 years. The wound area of full-thickness burns to burns with tendon and bone injury was 4.5 cm×2.0 cm-20.0 cm×10.5 cm. After debridement, thin abdominal flaps with subdermal vascular network in the size of 5.0 cm×2.5 cm-22.0 cm×12.0 cm were applied to cover the wounds, and the donor sites were sutured directly by relaxation. The disposable suction tubes with holes cut on side walls were used as drainage tubes. The part of drainage tubes with holes were wrapped with nano-silver antimicrobial dressings and then placed at the lowest position of pedicle and donor site of abdominal flap and the space between the injured limb and the abdominal wall. The loose nano-silver antibacterial dressing was used to fill the webs of fingers and the gap between the injured limb and the abdominal wall. The transparent film dressing was used to close the surgical area and then connected with a low negative voltage electric suction device to continuously suck at a negative pressure of -15 to -10 kPa. The self-made vacuum sealing drainage device was replaced at intervals of 4 to 5 days until pedicle breakage was performed 2 to 3 weeks after operation. The pedicled abdominal flaps of 8 patients had no torsion or avulsion, no pedicle blood supply disorder, and no infection or skin erosion in the operation area, and all the flaps survived after pedicle breakage.


Asunto(s)
Quemaduras/cirugía , Terapia de Presión Negativa para Heridas , Procedimientos Quirúrgicos Reconstructivos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos/trasplante , Extremidad Superior/cirugía , Adulto , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Piel , Adulto Joven
14.
Zhonghua Shao Shang Za Zhi ; 35(8): 614-616, 2019 Aug 20.
Artículo en Chino | MEDLINE | ID: mdl-31474044

RESUMEN

On October 3rd, 2017, one male patient, aged 27 years, was admitted to our hospital 6 hours after hydrothermal scald of torso, buttocks, and limbs. The total area of burn was about 60% total body surface area, and the depth was from deep partial-thickness burn to full-thickness burn. Immediately after admission, the patient was given symptomatic support treatments, such as anti-shock, fluid replacement, and anti-infection, etc. After being treated by debridement and xenogenic (porcine) skin grafting for 2 times, the wounds were healed well. On the 12th day of admission, linezolid was used to prevent infection according to the results of microbial culture and drug sensitivity test, since when the level of his blood lactate continued to increase. After 8 days, linezolid was discontinued and vitamin B1 was given orally for 1 week, and the level of lactic acid gradually decreased to normal in result. This case was used mainly to analyze whether linezolid could directly cause hyperlacticemia and its important mechanism, aiming at reminding clinicians of being alert to the risk of hyperlacticemia when using linezolid. If hyperlacticemia occurs, linezolid should be discontinued immediately and vitamin B1 should be taken orally to correct the high lactic acid value, and the treatment plan should be adjusted if necessary.


Asunto(s)
Quemaduras/complicaciones , Hiperlactatemia/inducido químicamente , Linezolid/efectos adversos , Adulto , Animales , Quemaduras/cirugía , Desbridamiento , Humanos , Masculino , Trasplante de Piel , Porcinos
15.
Cir. plást. ibero-latinoam ; 45(3): 327-336, jul.-sept. 2019. ilus, tab
Artículo en Español | IBECS | ID: ibc-184410

RESUMEN

La tercera campaña de ayuda humanitaria llevada a cabo por la Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) en Monrovia (Liberia) se desarrolló durante el mes de noviembre de 2018 y supone la continuación de este tipo de ayudas en el continente africano promovidas por la ONG Juan Ciudad. Como en otras misiones humanitarias protagonizadas por cirujanos plásticos, el objetivo es mejorar la calidad de vida de la población más vulnerable y colaborar en su reincorporación a la sociedad. Las campañas humanitarias quirúrgicas tienen una fecha de ida y otra de vuelta, con un proyecto de actividad quirúrgica que desarrollar en pocos días y en unas condiciones de recursos limitados. Una buena planificación, apoyándonos en los datos obtenidos de las experiencias anteriores, facilitó la consecución de nuestros objetivos. Con la presentación de este artículo queremos transmitir nuestra experiencia personal en este proyecto


