Burns : journal of the International Society for Burn Injuries
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Thermal injury to skin and subcutaneous tissue is common in both civilian and combat scenarios. Understanding the change in tissue morphologies and properties and the underlying mechanisms of thermal injury are of vital importance to clinical determination of the degree of burn and treatment approach. This review aims at summarizing the research involving experimental and numerical studies of skin and subcutaneous tissue subjected to thermal injury. ⋯ The first part deals with experimental studies including burn protocols and prevailing imaging approaches. The second part deals with existing numerical models for burns of tissue and related computational simulations. Based on this review, we conclude that though there is literature contributing to the knowledge of the pathology and pathogenesis of tissue burn, there is scant quantitative information regarding changes in tissue properties including mechanical, thermal, electrical and optical properties as a result of burns that are linked to altered tissue morphology.
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This study of burns patients from two eruptions of Merapi volcano, Java, in 1994 and 2010, is the first detailed analysis to be reported of thermal injuries in a large series of hospitalised victims of pyroclastic surges, one of the most devastating phenomena in explosive eruptions. Emergency planners in volcanic crises in populated areas have to integrate the health sector into disaster management and be aware of the nature of the surge impacts and the types of burns victims to be expected in a worst scenario, potentially in numbers and in severity that would overwhelm normal treatment facilities. In our series, 106 patients from the two eruptions were treated in the same major hospital in Yogyakarta and a third of these survived. ⋯ Crucially, 45% of patients were in the 40-79% TBSA range, with most suspected of suffering from inhalation injury, for whom survival was most dependent on the hospital treatment they received. After reviewing the evidence from recent major eruptions and outlining the thermal hazards of surges, we relate the type and severity of the injuries of these patients to the temperatures and dynamics of the pyroclastic surges, as derived from the environmental impacts and associated eruption processes evaluated in our field surveys and interviews conducted by our multi-disciplinary team. Effective warnings, adequate evacuation measures, and political will are all essential in volcanic crises in populated areas to prevent future catastrophes on this scale.
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Thermal injuries are one of the most physically and psychologically devastating causes of pediatric trauma. Post-traumatic sequelae such as hypertrophic scars and contractures often result in long lasting morbidity and disfigurement. Conservative therapy, including pressure garments and silicone, is the gold standard for scar management in the pediatric population. Most recently percutaneous collagen induction (PCI) was introduced as an alternative treatment in adults. The aim of this report was to share our experience with PCI in children and adolescents in scar management following thermal injuries. ⋯ PCI is an enrichment of the armamentarium for scar treatment following thermal injuries in children and adolescents. Further prospective studies are recommended regarding the optimal timing for this treatment and long term outcome in the pediatric population.
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Case Reports
Sub fascial flap based on the supraclavicular artery in reconstruction of neck burn contractures.
This study presents 3 cases of women ages ranged from 25 to 52 years with anterior cervical contractures caused by burns that resulted in functional and aesthetic deficit. Contracture release in 3 patients and reconstruction was done using a sub-fascial flap whose main pedicle was the supraclavicular artery and the occipito-postero-cervical vessels that were preserved. The flap was designed differently from the classically described that uses the skin of the shoulder but which presents differences of color and texture with relation to the skin of the neck. The results were satisfactory and no complications such as infections or necrosis.
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In hypertrophic scar assessment, laser Doppler imaging (LDI), colorimetry and subjective assessment (POSAS) can be used to evaluate blood flow, erythema and redness, respectively. In addition, the microvasculature (i.e. presence of microvessels) can be determined by immunohistochemistry. These measurement techniques are frequently used in clinical practice and/or in research to evaluate treatment response and monitor scar development. However, until now it has not been tested to what extent the outcomes of these techniques are associated, whilst the outcome terms are frequently used interchangeably or replaced by the umbrella term 'vascularization'. This is confusing, as every technique seems to measure a specific feature. Therefore, we evaluated the correlations of the four measurement techniques. ⋯ Blood flow, the presence of microvessels and erythema appear to be different hypertrophic scar features because they show an absence of correlation. Therefore, in the field of scar assessment, these outcome terms cannot be used interchangeably. In addition, we conclude that the term 'vascularization' does not seem appropriate to serve as an umbrella term. The use of precise definitions in research as well as in clinical practice is recommended.