Use of autologous adipose tissue in acute burn wound management: A systematic review.

Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in burn wounds and reconstructive surgery. The present systematic review aimed to evaluate the effectiveness of autologous fat transfer for acute burn wound management. A systematic review of the US National Library of Medicine, Cochrane Library, Web of Science, and Embase was conducted on October 15, 2022 (registration number CDR42022369726). A database watch was performed until submission of the manuscript. The review focused on wound healing. All studies reporting fat transfer in adult patients (at least 5 patients reported) with deep 2nd degree burn wounds were included. The database search yielded a total of 720 records and 367 patients were included from 3 studies. A statistically significant improvement in scar texture, scar appearance, and time to healing was reported in one study in the fat transfer group versus control (P<0.001). Similarly, scores for scar color, scar thickness, scar stiffness, and scar regularity increased significantly. The small number of included studies and their heterogeneity did not allow a meta-regression to be performed. This systematic review emphasizes the limited evidence currently available regarding the use of autologous fat transfer to improve burn wound healing in adult patients, even though it seems promising. Future search should focus on randomized controlled trials with a larger number of participants.

Modified Colson flap with subcutaneous liposuction for one-stage donor site removal: A case series.

OBJECTIVES: The aim of this study was to evaluate the functional and cosmetic results of an innovative procedure for modified Colson flap-graft consisting of immediate defatting of the flap by a liposuction cannula. METHODS: A cross-sectional study was performed among patients with deep hand burns requiring a modified Colson flap between 2018 and 2021. Outcomes included functional and cosmetic assessment of the hand through a quality-of-life questionnaire, a sensitivity scale and a scar assessment scale. RESULTS: During this period, 7 patients were operated on using our technique. One patient was lost to follow-up; 7 patients with a median age of 44 years were included, with a total of 10 burned hands. The burns were thermal in 5 out of 7 cases and the coverage concerned the whole hand in 50% of the cases. The flaps all received cannula defatting. The median time to flap weaning was 23 days (20 to 30 days). The median follow-up was 16 months. One case required remote flap weaning. The median POSAS (Patient and Observer Scar Assessment Scale) per patient was 4 and 2 per observer. The median BMRCSS (British Medical Research Council Sensory Scale) was 122. One case had recovered S2 sensitivity, the other cases had S3 or S4 sensitivity. CONCLUSION: Immediate defatting is one of the factors in tegumental quality allowing rapid functional recovery of the hand. The cannula defatting technique does not appear to require additional defatting time. The use of the liposuction cannula allows a one-step, homogeneous, and easier defatting, with a lower risk of devascularization.

[How to treat palmar burn sequelae in children, about 49 cases]. / Prise en charge des séquelles de brûlure palmaire chez l'enfant, à propos de 49 cas.

INTRODUCTION: Even if they represent only 2.5 % of the total body surface area, the hands are burnt in 50 % of hospitalized patients. The risk of sequelae is significant, especially in children, human being in full growth, and a source of aesthetic and functional handicap. The aim of this study is to research the predictive factors of sequelae, to study their treatment of and their evolution. MATERIAL AND METHODS: We included children under six years of age with deep palmar burns of the hand between 1998 and 2008. Demographics, characteristics of the initial burn and its treatment were noted. Then, we studied the types of hand burn sequelae and their treatment. Finally, we observed their evolution over time with an aesthetic and functional evaluation and their impact on quality of life. RESULTS: Forty-nine children, representing 70 hands, were included in the study. The mean age at the time of the initial burn was 16.2 months (6; 60). The initial treatment was directed healing in 39 % of cases and thin skin excision-grafting in 61 % of cases. The type of sequelae most represented was bridle in 73 % of cases. Treatment consisted of rehabilitation measures (13 %) or surgery (69 %). The mean age at the time of surgery was 10.1 years (4; 19). These were plasties (62 %), total skin grafts (15 %) or a combination of both (23 %). The current follow-up is 16.2 years. The aesthetic result is considered good in 52 % of cases, the functional result is good in 78 % of cases. The impact on the quality of life is low and the parents are satisfied with the initial care. CONCLUSION: The treatment of the sequelae of burnt hands gives good results but involves well-conducted rehabilitation and regular monitoring. The treatment period must be adapted and the surgery simple, effective and specific to the type of sequelae.