The third humanitarian aid campaign by the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE) in Monrovia (Liberia) was carried out in November 2018 and reflects the continuation of such aid programmes in the African continent promoted by the NGO Juan Ciudad. As in other humanitarian missions involving plastic surgeons, the objective is to improve the quality of life of the most vulnerable population and to collaborate in their reintegration into society. The surgical humanitarian campaigns have a round trip date, with a surgical activity project to be developed in a few days and under limited resource conditions. Good planning, based on the data obtained from previous experiences contributed to the achievement of our objectives. Our aim presenting this article is sharing our personal experience in this project


Asunto(s)
Humanos , Sistemas de Socorro , Sociedades Médicas/organización & administración , Cirugía Plástica/tendencias , Quemaduras/cirugía , Anomalías Congénitas/cirugía , Procedimientos Quirúrgicos Reconstructivos/historia , Procedimientos Quirúrgicos Reconstructivos/tendencias , África
16.
Rev. bras. cir. plást ; 34(3): 399-404, jul.-sep. 2019. tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047163

RESUMEN

Introdução: A Úlcera de Marjolin é definida como a malignização de cicatrizes, geralmente, crônicas, decorrentes de diversos tipos de lesão, sendo mais comum lesões por queimaduras. Métodos: Foi realizado levantamento bibliográfico nas plataformas BVS, PubMed, SciELO e Cochrane, tendo como critério de inclusão estudos publicados nos últimos 5 anos, que envolvem a espécie humana, disponíveis na web nos idiomas inglês ou português. Resultados: Analisados um total de 31, dos quais apenas 6 compuseram a amostra final. Discussão: As úlceras de Marjolin são encontradas em cicatrizes antigas de queimaduras, podem ocorrer em qualquer local, sendo mais comuns em membros superiores e inferiores. O diagnóstico inicia-se com a suspeita clínica baseada em características das lesões: lesões ulcerativas crônicas que não cicatrizam, com bordas elevadas e endurecidas e odor desagradável, podendo apresentar descarga purulenta. Esse só pode ser efetivado, entretanto, por meio do histopatológico da lesão. O período de latência entre a injúria da lesão e a sua malignização é, em média, de 30 a 35 anos. O tratamento deve ser individualizado, uma vez que depende de diversos fatores. Contudo, considera-se o padrão ouro a excisão cirúrgica. Conclusão: O conhecimento dos profissionais de saúde acerca dessa condição faz-se imprescindível para o melhor prognóstico do paciente. De modo que possíveis casos de malignização não tenham o seu diagnóstico subestimado, permita a terapêutica adequada à minimização das recidivas, e medidas profiláticas sejam efetivadas, no que tange à prevenção da queimadura e à minoração de fatores de risco para a malignização.


Introduction: Marjolin's ulcer is defined as a malignancy within scars that is usually chronic and results from several lesion types, with burn injuries being the most common. Methods: A bibliographic survey was conducted of the Virtual Health Library, PubMed, Scientific Electronic Library Online, and Cochrane databases using the inclusion criteria of studies published in the last 5 years, human studies, and published in English or Portuguese. Results: A total of 31 studies were analyzed, of which only 6 were included in the final sample. Discussion: Marjolin's ulcer is found in old burn scars and can occur anywhere, but it is more common in the upper and lower limbs. The diagnosis begins with the clinical suspicion based on lesion characteristics: chronic unhealed ulcerative lesions with high and hardened edges, an unpleasant odor, and purulent discharge. However, the diagnosis can only be made histopathologically. The latency period between injury and malignancy is 30­35 years. Although treatment should be individualized since it depends on several factors, surgical excision is considered the gold standard. Conclusion: Knowledge about this condition is essential to better patient prognosis and prevent underestimation of possible cases of malignancy, allowing for appropriate therapy to minimize recurrence and enabling prophylactic measures to prevent burn injury and reduce risk factors for malignancy.


