Las redes sociales: nuevos desafíos en el tratamiento del niño quemado / Social media: new challenges in pediatric burn treatment

Introducción y objetivo: El uso de las redes sociales está ampliamente difundido en los adolescentes y es sin duda una de las formas más comunes de vinculación social con sus pares. La información e imágenes utilizadas para construir el perfil se seleccionan para favorecer lo que se quiere mostrar de cada uno. Las secuelas estéticas del paciente quemado tradicionalmente han sido motivo de preocupación para el cirujano plástico. El amplio uso de las redes sociales ha aumentado notablemente la exposición física, por lo tanto, nos preguntamos cómo influyen las secuelas visibles de las quemaduras en esta forma de relación entre adolescentes. Material y método: Identificamos los niños quemados asistidos en el centro de referencia para el tratamiento de quemaduras pediátricas de Uruguay (UNIQUER) entre 2015 y 2022 con lesiones de gravedad funcional o vital. Seleccionamos aquellos que en el momento de realizar este estudio tuvieran 10 o más años de edad. Confeccionamos un cuestionario digital (Google Forms) que enviamos por mensajería instantánea (Whatsapp) previa autorización de un adulto responsable, y analizamos los datos recuperados. Resultados: Reunimos 51 pacientes que cumplieron los criterios de inclusión, de los cuales logramos contactar con 32 y obtuvimos 22 respuestas al cuestionario, con edades entre 10 y 19 años. Todos presentaban cicatrices: 9 en cara o cuello (40.9%) y 9 en manos (40.9 %); el resto en zonas menos visibles. De ellos, 17 (77.3 %) requirieron autoinjertos en el episodio agudo y 7 (31.8%) cirugías para tratamiento de secuelas.Encontramos 21 niños (95.4%) que utilizaban al menos una red social. En orden decreciente de frecuencia, la más utilizada era Whatsapp (17, 81%), Tik Tok (13, 61.9%), Instagram (9, 42.9%), Facebook (5, 23.8%), Twitter (3, 14.3%) y otra (3, 14.3%). Además, 18 niños (85.7%) no posteaban fotos con sus cicatrices y 5 (23.8%) utilizaban efectos siempre o algunas veces para disimular sus cicatrices en redes...(AU)

Background and objective: Social media is widely used by teenagers, in fact, it represents one of the main means of communication between them. The images used to construct a profile are specially selected in order to show only what they want to share about themselves. Aesthetic sequelae after burns have traditionally been a concern for reconstructive surgeons. We would like to find out if visible sequelae influence the way these patients interact with social media given the vast physical exposure that they include. Methods: Burned children with severe vital o functional injuries treated between 2015 and 2022 in the national reference center for pediatric burn treatment in Uruguay (UNIQUER) were identified. Those aged 10 or above were selected. We designed a digi-tal form (Google Forms) that was sent by instant messaging (Whatsapp) to the selected population with an adult previous authorization and we analyzed the collected data. Results: Fifty-one patients met the inclusion criteria, we contacted 32 and obtained 22 responses to the questionnaire; patients aged between 10 and 19 years. All had scars: 9 in face or neck (40.9%) and 9 in hands (40.9 %). The rest of the scars were in less visible places. Of them, 17 (77.3%) required autografts in the acute episode and 7 (31.8%) required surgeries to treat sequelae. We found 21 children (95.4%) who used at least one social network.The most used was Whatsapp (17,81%), Tik Tok (13,61.9%), Instagram (9,42.9%), Facebook (5,23.8%), Twitter (3,14.3%) and other (3,14.3%). Furthermore, 18 children (85.7%) do not post photos with their scars and 5 (23.8%) always or sometimes used effects to hide their scars on social networks. Of the total, 12 patients (54.5%) reported having felt discrimination because of their scars and 9 (40.9%) had been victims of bullying; 14 (63.6%) would be interested in participating in campaigns to prevent discrimination against people with scars...(AU)

Reconstrucción de cuero cabelludo, por quemadura química extensa, en tiempos de COVID / Scalp reconstruction, from extensive chemical burn, in time of COVID

Las quemaduras químicas en cuero cabelludo, que se producen en lugares públicos como salones de belleza o peluquerías causadas por mezclas de sustancias activas como persulfatos y peróxido de hidrógeno, secundarias a la decoloración de cabellos, producen graves secuelas de alopecias en pacientes jóvenes. Se trata de un caso clínico, de quemadura química, espesor completo, extensa, en cuero cabelludo. Productos utilizados en forma cotidiana en salones de belleza, peluquerías o domicilios, que tiene estrecha relación con el daño. Resolución del caso con colgajos locales, con tiempos de internación y quirúrgicos cortos, en tiempos de COVID. Enfoque de la falta de control de sustancias usadas en peluquerías, pocos casos publicados y secuelas psicosociales importantes, con pronta mejoría de calidad de vida y reinserción social