Innovative adaptation of the "spare tissues concept" applied for olecranon coverage of a severe burn patient: A case report.

BACKGROUND: The management of bone exposure in patients with extensive burns could be a challenge due to the lack of healthy tissue. In such cases, it could be interesting to use any still healthy tissue initially destined for amputation and use it to cover up another site. We present the case of a sever burn patient for whom we used the only healthy palmar hand skin to cover an olecranon exposure. CLINICAL CASE DESCRIPTION: A 38-year-old man has been admitted in burn victim unit with extensive deep burns on 60% of the total body surface. An exposure of the left olecranon was appeared occurring on a burned area, with absence of healthy local tissues available for coverage. Concomitantly a trans-radial amputation was indicated because of severe digits burns leading to an impossibility to preserve the function of the hand. A palmar skin area was healthy leading to harvested this palmar skin flap pedicled on ulnar vessels. Early post-operative healing was satisfactory and no vascular suffering of the flap has been observed with a total healing at three weeks. CONCLUSION: In any patient the spare tissues concept should be keep in mind when amputation is indicated simultaneously with a problematic of loss of substance coverage to a proximity area. In this case of severe burn patient, we used a palmar skin flap pedicled on the ulnar vessels to cover an olecranon exposure.

[Diagnostic pitfall: Early arising, multiple and recurrent Marjolin's ulcer. About 8 patients (16 tumors) and literature review]. / Piège diagnostique : l'ulcère de Marjolin d'apparition précoce, multiple ou récidivant. À propos d'une série de 8 patients (16 tumeurs) et revue de la littérature.

INTRODUCTION: Marjolin's ulcer (MU) is a large entity representing skin cancers resulting from the transformation of chronic wounds of a heterogeneous nature. Burn scars are the most at risk of degeneration, in particular because there are the sites of important skin tension. Atypical forms are not uncommon. The objective of this study is to present these exceptions which are underestimated. MATERIALS AND METHODS: All patients with UM in our centre between January 2011 and February 2019 have been included permitting to report the initial pathology, the location, the latency time, the histology and the management carried out. RESULTS: Eight patients were treated in our center for MU, they developed 16 skin cancers. Fourteen were squamous cell carcinomas (SCC). The shortest latency period was 2 months. The youngest patient was 22 years old when she was diagnosed with MU. Three patients had at least 2 synchronous SCC. One patient had a recurrence after a split-thickness skin grafting on artificial dermis and 2 patients had second locations. CONCLUSION: Atypic forms are not rare. MU is commonly recurrent, multiple, early arising and may appear in young people. The treatment of chronic wounds cannot be dissociated from the treatment of contractures, otherwise the wound will inevitably reappear.

[Plastic surgery and fighting: Our experience during Nagorno-Karabakh war in 2020]. / Chirurgie plastique et conflit armé : notre expérience lors du conflit au Haut-Karabakh en 2020.

INTRODUCTION: This work relates the experience of three French surgical missions in the care of the war wounded during the armed conflict in Nagorno Karabakh which took place from September 27 to November 10, 2020. MATERIALS AND METHODS: Three surgical missions were carried out in Armenia between October 2020 and January 2021. Surgeons intervened in different hospitals, at different times of the conflict and on various war wounds. RESULTS: The presence of a plastic surgeon proved to be essential in the care of war wounded, especially in delayed emergency and secondary care. The ortho-plastic treatment offered during these missions has proven to be effective in the reconstruction of limbs. These missions made it possible to introduce the induced membrane technique of Masquelet AC in Armenia. During our visit to the Yerevan burn center, we mentioned the very probable use of white phosphorus as an etiology in several of the cases analyzed. CONCLUSION: We relate the particular experience of civilian surgeons in the context of a modern armed conflict. The presence of a plastic surgeon proved to be indispensable in the care of war wounded and especially in their secondary reconstructions.

[Use of methoxyflurane on acute pain during burn dressing in adult consultation]. / Utilisation du méthoxyflurane sur la douleur aiguë lors du pansement en consultation des brûlés adultes.

