The Journal of craniofacial surgery
-
Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. ⋯ Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.
-
Fluid resuscitation after thermal injury in a child or infant can pose a set of unique and significant challenges. Many approaches to fluid resuscitation of children after burns exist, and most are nonevidence based. This review will highlight the important concepts involved in pediatric fluid resuscitation from thermal injury.
-
Lower-extremity burns in a pediatric patient require special consideration. The management of burn reconstruction in pediatric patients is often complex, requiring multiple reconstructive operations, and the primary intention of the surgeon is to prevent burn scar deformities. ⋯ In addition, we address methods of repairing scar contracture, a common occurrence in burn patients, at specific locations on the lower extremity. Finally, special scenarios such as burns associated with fractures, burn injury in insensate children, and Marjolin ulcer are discussed.
-
Burns are common injuries in the pediatric population, with an estimated 250,000 pediatric burn patients seeking medical care annually. A relative few require inpatient management. This article discusses suggestions for burn prevention, as well as acute burn care and long-term management of small burns.
-
Advances in cellular biology and knowledge in wound healing and growth factors have given us a wide variety of choices to attack the problem of the complex burn wound. Split-thickness skin grafting with autograft is at present the standard of care. It, however, is not an ideal substitute and frequently is not available for full-burn coverage. This article will review honey, human amnion, xenograft, allograft, cultured epithelial autograft, and various engineered commercial products for use in the biologic treatment of burn wounds.