Chemical burns in scalp after hair bleaching are produced in public places such as hairdressing salons and are caused by the combination of active agents like persulfate and hydrogen peroxide. The burns leave severe sequels of alopecia in young patients. This is about a clinical case of a chemical burn in the sculp which is full thickness and has a great large. Products used on a daily basis in hairdressing salons or in the domiciles have a close connection with the hurt. In times of COVID the case was resolved with local flaps, and short period of hospitalization and surgical. Focus on the lack of control in the usage of substances made by hairdressing salons, the existence of few published cases and the main psychosocial sequels, a speedy recovery in the quality of life and social reintegration

Nested graft for chronic ulcer in scar tissue after heroin extravasation in a drug addict.

INTRODUCTION: Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue. CASE REPORT: We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed. CONCLUSIONS: Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

Dermatoporosis en estadio IV: a propósito de un caso / Stage IV dermatoporosis: a case report

Paciente de 79 años, remitida a consulta de enfermería para valoración de lesión postraumática en miembro inferior derecho de una semana de evolución, tratada con vendaje elástico y heparina de bajo peso molecular. OBJETIVO: Conocer el rol de la enfermería en la prevención y tratamiento de la dermatoporosis, a propósito de un caso clínico. METODOLOGÍA: Caso clínico con planteamiento metodológico, con consentimiento informado de la paciente y fotografías del caso. RESULTADO: La cicatrización se consiguió en un periodo de 65 días, con una correcta preparación del lecho de la herida para el posterior éxito del injerto cutáneo, controlando el edema, exudado y dolor durante las curas, realizadas cada 2-3 días de acuerdo con la efectividad del tratamiento. DISCUSIÓN: La dermatoporosis exige un mayor esfuerzo en prevención primaria y secundaria desde Atención Primaria, sobre todo a partir de la detección de las manifestaciones clínicas y complicaciones iniciales derivadas de la misma

A 79-year-old patient referred to a nursing consultation to evaluate a traumatic lesion in the right lower limb for one week, treated with elastic bandage and low molecular weight heparin. OBJECTIVE: Knowing the role of nursing in the prevention and treatment of dermatoporosis, in relation to a clinical case. METHODOLOGY: Clinical case with methodological approach, with informed consent of the patient and photographs. RESULT:The healing was achieved in a period of 65 days, with a correct preparation of the wound bed for the subsequent success of the skin graft, treating the edema, exudate and pain during the cures, made every 2-3 days in accordance with the effectiveness of the treatment. DISCUSSION: Dermatoporosis requires a greater effort in primary and secondary prevention from primary care, especially from the detection of clinical manifestations and initial complications derived from it

Sweat gland organoids contribute to cutaneous wound healing and sweat gland regeneration.

Sweat glands perform a vital thermoregulatory function in mammals. Like other skin components, they originate from epidermal progenitors. However, they have low regenerative potential in response to injury. We have established a sweat gland culture and expansion method using 3D organoids cultures. The epithelial cells derived from sweat glands in dermis of adult mouse paw pads were embedded into Matrigel and formed sweat gland organoids (SGOs). These organoids maintained remarkable stem cell features and demonstrated differentiation capacity to give rise to either sweat gland cells (SGCs) or epidermal cells. Moreover, the bipotent SGO-derived cells could be induced into stratified epidermis structures at the air-liquid interface culture in a medium tailored for skin epidermal cells in vitro. The SGCs embedded in Matrigel tailored for sweat glands formed epithelial organoids, which expressed sweat-gland-specific markers, such as cytokeratin (CK) 18 and CK19, aquaporin (AQP) 5 and αATP. More importantly, they had potential of regeneration of epidermis and sweat gland when they were transplanted into the mouse back wound and claw pad with sweat gland injury, respectively. In summary, we established and optimized culture conditions for effective generation of mouse SGOs. These cells are candidates to restore impaired sweat gland tissue as well as to improve cutaneous skin regeneration.

Curativos tópicos para áreas doadoras de enxertos de pele parcial: é possível estabelecer o mais adequado com base em uma revisão da literatura? / Split-thickness skin graft donor-site dressings: is it possible to establish the ideal dressing based on a literature review?