INTRODUCTION: The objective was to compare the short-term efficacy of methoxyflurane vs. MEOPA on acute pain during burn dressing in consultation, the secondary outcome was to assess the patient's comfort and the quality of the dressing performed. MATERIALS AND METHODS: Monocentric, prospective study from April 2018 to January 2019. Men and women>18 years presenting acute burn on<10% SCT were included. A pain≥4 on the numerical scale (from 0 to 10) at the beginning of the treatment established the indication of methoxyflurane or MEOPA, with randomization done by a nurse. The following data were collected: burn description, performed debridement, pain assessment by numerical scale: on arrival, at the beginning of care, after 6 to 10 inhalations for methoxyflurane or 3 to 4minutes of inhalation for MEOPA and at the end of care. RESULTS: Sixty patients were included, 30 in each group. There was a decrease of -2.47 points of numerical scale when initiating methoxyflurane against -1.53 points for MEOPA (P=0.08). Patients were significantly less painful when stopping treatment in the methoxyflurane group -4 points vs -2 points (P=0.001). Methoxyflurane significantly improved the debridement of the burn (P=0.018). CONCLUSION: Methoxyflurane is more effective than MEOPA in acute pain in burn dressing, improved patient comfort, and improved dressing quality.

[Tissue expansion in child's burn reconstruction. Management principles and eleven years retrospective study of 42 patients]. / Expansion cutanée pour séquelles de brûlure de l'enfant. Principes de prise en charge et étude rétrospective de 42 patients sur 11 ans.

PURPOSE: With constraints and a risk of complication, tissue expansion in child's burn sequelae need a controlled surgical procedure, and a therapeutic plan appropriate to the specific pediatric healing, growth, and development. MATERIAL AND METHODS: Our principles of management and technical points are described. A retrospective study of tissue expansion in child's burn sequelae between 2005 and 2016 is submitted. RESULTS: There are 185 expanders, 98 protocols in 41 children, over half of sequelae concerning scalp, neck and chest. Mean age at the first expansion was 10.3 years old (5.8 years after burn). There are in average 2,4 (1-8) protocols by patient, with 1.9 (1-4) expanders by procedure. Surgical repair was a flap (78.8%), a full-thickness skin graft (13.3%) or both. Fifteen patients (30 expanders (14.6%) and 22 protocols (22.4%)), had expansion's complications, mostly infections and expositions. Eight patients (14 expanders (7.6%) and 10 protocols (10.2%)) had reconstructive's complications. An increase of burn area was a risk factor of complication (significant). Complicated expanders rate by location was 7.9% (scalp), 12.5% (neck), 9.8% (supraclavicular), 10.5% (chest), 19.4% (abdomen), 30% (buttock), 29.4% (lower limb), 1/2 (face). CONCLUSION: Tissue expansion in child's burn sequelae is ideal in scalp, good in neck, chest and proximal upper limb, and to do carefully in lower limb and face.

[Burns by immersion in children and abuse]. / Brûlures par immersion chez l'enfant et maltraitance.

AIM OF THE STUDY: Ten percent of childhood burns could arise from maltreatment. While describing 6 severe cases of inflicted scalds by immersion in children, we expose our systematic diagnostic approach of abuse and confirm the serious nature of burn when they are inflicted. PATIENTS AND METHOD: The retrospective study concerned children hospitalized for scalds by immersion between 2013 and 2016 and for whom child abuse has been confirmed. Sex, age, burns description, needs of surgery, length of stay at hospital and protection plan set up were collected. RESULTS: Six cases of burns by immersion due to maltreatment were identified (5 boys, 1 girl) with a median age of 12 months. The average total burn surface area was 19%. Burns were of deep second and third degree and always symmetric. Every child underwent surgery at least once. Concern information was transferred for all of them. CONCLUSION: Teams taking care of children with burns must be trained to the difficult diagnostic of abuse or neglect so that early social interventions can be set up in case of maltreatment.

Thermal and chemical burns caused by e-cigarette battery explosions.

