Management of extensive facial burns in the intensive care unit: introducing a novel device with a four-fold use.

Perioral facial burns have a high propensity to formation of microstomia and numerous prosthetic devices have been described that can be used postoperatively to address this problem. We introduce a novel device, the Whiston Buccal Prosthesis, which is used intraoperatively and in the early postoperative period and it acts as a surgical aid to prevent or curtail microstomia, as well as to address other problems associated with facial burns. Our device has an overall 4-fold purpose; 1) it acts as a commissural and circumoral retractor, 2) as a means of counter-pressure during excision of burn eschar, 3) counter-pressure for the graft after its placement, and 4) for access to the mouth to maintain oral hygiene. It has been used on 3 patients who have benefited from all or some of the above uses. We have used this device in 3 patients thus far. One died 2 months after her operation but received benefit in the daily maintenance of oral hygiene and also the skin grafts. The other 2 patients were young adults, 19 and 20 years old at the time of injury, who after a 3-year follow-up were discharged not having required any further surgical intervention for microstomia. The Whiston Buccal Prostheses were used for a length of time between 1 and 3 months. Although limited objective evidence exists for our device, subjectively we have seen value intraoperatively, in the prevention of microstomia, the maintenance of oral hygiene, and maintenance of grafts.

The Mersey Burns App: evolving a model of validation.

INTRODUCTION: 'Mersey Burns App' is a smartphone/tablet application that aids in the assessment of total burn surface area (TBSA) and calculation of fluid resuscitation protocols in burns. This paper presents two studies assessing the speed and accuracy of calculations using Mersey Burns (App) in comparison with a Lund and Browder chart (paper) when a burn is assessed by medical students and clinicians. METHODS: The first study compared the speed and accuracy of TBSA and resuscitation calculation for a photograph of a burn with App and paper using burns and plastics and emergency medicine trainees and consultants. Developing on some of the feedback and results of that study, a second study was then carried out using burns-naive medical students assessing a fully simulated burn with both modalities. Preference and ease of use of each modality were assessed anonymously. RESULTS: The clinician study showed a lower variance in TBSA and fluid calculations using the App (p<0.05). The student study showed no difference in mean TBSA estimations (p=0.7). Mean time to completion of calculations was faster and calculations were more likely to be correct with the App (p<0.001). Students favoured the App in the following categories: preference in emergency setting, confidence in output, accuracy, speed, ease of calculation, overall use and shading (p<0.0001). CONCLUSIONS: Mersey Burns App can facilitate quicker and more accurate calculations than Lund and Browder charts. Students also preferred the App. This suggests a useful role for the App in the care of patients with burns by inexperienced staff.

Customised silicone prostheses for the reconstruction of chest wall defects: technique of manufacture and final outcome.

Chest wall reconstruction with a customised silicone prosthesis in 13 patients (five patients with pectus excavatum, six Poland's syndrome and two with post-surgical chest wall deformity) is presented. An alginate impression or CT scan with three-dimensional reconstruction was used to produce the final mould from which the silicone prosthesis was fabricated. The surface of the silicone implant was roughened to reduce capsular contracture and holes were incorporated to allow for tissue integration. Twelve patients had aesthetically acceptable results after a mean of 5 years follow up. This series indicates that accurate assessment of the defect, modifications on manufacture and proper placement of the implant result in a more satisfactory final outcome.