O objetivo deste estudo foi verificar, por meio de uma revisão da literatura, a possibilidade de se estabelecer, com base em evidências científicas, o curativo tópico mais adequado para a aplicação em áreas doadoras em enxertos de pele parcial. Foram analisados os mais relevantes estudos publicados originalmente nos últimos sete anos, em qualquer idioma, porém, que estivessem indexados às bases de dados US National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). As buscas foram realizadas por meio do uso de descritores associados ao tema e de critérios de inclusão e exclusão. A amostra final deste estudo foi composta por 25 publicações, sendo uma nacional e 24 internacionais. Com base nos achados, constatou-se que há uma lacuna na literatura acerca de estudos que visam analisar os diferentes tipos de curativos usados em áreas doadoras em enxertos de pele parcial. Por meio da revisão da literatura realizada, pode-se concluir que não é possível se estabelecer o curativo mais adequado para uso em áreas doadoras de enxertos de pele parcial, devido à falta de evidências científicas que possibilitem um achado conclusivo acerca do tema.

This study aimed to assess the possibility of establishing the most suitable split-thickness skin graft donor site dressings on the basis of scientific evidence gathered through a literature review. The most relevant studies originally published in any language in the last 7 years and indexed in the US National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and Latin American and Caribbean Literature Health Sciences (LILACS) databases were evaluated. A literature survey was performed using keywords related to the theme and inclusion and exclusion criteria. The final sample comprised 25 publications, one domestic and 24 international. The results showed a gap in the literature with respect to studies that evaluated different split-thickness skin graft donor site dressings. The literature review revealed the impossibility of establishing the most effective split-thickness skin graft donor site dressing due to the lack of scientific evidence, thus preventing the formulation of a definite conclusion on this topic.

[Covering of Finger-Tissue Loss by Local Flaps in Hanoi, Vietnam]. / Recouvrement des pertes de substance de la pulpe des doigts par des lambeaux locaux à Hanoï, Vietnam.

The accidental loss of fingertip soft tissues, which may expose tendons and bones, is a common injury in emergency departments. If these lesions are poorly treated, they can impair fine motor skills and tactile sensitivity of the fingertips. The study was conducted on 30 patients (24 males and 6 females) with 32 soft tissue defects of the fingertip treated in emergency plastic surgery with local pedicled flap at the Plastic Surgery Department of Saint Paul Hospital Hanoi from 01/2016 to 06/2017. The most common cause of injury (21/30) was occupational accidents. At the time of the accident, 12 patients did not have personal protective equipment (PPE). Among 18 patients who had one, eight had incomplete equipment. Of 32 implanted skin flaps, 31 survived completely without necrosis or infection, only one being affected by epidermolysis. Postoperative evaluation showed excellent motor skills for 31/32 fingers and a sensitivity restoration at S4 level for 27/32. Workplace accident is the main cause of fingers soft tissue defects. Covering the fingers soft tissue defects with local pedicled flap in emergency preserves the fine motor function and the delicated tactile sensation of the fingers.

Une étude sur les pertes de substance accidentelles de la pulpe des doigts et leur recouvrement par lambeaux locaux a été réalisée dans le service de chirurgie reconstructive de l'hôpital Saint Paul de Hanoï de janvier 2016 à juin 2017. Elle a concerné 30 patients, 24 hommes et 6 femmes. La cause la plus fréquente était l'accident de travail, soit 21/30 cas. Au moment de l'accident, 12 patients ne disposaient pas d'équipement de protection individuelle (EPI). Sur les 18 patients qui en possédaient, 8 avaient un équipement incomplet. Sur 32 lambeaux mis en place, 31 ont survécu complètement sans nécrose, ni infection, et un a subi une épidermolyse. Trente et un des 32 doigts opérés ont conservé une fonction motrice de bonne qualité et 27 ont récupéré une sensibilité de niveau S4. Le traitement en urgence des pertes de substance de la pulpe des doigts par des lambeaux locaux permet de préserver la fonction motrice fine et la sensibilité des pulpes des doigts.

Cierre de lesiones en pacientes con pie diabético por injerto de Davis / Closure of injures in patients with diabetic foot by using Davis' skin grafting