Asunto(s)
Humanos , Femenino , Adulto , Historia del Siglo XXI , Úlcera Cutánea , Cirugía Plástica , Cicatrización de Heridas , Quemaduras , Quemaduras por Electricidad , Carcinoma , Úlcera Cutánea/cirugía , Cirugía Plástica/efectos adversos , Cirugía Plástica/métodos , Quemaduras/cirugía , Quemaduras/complicaciones , Carcinoma/cirugía , Carcinoma/complicaciones
17.
J Craniofac Surg ; 30(8): 2551-2554, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31449203

RESUMEN

BACKGROUND: Facial burns have lasting physical and psychological effects on pediatric patients. Proper management to minimize morbidities challenges reconstructive surgeons. New technologies allowed the development of skin substitutes such as amniotic and chorionic membranes, yet the use of these skin dressings and their impact on burn outcomes have not been sufficiently studied to guide practices. The objective of this study is to report on the outcomes of dehydrated amniotic membrane as a biologic skin dressing in pediatric facial burn injury compared to cadaveric allografts. METHODS: Retrospective review of data collected from our institutional burn registry from 2012 to 2016. The study population included patients younger than 16 years with facial burns. Patients between 2012 and 2014 received cadaveric allografts, whereas during 2015 to 2016 patients received dehydrated human amniotic/chorionic membrane as standard treatment. Demographic characteristics and outcome measures were compared between the 2 groups. RESULTS: Included 30 patients with a mean age of 3.7 years and with an average total body surface area burn of 6.8% (2%-27%). Mean injury severity scores did not significantly differ between both groups, 1.8 in amniotic group versus 2.3 in cadaveric skin group (P > 0.05). There were 4 complications (3 hypertrophic scars and 1 wound infection) in the cadaveric allografts group versus no complications in the amniotic membrane group (P < 0.05). CONCLUSION: Dehydrated amniotic/chorionic membrane wound dressings are a safe alternative to cadaveric allografts in treating pediatric partial thickness facial burns.


Asunto(s)
Amnios/cirugía , Quemaduras/cirugía , Traumatismos Faciales/cirugía , Vendajes , Apósitos Biológicos , Superficie Corporal , Preescolar , Cicatriz Hipertrófica/cirugía , Femenino , Humanos , Masculino , Estudios Retrospectivos , Piel , Trasplante de Piel , Piel Artificial , Trasplante Homólogo
18.
J Craniofac Surg ; 30(5): e406-e408, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31299794

RESUMEN

The ugly face of civil war shows itself in the desperate patients and their extreme sequellae. The options for reconstruction of patients with late-term serious sequellae decrease and their treatments also become more difficult. A 31-year-old male patient was injured 18 months ago due to a bomb explosion and received long-term treatment through local wound care in his country. A patient who is referred to us with such late-term ectropion and lagophthalmos is likely to have both morphologic and functional deterioration. A frontal muscle flap was planned for this patient. The frontal muscle flap has been used for a long time in ptosis surgery and was used in the treatment of the patient to repair both lagophthalmos and ptosis. Satisfactory results were obtained at the end of a 6-month period during which the patient was monitored.