INTRODUCTION: E-cigarettes have become the main alternative to traditional cigarettes. An increasing number of explosive accidents with e-cigarettes have been described over the past years. Through our experience of sixteen consecutive cases, we wanted to acquire a better understanding of the origins and to specify the principles of management for these particular new burns. METHODS: A retrospective study was conducted to review all cases of burns related to e-cigarettes referred to our burn center from April 2014 through May 2019. Several key data were collected in relation to the patients, the circumstances and characteristics of the burns, their treatment and follow-up. RESULTS: In the past five years, sixteen patients were burned by e-cigarette explosions. They were all males with an average age of 41 years. They all had second or third degree burn injuries. The average burned area was 5% TBSA. The areas that were burned were the hands, buttocks, thorax, thighs and genital areas, and were always related to clothes pocket location. Eight patients described an increase in pain after cooling, suggesting significant contamination of the burn by lithium-ion deposits. Six required surgical management with excision and split-thickness skin graft. The others healed spontaneously in several weeks. CONCLUSIONS: Burns by e-cigarette lithium batteries explosion have a double mechanism (thermal and chemical). Carrying cigarettes in a pocket close to the body is a significant risk factor to which the male population is particularly exposed. Early debridement is recommended when possible while initial cooling does not seem helpful and is sometimes painful.

[Superficial circumflex iliac artery perforator free flap in pediatric reconstruction: A case report]. / Lambeau libre SCIP en reconstruction pédiatrique : à propos d'un cas.

The dorsalis pedis reconstruction requires to bring a thin tissue to recover every noble structure of the foot including tendons, nerves and vessels while resisting the stress induced on these structures when walking or wearing shoes. We report the case of a thirteen year-old child who presented a third-degree burn sequelae on the dorsalis pedis with scar retraction and chronic ulceration on the fifth metatarsal despite multiple skin grafts. He couldn't put on his shoes because of the pain and walking was difficult. We performed a SCIP flap (Superficial Circumflex Iliac Artery Perforator) to reconstruct this defect. The flap measuring 12×7cm has been harvested on the right groin and anastomosed with the pedicle of the first intermetatarsal space. At 3 months postoperatively, the child can put on his shoes again and walk without pain. The donor site is discrete in the inguinal crease, hidden in the underwear. The SCIP flap is a thin and pliable flap with a discrete donor site. It is suitable for reconstructions of distal extremities of limbs, both in adults and children.

[Nutritional aspects of the management of the severely burned patient]. / Aspects nutritionnels de la prise en charge du patient brûlé grave.

The nutrition of the severely burned patient is one of the pillars of his or her care, from the first few hours after the accident to rehabilitation. When properly conducted, there is a recognized beneficial effect on morbidity and even mortality.

[Adult thermal burn dressings in three acts]. / Les pansements de brûlés thermiques adultes en trois actes.

Dressings are a real challenge in the care of patients with thermal burns. They help to heal and prevent or treat possible skin infections. Paramedical teams must have a perfect strategy for organizing, managing pain and optimizing hygiene and asepsis rules. The purpose is to facilitate the understanding and implementation of this treatment by suggesting protocols that can be applied by all. It remains essential to mobilize specialized services to promote the evolution of burns.

[Management of severe burn pain]. / Prise en charge de la douleur du brûlé grave.

The experience of pain during a severe burn is multifactorial, both in the typology of the burn and in the circumstances of its occurrence. Third-degree burns are painless as the dermis and its nociception sensors are damaged. After a severe burn, from initial management, to home care, to a long hospital stay, pain evolves with its etiology and requires specific management.

[Severe burns, a long journey of care and rehabilitation]. / Le brûlé grave, un long parcours de soins et de réhabilitation.

At the patient's bedside 24 hours a day, the nurse is at the heart of the rehabilitation management of the severely burnt patient: installation, technical dressings, supervision of postures and placement of compressors, to limit the functional consequences to the type of retractable and hypertrophic scars. The nurse takes care of the patient in this long journey leading to social reintegration; from accompaniment to autonomy and acceptance of self-image.

[Pre-hospital treatment of the seriously burned person]. / Parcours préhospitalier du brûlé grave.

Pre-hospital management of a severe burn begins with an early assessment of the burn (burned skin surface, depth, location) and the concerned patient (age, comorbidities, injury associations). The immediate vital prognosis is more often due to associated injuries (trauma or poisoning) rather than burns. The patient must be referred by medical regulation to a burn treatment centre.

[Telemedicine and initial medical regulation of severe burns]. / Télémédecine et régulation médicale initiale du brûlé grave.

The evaluation of the patient and his burned body surface is one of the fundamental prerequisites for his care on site as well as for the initiation of his care journey. New tools such as the E-burn application and telemedicine improve this assessment and remote medical assistance management by reducing the risk of under-sorting or over-sorting. Telemedicine limits inappropriate secondary inter-hospital transfers and the resulting increased mortality. It is carried out according to standards that ensure safety and confidentiality for the patient and caregivers.