Los injertos de piel por método de Davis se caracterizan por ser injertos cutáneos autólogos con características especiales que comparten de otros tipos de injertos y que a su vez lo diferencian de ellos, tales como su grosor, el cual a nivel central es de mayores proporciones, pero que paulatinamente se adelgaza hacia la periferia con un diámetro alrededor de tres milímetros, facilitando su prendimiento. Debido a la gran resistencia que presentan son de mucha utilidad en áreas sometidas a traumas externos, como en pacientes portadores de pie diabético a los cuales se les haya realizado algún tipo de amputación menor, especialmente a nivel transmetatarsiano. A pesar de la sencillez y utilidad de esta técnica quirúrgica, continúa subutilizada debido a su poca difusión, lo que ocasiona su desconocimiento. Por lo anterior se considera de interés su publicación. Se presenta el caso de un paciente diabético tipo 2 e hipertenso de largo tiempo de evolución de ambas enfermedades. Es ingresado en el Servicio de Angiopatía Diabética con el diagnóstico de pie diabético neuroinfeccioso. Se le realizó desbridamiento quirúrgico con amputación de los dedos e injerto libre de piel por el método de Davis. La evolución y resultados fueron satisfactorios. El injerto de piel por este método constituye una buena opción para aquellos pacientes portadores de pie diabético que necesiten de cobertura cutánea, con baja morbilidad y excelentes resultados en aquellos pacientes en los que no se pueda realizar un colgajo en primera instancia(AU)

Davis´s skin grafting method is autologous skin graft with special characteristics that are similar to other types of grafting but some others make it different such as thickness which is at the central area thicker, but it gradually becomes thinner toward the peripheral area, with a 3 mm diameter, thus facilitating the engraftment. Due to its great resistance, this type of graft is very useful in areas under external traumas such as patients with diabetic foot who have undergone some kind of minor transmetatarsal amputation. Despite de simplicity and usefulness of this surgical technique, it remains underutilized since it is poorly publicized and practically unknown. This is the reason why it is interesting to provide information about it. Here is a type 2 diabetic and hypertensive patient who had suffered from both diseases for a long period of time. He was admitted to the diabetic angiopathy service and diagnosed with neuroinfective diabetic foot. He was performed surgical debridement with amputation of toes and free skin graft by using Davis' method. The results and the recovery were satisfactory. Skin grafting by Davis' method is a good choice for those patients with diabetic foot in need of cutaneos cover, with low morbidity rate and excellent results in patients who cannot be treated with a flap as a first option(AU)

Cierre de lesiones en pacientes con pie diabético por injerto de Davis / Closure of injures in patients with diabetic foot by using Davis' skin grafting

Los injertos de piel por método de Davis se caracterizan por ser injertos cutáneos autólogos con características especiales que comparten de otros tipos de injertos y que a su vez lo diferencian de ellos, tales como su grosor, el cual a nivel central es de mayores proporciones, pero que paulatinamente se adelgaza hacia la periferia con un diámetro alrededor de tres milímetros, facilitando su prendimiento. Debido a la gran resistencia que presentan son de mucha utilidad en áreas sometidas a traumas externos, como en pacientes portadores de pie diabético a los cuales se les haya realizado algún tipo de amputación menor, especialmente a nivel transmetatarsiano. A pesar de la sencillez y utilidad de esta técnica quirúrgica, continúa subutilizada debido a su poca difusión, lo que ocasiona su desconocimiento. Por lo anterior se considera de interés su publicación. Se presenta el caso de un paciente diabético tipo 2 e hipertenso de largo tiempo de evolución de ambas enfermedades. Es ingresado en el Servicio de Angiopatía Diabética con el diagnóstico de pie diabético neuroinfeccioso. Se le realizó desbridamiento quirúrgico con amputación de los dedos e injerto libre de piel por el método de Davis. La evolución y resultados fueron satisfactorios. El injerto de piel por este método constituye una buena opción para aquellos pacientes portadores de pie diabético que necesiten de cobertura cutánea, con baja morbilidad y excelentes resultados en aquellos pacientes en los que no se pueda realizar un colgajo en primera instancia(AU)

Davis´s skin grafting method is autologous skin graft with special characteristics that are similar to other types of grafting but some others make it different such as thickness which is at the central area thicker, but it gradually becomes thinner toward the peripheral area, with a 3 mm diameter, thus facilitating the engraftment. Due to its great resistance, this type of graft is very useful in areas under external traumas such as patients with diabetic foot who have undergone some kind of minor transmetatarsal amputation. Despite de simplicity and usefulness of this surgical technique, it remains underutilized since it is poorly publicized and practically unknown. This is the reason why it is interesting to provide information about it. Here is a type 2 diabetic and hypertensive patient who had suffered from both diseases for a long period of time. He was admitted to the diabetic angiopathy service and diagnosed with neuroinfective diabetic foot. He was performed surgical debridement with amputation of toes and free skin graft by using Davis' method. The results and the recovery were satisfactory. Skin grafting by Davis' method is a good choice for those patients with diabetic foot in need of cutaneos cover, with low morbidity rate and excellent results in patients who cannot be treated with a flap as a first option(AU)

Acellular dermal matrix and heel reconstruction: a new prospective.

