Fractional CO2 laser therapy of hypertrophic scars - evaluation of efficacy and treatment protocol optimization.

INTRODUCTION: Hypertrophic scars are an unwanted and mutilating consequence of deep burns, and are further exacerbated by extensive burn injuries. Fractional CO2 laser therapy is one of the methods for complex treatment of hypertrophic scars, it has been used since 2007 [1]. Although its effectiveness has been objectively proven in clinical practice, the optimal settings parameters have not been determined. To evaluate the effect of laser therapy, previously designed evaluation tools are used, which evaluate the quality of scars well, but fail to capture specific changes for the performed laser therapy. MATERIAL AND METHODS: Fractional CO2 laser therapy of hypertrophic scars is performed at the Department of Plastic and Esthetic Surgery, University Hospital Olomouc, since 2017 and the systematic study took place in 2019-2020. In common, 25 hypertrophic scars were treated in 13 patients; each scar was treated by fractional CO2 laser therapy more than once. RESULTS: Statistical analysis detected statistically significant improvement of the texture of the scars and the improvement of overall functional and esthetic result. We found significant reduction of the height under 2 mm (62,5% of scars) in scars with the height > 2 mm before the initiation of laser therapy. Correlation analysis detected a statistically significant positive correlation between the energy of laser beam and the reduction volume of the scar protruding above the niveau of healthy surrounding tissue. Fractional CO2 laser therapy showed statistically significant efficacy in the reduction of the risks associated with full-format CO2 laser-therapy. Fractional treatment was very well tolerated by the patients. Topical 5% lidocaine gel was effective in 24 out of 25 patients. Further healing was without complications in all patients. CONCLUSION: Fractional CO2 laser therapy has achieved statistically significant improvement of the texture and reduction of hypertrophic scars and overall improvement of functional and esthetic result in our study.

MEEK MICROGRAFTING TECHNIQUE AND ITS USE IN THE TREATMENT OF SEVERE BURN INJURIES AT THE UNIVERSITY HOSPITAL OSTRAVA BURN CENTER.

BACKGROUND: Early necrectomy and skin autotransplantation are prerequisites for successful treatment of extensive burns. Insufficient autograft donor site availability is a limiting factor. The Meek micrografting technique, published by C. P. Meek in 1958, appears to be a potential solution. Skin grafts are cut into micrografts and expanded at a ratio of 1:3, 1:4, 1:6 or 1:9. Thus, even in cases with limited donor site availability, it is possible to cover large areas after necrectomy. MATERIAL AND METHODS: Meek micrografting was first used at the University Hospital Ostrava Burns Centre in 2013. To date, 14 operations have been performed in 4 patients with extensive burn trauma. Engraftment, healing rate, and subsequent scarring (with a particular focus on scar contracture formation) were observed postoperatively. RESULTS: The average micrograft success rate was 86.5%. The best success rates were observed in areas with deferred transplantation after necrectomy. Hypertrophic scarring occurred in both Meek and meshed transplant areas. No scar contractures requiring surgical management developed in micrografted areas. Surgical scar contracture release was required in 1 patient who underwent meshed graft transplantation. DISCUSSION: The Meek technique demonstrated significant advantages. Micrografts can be prepared with very small skin grafts, which is impossible with the mesh technique. Meshed grafts with expansion ratios of 1:3 or higher require allograft or xenograft coverage. In our experience, overlays were not necessary for micrografts with a 1:6 expansion ratio. Given that no serious scar contractures developed in micrografted areas, we speculate that micrografts may pose a lower risk for their development when compared to meshed grafts. The disadvantage of the Meek technique is greater economic demands. CONCLUSION: Meek micrografting is effective in the surgical management of deep burns in extensive thermal injuries with limited donor site availability...

[The use of acellular biological xenografts in local treatment of Lyells syndrome]. / Vyuzití acelulárních biologických xenotransplantátu v lokální lécbe Lyellova syndromu.

Lyells syndrome, also known as toxic epidermal necrolysis (TEN), is a rare skin disease characterized by a high mortality rate, systemic toxicity and extensive epidermal necrolysis with mucosal erosions. TEN is caused by an allergic autoimmune response, most commonly occurring as a result of an allergic reaction to medication. Our case report describes a nine-year-old boy suffering from Lyells syndrome, with 95% of the body surface area affected.

Analysis of a retrospective double-centre data-collection for the treatment of burns using biological cover Xe-derma®.

Xe-Derma(®) is a new biological acellular temporary wound cover derived from pig dermis in the form of a mesh of collagen and elastic fibers. It is recommended for use in similar indications as classical pig xenografts. A data collection of 2 burns centres in the treatment of burns with Xe-Derma(®) was obtained from the medical records of 101 patients admitted from January 1, 2010 to December 31, 2011. The primary objectives of the study were to assess efficacy and safety when using Xe-Derma(®) in burn treatment, and to analyse the course of healing. The secondary objectives were to define the suitable spectrum of indications of Xe-Derma(®) in terms of burn depth, and to evaluate subsequent scarring using the Vancouver Scar Scale. No undesirable systemic effects or adverse device events were observed. The use of Xe-Derma(®) was not associated with a higher risk of burn wound infection. On the other hand, the infection was the most common cause of Xe-Derma(®) dissolution. The majority of patients (81.4%) had no signs of Xe-Derma(®) dissolution. The mean healing time in the group of patiens under review was close to 12 days and mean hospitalization time was almost 14 days. Using Xe-Derma(®) proved to be effective as a temporary covering for partial-thickness burns with the capacity of spontaneous healing. It proved to be a well-tolerated wound coverage with minimal complications and low level of pain during dressing changes. Xe-Derma(®) firmly adhered to the wound bed. There was a lower frequency of wound dressing changes and only a minimal rate of wound infection.