Asunto(s)
Traumatismos por Explosión/cirugía , Quemaduras/cirugía , Párpados/cirugía , Músculos Oculomotores/cirugía , Colgajos Quirúrgicos , Adulto , Blefaroplastia/métodos , Blefaroptosis/cirugía , Ectropión/cirugía , Humanos , Cuidados a Largo Plazo , Masculino , Terapia Recuperativa , Colgajos Quirúrgicos/cirugía
19.
J Craniofac Surg ; 30(5): e460-e462, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31299814

RESUMEN

Postburn maxillofacial deformities, although rare, are a significant cause of morbidity. Since contracture scars have a potential role in deforming the maxillofacial skeleton, the focus of treatment should be on growing patients, where scar contractures can drastically influence growth and morphology of the maxillofacial units. There are certain aspects of severe facial burns and deformities, especially of the jaws, that deserve sincere attention to overcome aesthetic and functional disabilities such as inability to masticate and incompetent lips. The purpose of this article, therefore, is to discuss these injuries, the mechanism of development of deformities of the jaws and associated structures and their management for better aesthetic, functional, and psychological health of patient. An interpretive clinical report is presented.


Asunto(s)
Quemaduras/cirugía , Traumatismos Faciales/cirugía , Anomalías Maxilofaciales/cirugía , Modalidades de Fisioterapia , Adulto , Quemaduras/complicaciones , Cicatriz/cirugía , Contractura/cirugía , Traumatismos Faciales/complicaciones , Humanos , Masculino , Masticación , Anomalías Maxilofaciales/etiología , Anomalías Maxilofaciales/terapia , Cirugía Plástica
20.
Zhonghua Shao Shang Za Zhi ; 35(6): 423-427, 2019 Jun 20.
Artículo en Chino | MEDLINE | ID: mdl-31280534

RESUMEN

Objective: To explore the clinical effects of scapular region flaps pedicled with circumflex scapular artery in the reconstruction of axillary burn scar contractures. Methods: From December 2008 to December 2018, 21 patients with axillary burn scar contractures were admitted to our department. There were 12 male patients and 9 female patients, aged 2-48 years, with an average of 17.4 years. According to the characteristics of axillary scar contractures, the patients were divided into type Ⅰ of 5 patients, type Ⅱ of 2 patients, type Ⅲ of 5 patients, and type Ⅳ of 9 patients. The preoperative abduction ranges of shoulder joint were 20-150°, with an average of 68.33°. The wound areas after resection and release of scar contractures ranged from 12 cm×4 cm to 33 cm×11 cm, with an average of 18.13 cm×5.41 cm, and the wounds were repaired with scapular region flaps pedicled with circumflex scapular artery in the areas of 14 cm×5 cm-35 cm×14 cm, with an average of 20.19 cm×7.71 cm. The donor sites of 5 patients were expanded prior to flap repair operation, and the other 16 patients were repaired by direct transfer of flaps. The donor sites were closed directly. The type, number, and transfer way of scapular region flaps were calculated, and the improvement of abduction angle of shoulder joint and condition of the flaps were observed during follow-up after operation. Results: There were 5 ascending scapular flaps, 13 scapular flaps, and 3 parascapular flaps. The flaps were transferred through open wounds in 18 cases, subcutaneous tunnel in 1 case, and trilateral foramia in the remaining 2 cases. All the flaps survived after operation. During follow-up of 3 months to 5 years, with an average of 19.4 months, the abduction angles of shoulder joints were 90-180°, with an average of 137.62°, which showed that the abduction function of shoulder joint improved obviously. The texture of flap was soft, and the color of the flap was close to the surrounding skin. The patients and/or their family members were satisfied with the operation results. Conclusions: The scapular region flap pedicled with circumflex scapular artery has a lot of advantages, including a long vascular pedicle, simple technique for flap harvest, a hidden donor site, and flexible and diverse transfer mode of flap. It is an effective option for clinical reconstruction of severe axillary burn scar contracture.


Asunto(s)
Axila/cirugía , Quemaduras/cirugía , Cicatriz/cirugía , Contractura/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Articulación del Hombro , Colgajos Quirúrgicos/irrigación sanguínea , Adolescente , Adulto , Anciano , Arterias , Quemaduras/complicaciones , Niño , Preescolar , Cicatriz/etiología , Contractura/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escápula , Trasplante de Piel , Dispositivos de Expansión Tisular , Adulto Joven
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