BACKGROUND: Heel reconstruction represents a challenge for all plastic surgeons due to the anatomical and functional features of this weight-bearing area. In the last decade a combined use of acellular dermal matrices and skin grafts has been proposed as a reliable and less invasive alternative for complex wound management; nevertheless only a few cases have been reported in the literature. METHODS: We describe the long-term outcome of 2 cases of severe degloving trauma of the plantar region with massive soft tissue defects of the foot, that underwent surgical reconstruction with artificial dermis and skin grafts. At the fifth year of follow-up, both patients underwent a clinical and a computerized gait analysis to study their functional outcomes and the kinematics of their gait. RESULTS: Both patients recovered functional ambulation and returned to their own work and vocational activities, showing a symmetric gait and parameters of upright posture fully comparable to normality. CONCLUSIONS: Despite the initial concerns about the use of acellular dermal matrices and skin grafts for this kind of injury, they seem to be a simple and safe alternative for weight-bearing reconstruction of the degloved foot. The authors believe that the current study yields useful information and reassurance about their long-term reliability.

Neo-onfaloplastia com enxerto cutâneo / Neoomphaloplasty with cutaneous graft

Introdução: A cicatriz umbilical é decorrente da queda do coto umbilical, que ocorre alguns dias após o nascimento. Sua presença, formato e localização na parede abdominal fornecem ao indivíduo uma conotação estética e sensual. Métodos: Estudo primário, prospectivo, de intervenção. A casuística foi de conveniência, no período de fevereiro de 2006 a junho de 2016, incluindo pacientes de ambos os gêneros, alocados do ambulatório do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE) e clínica privada. Os critérios de inclusão foram pacientes com indicação de abdominoplastia e que apresentavam um comprometimento da irrigação da pele da região umbilical e periumbilical devido a defeitos herniários da região. O estudo seguiu os critérios de Helsinki e os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: Foram operados 28 pacientes, sendo observada uma boa integração da pele enxertada, resultando em uma cicatriz umbilical de aparência natural e sem complicações. Conclusões: A neo-onfaloplastia com enxerto cutâneo é de fácil execução e que, a longo prazo, tem demonstrado um bom resultado estético, principalmente nos retalhos abdominais espessos, demonstrando ser mais uma opção técnica na realização de neo-onfaloplastias.

Introduction: The umbilical scar is due to the fall of the umbilical stump that occurs a few days after birth. Its presence, shape, and location on the abdominal wall provide the individual with an aesthetic and sensual connotation. Methods: A primary prospective interventional study. The sample was of convenience, from February 2006 to June 2016, and included patients of both sexes attending the outpatient clinic of the Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE), a private clinic . The inclusion criteria were patients with abdominoplasty indications presenting with compromised circulation to the skin of the umbilical and periumbilical region caused by hernia defects in this area. The study followed the criteria of Helsinki and the patients signed an Informed Consent Form. Results: Twenty-eight patients underwent surgery and good integration of the grafted skin was observed. This resulted in an umbilical scar with a natural appearance and without complications. Conclusions: Neoomphaloplasty with a cutaneous graft is easy to perform and, in the long term, has shown to provide good aesthetic results, especially in thick abdominal flaps, thus proving to be an additional technical option for neoomphaloplasty procedures.

A Skin-stretching Wound Closure System to Prevent and Manage Dehiscence of High-tension Flap Donor Sites: A Report of 2 Cases.

Tension on the suture line of flap donor sites raises the risk of delayed healing and wound dehiscence. Closing a large flap donor site without a skin/flap graft is a major surgical challenge. Recently, the authors started using a skin-stretching wound closure system designed to harness both mechanical creep and stress-relaxation principles for the management of a variety of surgically closed wounds, including flap donor sites. The system consists of a pair of attachment plates connected by a long, flexible approximation strap that can be invasively (sutured) or noninvasively (by adhesion) secured to the skin wound edges and gradually tightened. The care and outcomes of 2 of the 41 patients whose wounds were managed with this system at the authors\'92 plastic/reconstructive and wound repair center during a period of 7 months are described. The first case involved a 20-year-old patient with a 16 cm x 8 cm deep inferior epigastric perforator flap to reconstruct a malignant tumor resection of the groin. The second patient required a 10 cm x 8 cm anterolateral thigh free-flap to repair a traumatic dorsal skin, soft tissue defect. Wounds were assessed and tension adjusted every 2 or 3 days. Both lesions healed by primary intention and with a good cosmetic outcome. Controlled clinical studies are needed to examine the effectiveness, efficacy, indications, complications, and cost effectiveness of this closure system.