Le Xe-Derma® est un nouveau pansement acellulaire biologique provisoire à base de derme porcin, se présentant sous la forme d'un filet de fibres de collagène et d'élastine. Son utilisation est recommandée dans les indications similaires aux xenogreffes porcines classiques. Nous avons recueilli et analysé les données de 101 patients, dont les brûlures ont été traitées par Xe- Derma® dans 2 centres de grands brûlés entre le 1er janvier 2010 et le 31 décembre 2011. L'objectif principal de cette étude consistait à évaluer l'efficacité et la sécurité de l'utilisation du Xe-Derma® pour le traitement des brûlures et d'analyser le processus de guérison. Les objectifs secondaires étaient de déterminer un spectre d'indications pour l'utilisation du Xe-Derma® selon la gravité de la brûlure et d'évaluer le processus de cicatrisation consécutif à l'aide de la VSS (Vancouver Scar Scale, échelle cicatricielle de Vancouver). Aucun effet systémique défavorable ou effet local indésirable n'a été observé. L'utilisation du Xe-Derma® n'a pas été associée à un risque plus élevé d'apparition d'infections de la plaie. En revanche, les infections ont représenté la cause la plus fréquente de dissolution du Xe-Derma®. La majorité des patients (81,4%) n'ont toutefois manifesté aucun signe de dissolution du Xe-Derma®. Quelle que soit la gravité de la brûlure, le durée moyenne de guérison était proche de 12 jours et la durée moyenne d'hospitalisation était de presque 14 jours. L'utilisation du Xe-Derma® s'est avérée efficace en tant que pansement provisoire sur les brûlures de second degré, présentant un potentiel de guérison spontanée. Le Xe-Derma® est un pansement bien toléré, causant peu de complications et réduisant la douleur lors des changements de pansement. Il adhère très bien au fond de la plaie. La faible fréquence de changement de pansement a permis de limiter les infections des brûlures.

Our first experience with Integra.

The advantages of Integra have lead to an increase in its use after extensive burn injuries, in reconstructive surgery after burns, and abroad in general reconstructive surgery as well. At the Burn Center of FNsP Hospital in Ostrava Integra was used for the first time in March 2003. Since then, seven patients have undergone operations, involving the use of Integra in 14 body areas. In four of the patients scars after burns were corrected--on the neck, axilla, two on the trunk, two in the popliteal area and one between the toes. In three patients the artificial skin was applied after necronectomy. In a 7-month-old baby and in a 2-year-old child with burn injuries exceeding 25% of the body surface it was applied twice on the trunk, once on the upper extremity and once on the lower extremity. In an adult female Integra was applied on her neck and axilla after burns to a lesser extent. We have evaluated the scars one year after surgery in two patients. Cosmetic appearance was good in both of them. We have noted good functional result after the reconstruction of axilla. After reconstruction in the neck area and reconstruction of the necrectomy in the neck area and axilla, the functional results were average. The average functional results in both patients are probably due to poor compliance with the immobilization and following rehabilitation program.

Surgical treatment of electrical burns by local flap plastic surgery.

Electrical burns are a serious problem within burn medicine even though they are relatively uncommon. The size of the burn is small, but the wound is often deep, and frequently the patient has systemic complications as well. In the majority of patients with such injuries immediate surgical intervention is essential, consisting of escharotomy, fasciotomy, and debridement of the devitalized tissues, necrectomy of the burn area, and closure of the defect by a direct suture, a dermo-epidermal graft, or local flap. Our report consists of three case studies. The patients underwent local flap plastic surgery after a full thickness soft tissue loss. All three patients healed primarily and did not require further correction of flaps. Final functional and aesthetic results are very good if the local flap is used appropriately.

Burn injury in senior citizens over 75 years of age.

This is a retrospective analysis of a group of 67 senior citizens over 75 years of age who had been hospitalized at the Burn Center of the FNsP Hospital in Ostrava--Poruba in the years 1999 - 2003. We have studied a group of males and females, noting their average age, most common causes of burn injuries, mechanisms of burn injuries, average extent of burn injuries, and most commonly burned body parts. We have also reviewed the seriousness of burn injury in senior citizens, factors that complicated the course of treatment as well as its impact on the final therapeutic effect. The importance of specific approach and individual therapeutic strategy is emphasized. We would also like to emphasize the need for complex therapy approach due to secondary diseases that are very common in this age group. The treatment of burn patients in this age group is very challenging from a personal and economic point of view. The goals of therapy are a full recovery and the return of the patient to normal life. However, goals and therapeutic results are determined and limited by the above-mentioned factors. Nevertheless, every therapeutic success, although partial, should be perceived as positive. For the patient, every success from the point of view of the ability to take care of himself or herself and the overall quality of life is fundamental.

First experience with the use of vacuum assisted closure in the treatment of skin defects at the burn center.

Morykwas and Argenta developed Vacuum Assisted Closure (VAC) in the early 90s for the treatment of tissue defects. In 2004, for the first time at our workplace, we used this method in the treatment of six patients between 54 and 91 years of age. Two of the patients were treated for a varicose ulcer on a lower extremity, two patients for loss of skin after an inflammation secondary to infection, one high-risk patient for deep burns, and one patient for a deep defect caused by an inappropriate medical care. We observed blood circulation improvement in all patients, which permitted an early dermo-epidermal graft.