[Scalp burns induced by hair bleaching]. / Brûlure du cuir chevelu induite par les décolorations capillaires.

BACKGROUND: Hair bleaching is increasingly being carried out in hairdressing salons. The products used are a mixture of hydrogen peroxide and persulfates, both active chemical agents. Scalp burns secondary to hair bleaching are a traumatic adverse effect rarely discussed in publications that continue to be little known among healthcare professionals. PATIENTS AND METHODS: We report the case of a 15-year-old girl with a plaque of scarring alopecia on the vertex. This lesion resulted from a deep burn following a hair-bleaching procedure. Healing took around 4 months, resulting in discomfort for our patient. DISCUSSION: This is a rare case of scarring alopecia following a basic chemical burn to the scalp. The oxidation reaction induced by the mixture of hydrogen peroxide and persulfates, prepared in a basic medium, causes bleaching of the melanin pigments in hair. The clinical presentation of a single, well limited, painful, oozing ulceration located at the vertex was similar to the other cases published in the literature. Although a chemical burning mechanism is most often incriminated, the procedure is always coupled with use of a heat source and associated thermal burn may occur. The delayed appearance of the lesion appears to be caused by the forming of surfactants by the hydrogen peroxide/persulfate mixture, resulting in slow dissolution of the oxidizing compounds within the stratum corneum.

Our 35 years' experience on postburn heterotopic ossification: A three-step treatment.

Our retrospective study of burn patients presents a three-step treatment of heterotopic ossification: excision surgery, early rehabilitation, and analgesia. We included patients admitted to the department for treatment of postburn heterotopic ossification between January 1, 1979, and September 30, 2015. The mean age at the time of the burn was 43.3 years. Men accounted for the majority of burn patients who developed an osteoma (70.8%). The mean total skin area burned was 38.4%. No osteoma justifying surgery was found for any patient with a total burned skin area less than 19%. The burned zones were related to the osteoma development in 94.3% of cases. On average, the surgery took place 10.8 months after the burn. The osteotomy was accompanied by surgical treatment of a contracture in 37.1% of patients. Most of the osteomata were found at the elbows (30), followed by the shoulders (3), and finally the knees (2). Rehabilitation began on D0 after the surgery, except if a flap or a thin-skin graft was used. Regarding analgesia, opiates were prescribed systematically during the immediate postoperative period. Elbow range of motion on flexion improved by a mean of 84.1°. During the postoperative period, we found 2 recurrences of osteoma and 1 elbow hematoma in two separate patients. There were no postoperative infections or neurological sequelae. Our retrospective French study confirmed results found in the international literature. The three-step treatment - excision surgery, early rehabilitation, and antalgia - seems to be the best means of treating osteoma with satisfactory results. Surgery is indicated only in the case of functional impairment and not simply based on imaging.

[Management of hypopigmented scars following burn injuries]. / Prise en charge des cicatrices hypopigmentées post-brûlure.

OBJECTIVE: Permanent hypopigmentation of burn scars is a common consequence after partial and full thickness burns that heal by secondary intent, and they can cause severe aesthetic issues. The surgical goals for effective treatment of postburn hypopigmentation are to remove scar tissues, and to produce healthy melanocytes, with minimal donor site morbidity. This article reviews the current literature about the different ways to treat hypopigmentation following burn injuries and discusses the indications. METHODS: The PubMed database was searched for articles published from 1985 and up to 2016. Papers with regards to the management of hypopigmented lesions were included only if scars were following burn injuries. The treatments were assessed according to body region treated, surface involved, skin color, effectiveness on restoring skin pigmentation. RESULTS: Sixteen studies were included in this review. Non-surgical treatments like makeup and tattooing, and surgical treatments including thin skin grafting, chip skin grafting, punch grafting, non-cultured keratinocyte-melanocyte cell suspension, and cultured epidermal cells were all compared. CONCLUSION: Thin skin grafting is a reliable treatment especially for patient who suffer from small hypopigmented lesions as this method requires a donor skin of the same size. The cell suspension procedure may be beneficial for larger scars. Moreover demarcation between skin graft and normal skin may exist and when a precise color match is required, particularly in the head, tattooing and chip skin grafting produce a good pigmentation outcome.