Reabilitação em queimaduras de membros superiores / Rehabilitación en quemaduras de las extremidades superiores / Rehabilitation of the burned upper extremity

Objetivo: Analisar o perfil dos pacientes portadores de sequelas de queimaduras admitidos para reabilitação no Hospital Sarah Brasília, e descrever o número de atendimentos de acordo com a classificação de escala Graham e de McCauley. Método: Trata-se de estudo retrospectivo consecutivo de prontuários de pacientes atendidos no Hospital Sarah Brasília durante o período de cinco anos, devido à sequela de queimaduras nos membros superiores. Na admissão realizou-se a avaliação física e funcional, o exame radiológico, Classificação de Graham e de McCauley, nos casos de queimaduras elétricas, e eletroneuromiografia (EMG), para o planejamento cirúrgico. Os procedimentos cirúrgicos foram realizados em centro cirúrgico, sob anestesia geral e ou bloqueio de plexo braquial. Realizou-se análise das variáveis encontradas com auxílio do programa Epiinfo. O estudo foi avaliado e aprovado pelo Comitê de Ética em Pesquisa da Associação das Pioneiras Sociais (CEP/APS). Resultados: Foram atendidos 71 pacientes, 97 lesões de membros superiores, devido a queimaduras, entre 1 a 20 anos de idade (49%), predomínio do sexo masculino, provocadas por fogo (28%) e queimadura elétrica por alta tensão (25%), classificados Grau III e IV (60%), com 24% de pacientes amputados. Para 29% realizou-se mais de uma cirurgia, entre estes retalhos locais (13%), enxerto de pele (24%), fixação com fios de Kirschner (44%), retalho à distância (2%). Entre os procedimentos não cirúrgicos, foram utilizados órteses, fisioterapia e próteses. Conclusão: Constatou-se que no perfil do paciente portador de sequela de queimadura no Hospital de Reabilitação predominou o atendimento a adultos jovens, com deformidades antigas, graves de Grau III, IV e amputações. As limitações físicas causadas pela queimadura ocasionaram redução da função do membro superior, com sequelas variáveis e variedade de cirurgias, e programa de reabilitação multidisciplinar foi necessário.

Objective: To analyze the profile of patients with burn sequels at Hospital Sarah Brasília, and describe the number of medical staff appointments according to the rating scale Graham and McCauley. Method: Retrospective study of patients seen in Sarah Hospital for five years, due to sequels of burns on the upper limbs. On admission there was the physical and functional evaluation, radiological examination, Graham classification and McCauley in cases of electrical burns, and electromyography (EMG), for surgical planning. Surgical procedures were performed in the operating room under general anesthesia or brachial plexus block. We conducted analysis of the variables found with the aid of Epi-info program. The study was approved by the Ethics Committee. Results: We served 71 patients, 97 upper limb injuries due to burns, between 1-20 years of age (49%), male predominance, caused by fire (28%) and high-voltage electrical burn (25%) ranked Grade III and IV (60%), with 24% of amputees. For more than 29% undergone surgery, among these local flaps (13%), skin grafts (24%) with Kirschner wire attachment (44%), the distance retail (2%), among nonsurgical procedures were used orthotics, physical therapy and prosthetics. Conclusion: It was found that the profile of the burn sequel to a patient at the Rehabilitation Hospital predominant care for young adults with old deformities, severe Grade III, IV and amputations. The physical and psychological limitations caused by the burn caused reduction of upper limb function, with varying consequences and variety of surgeries, and multidisciplinary rehabilitation program was necessary.

Objetivo: Analizar el perfil de los pacientes con secuelas de quemaduras en el Hospital de Rehabilitación Sarah Brasília, y describir el número de evaluaciones de acuerdo a la escala de calificación Graham e de McCauley. Método: Se trata de un estudio retrospectivo consecutivo de las historias clínicas de pacientes tratados en el Hospital Sarah Brasília durante cinco años debido a secuelas de quemaduras en las extremidades superiores. A su ingreso se hizo la evaluación física y funcional, exámenes radiológicos, clasificación de Graham y McCauley en casos de quemaduras eléctricas, y electromiografía (EMG), para la planificación quirúrgica. Los procedimientos quirúrgicos se realizaron en el quirófano bajo anestesia general o bloqueo del plexo braquial. Hemos llevado a cabo análisis de las variables encontradas con la ayuda del programa Epiinfo. El estudio fue aprobado por el Comité de Ética. Resultados: Se atendieron 71 pacientes con 97 lesiones de los miembros superiores debido a quemaduras, entre 1-20 años de edad (49%), predominio masculino, causado por el fuego (28%) y quemadura eléctrica de alta tensión (25%) clasificados en grados III y IV (60%), 24% de amputados. Para el 29% se realizó más de una operación, entre colgajos locales (13%), injertos de piel (24%), fijación con agujas de Kirschner (44%), colgajos a distancia (2%). Entre los procedimientos no quirúrgicos, se usaron órtesis, terapia física y prótesis. Conclusión: Se encontró que en el perfil de pacientes con secuela de quemadura en Hospital de Rehabilitación predominaron adultos jóvenes con deformidades antiguas y severas, grado III y IV, y amputaciones. Las limitaciones físicas causadas por la quemadura causaron reducción de la función de los miembros superiores, con diferentes secuelas y variedad de cirugías, y programa de rehabilitación multidisciplinario era necesario.

The use of split-thickness versus full-thickness skin graft to resurface volar aspect of pediatric burned hands: A systematic review.

OBJECTIVE: The aim of this systematic review was to discuss the comparison of split-thickness skin graft (STSG) and full-thickness skin graft (FTSG) use as the treatment for volar digital and palmar burns in children. METHODS: We conducted PubMed and Cochrane Library searches using keywords "hand injuries", "contracture" and "skin transplantation". The search was limited to studies published from 1st January 1980 until 31st December 2013 and used English language. We selected the studies based on specific inclusion and exclusion criteria. We assessed the quality of the studies by using Newcastle-Ottawa Scale (NOS) for cohort studies. RESULTS: We included eight articles in our systematic review. One of those studies is a prospective cohort study and the others are retrospective cohort studies. Based on combined range of motion (ROM) evaluation in three studies, STSG group yielded poorer functional outcomes than FTSG group. However, there is no study which can fairly show that FTSG was significantly superior to STSG to achieve good functional outcomes. CONCLUSION: Currently, there is no strong, high-quality evidence to prove that FTSG is superior to STSG to cover pediatric palmar burns. Either FTSG or STSG can be utilized with consideration of several influential factors especially splinting and physiotherapy.

[Post-surgical management of split-thickness skin grafts in oculoplastic surgery]. / Operatives Management und Nachsorge freier Spalthauttransplantate in der okuloplastischen Chirurgie.

Malignant skin tumours in periocular regions often demand ophthalmo-surgical measures. Split-thickness skin grafts still represent an important treatment alternative when plastic-reconstructive covering through local tissue of the facial area is impossible. Essential technical steps to gain viable split-thickness skin grafts are introduced. Current standards in the after-treatment of split-thickness skin grafts at the receiving location as well as in the after-care of the donor area are presented from interdisciplinary points of view referring to the latest publications. Hydrocolloidal dressings are recommended for the after-treatment of removal areas such as the inside of the forearm since they improve post-surgical management for the ophthalmologist significantly and help in abbreviating healing duration. Pain sensation of the patient as well as the rate of infection are minimal. Throughout the early stages, split-thickness skin grafts at reception areas often demand an intensified local massage treatment with hydrocortisone 2.5 % ophthalmic cream. During the later stages follow-up measures should be stopped neither too soon nor abruptly. Ointments with polysiloxane and silicon dioxide preserve skin suppleness and prevent the occurrence of shrinkage as well as hypertrophic scars.

Nonsurgical scar management of the face: does early versus late intervention affect outcome?

Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity.

Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft.

BACKGROUND: The management of irreparable massive or full-thickness 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis remains a difficult challenge for the treating surgeon. Many different treatment options, with varied success, have been proposed. HYPOTHESES: (1) Patients undergoing reconstruction of irreparable massive or full-thickness 2-tendon rotator cuff tears by dermal tissue matrix xenograft would demonstrate improvements in pain, range of motion, strength, and subjective functional outcomes. (2) Postoperative ultrasonography would demonstrate intact repairs at a minimum 2-year follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty-six patients (27 shoulders) underwent reconstruction of irreparable massive or full-thickness 2-tendon rotator cuff tears by dermal tissue matrix xenograft. Pain level (scale 0-10, 10 = severe pain), active range of motion, and supraspinatus and external rotation strength were assessed. Subjective outcome measures included American Shoulder and Elbow Score (ASES) and Short Form-12 (SF-12) score. Clinical and radiographic analyses were performed at an average 32-month follow-up period (minimum 2-year follow-up). Ultrasound imaging (static and dynamic) of the operative shoulder was performed at final follow-up to assess the integrity of the construct. RESULTS: Mean patient age was 60 years. Mean pain level decreased from 5.1 to 0.4 (P = .002). Mean active forward flexion and abduction improved from 138.8° to 167.3° (P = .024) and 117.9° to 149.3° (P = .001), respectively. Supraspinatus and external rotation strength improved from 7.2 to 9.4 (P = .001) and 7.4 to 9.5 (P = .001), respectively. Mean ASES improved from 62.7 to 91.8 (P = .0007), and mean SF-12 scores improved from 48.4 to 56.6 (P = .044). Twenty-one patients (22 shoulders) returned for a dynamic and static ultrasound of the operative shoulder at a minimum 2-year follow-up. Sixteen patients (73%) demonstrated a fully intact tendon-graft reconstruction, 5 patients (22%) had a partially intact reconstruction, and 1(5%) had a complete tear at the graft-bone interface caused by suture anchor pullout as a result of a fall. There were no cases of infection or tissue rejection. CONCLUSION: Active patients with massive or 2-tendon rotator cuff tears with minimal glenohumeral arthritis continue to be a subset of the population for whom there is no current standard of care. Results suggest that the use of porcine xenograft may be an effective means by which to treat these patients.

Uso de matriz dérmica associado ao curativo por pressão negativa na abordagem da contratura em pacientes queimados / Use of dermal matrix and negative pressure dressings for the treatment of contractures in burn patients

INTRODUÇÃO: O aperfeiçoamento no tratamento inicial do paciente queimado, por meio da reposição volêmica e, principalmente, com excisão e enxertia precoce das lesões, resultou em profundo impacto na evolução dos indivíduos queimados, ocorrendo aumento da taxa de sobrevida. Com a maior sobrevida desses pacientes surgiu um novo desafio para a cirurgia reparadora, o tratamento das sequelas de queimaduras, principalmente compostas pelas contraturas. O objetivo deste estudo é demonstrar o uso da matriz dérmica artificial associado a terapia por pressão negativa no tratamento de sequelas de queimaduras. MÉTODO: Foram selecionados 10 pacientes com contratura por queimadura. Os pacientes selecionados foram submetidos a liberação da contratura cicatricial e colocação de matriz dérmica artificial (Integra®), conforme técnica padrão, e curativo por pressão negativa para cobertura. A cada 5 dias, foram realizadas trocas do curativo até completar período de 3 semanas a 4 semanas. Após esse período, o leito foi submetido a enxertia de pele. Os pacientes foram questionados, no pré e pós-operatório, quanto a sua satisfação com os aspectos estético e funcional da região abordada. RESULTADOS: Houve integração de cerca de 98% da matriz de regeneração dérmica na área em que a contratura foi ressecada. Também ocorreu integração de aproximadamente 85% dos enxertos utilizados. Todos os pacientes abordados referiram significativa melhora estética e, principalmente, funcional da região abordada. CONCLUSÕES: O uso da matriz de regeneração dérmica associado a terapia por pressão negativa promove maior taxa de sucesso na abordagem da contratura cicatricial, proporcionando melhor resultado tanto funcional como estético nos pacientes com sequelas graves de queimadura.

BACKGROUND: Burn patients are initially treated with volume replacement and, importantly, subsequent excision and early grafting of their injuries. These first aid measures improve the progress and survival rates of burned individuals. However, this treatment creates a new challenge in reparative surgery with regard to the management of burn sequelae, which mainly include contractures. In this study, we aimed to assess the effect of artificial dermal matrix application and negative pressure therapy on the treatment of burn sequelae. METHODS: Ten patients with burn contractures were selected for this study and underwent scar contracture release, wound coverage with an artificial dermal matrix (Integra®), and negative pressure dressing according to the standard procedures. Dressing changes were performed every 5 days for 3-4 weeks. A skin graft was then laid on the wound bed. In the pre- and postoperative period, the patients were asked to rate their satisfaction with the aesthetic and functional aspects of the treated region. RESULTS: In the areas in which the contractures were resected, integration of almost 98% of the dermal regeneration matrix was observed. Also integration was observed in 85% of the grafts used. All the patients reported a significant aesthetic and, in particular, functional improvement of the treated region. CONCLUSIONS: The use of dermal regeneration matrix and negative pressure therapy for the treatment of scar contractures improves the success rate and the aesthetic and functional outcomes of patients with severe burn sequelae.

[Cost-effective change in treatment after split skin grafting to lower leg defects]. / Omkostningseffektiv ændring af behandling ved delhudstransplantat på crus.

We present a clinical comparison of short stretch bandage versus a two-layer compression bandage and early mobilization after split skin grafting to lower leg defects. A total of 38 patients were included. The first group were immobilized for four days and given a short stretch support bandage. Group 2 were mobilized one day after the operation with a two-layer compression bandage (Pro-Guide). There was no difference in healing or frequency of complications. The patients treated with Pro-Guide had significantly fewer admission days and out-patient consultations. Larger randomized trials are warranted.