Four consecutive patients underwent composite resection of tonsillar cancer and reconstruction with a microvascular radial forearm free flap. Three patients had postoperative assessments of speech at six to nine months respectively. One patient could not attend for the postoperative assessment. The speech assessment was examined by same speech therapist. All the patients had an good postoperative speech assessment. Compared to conventional local or regional myocutaneous flaps, the thin forearm free flaps offers better postoperative articulatory recovery.
Forearm* ; Free Tissue Flaps* ; Humans ; Myocutaneous Flap ; Tonsillar Neoplasms

PURPOSE: Burns are an important cause of injury to young children. The aim of this study was to investigate epidemiology in preschooler's burns. METHODS: A retrospective study was reviewed age, sex, burn surface area, and burn type in preschool children underwent burn surgery. Children were classified into three age groups: infant group (<1 years), toddler group (1~3 years), and early childhood group (4~7 years). RESULTS: Over the 3 year period a total of 2041 burned preschoolers received burn surgery. The mean age was 2.3+/-1.7 years old. Boys accounted for 55.4% of the cases. Scalding was the most common cause (56.8%), followed by contact (31.7%). Averaged burn size was 2.6+/-4.2%. Toddler group was most affected by burns (60.1%). The incidences of severe burns (> or =10% of the body surface area) in groups of infant, toddler, and early childhood were 7.9%, 5.6%, and 4.7%, and the mean burn size were 18.7+/-1.7% (P=0.003 vs. toddler group), 13.7+/-0.4%, and 17.7+/-2.7%, respectively. CONCLUSION: The major etiology in preschool children' burns was scalding. Toddler was most affected age group. In severe burns, infant group showed larger burn size than toddler group.
Burn Units ; Burns ; Child ; Child, Preschool ; Humans ; Incidence ; Infant ; Retrospective Studies

PURPOSE: Ascorbic acid is a potent antioxidant capable of scavenging oxygen free radicals. We investigated the effect of ascorbic acid on initial management of a major burn. METHODS: A total of twenty two patients with extent of burn injury greater than 30% of the body surface area (BSA) were enrolled. Early fluid resuscitation was performed with Parkland formula (<40% BSA) and modified hypertonic formula (> or =40% BSA). In ascorbic acid group, ascorbic acid was continuously infused at a dose of 30 mg/kg/h during first 24 hours of fluid resuscitation. Target urine output was 0.5~1 ml/kg/h. RESULTS: There were no significant differences in age, sex, and BSA among the groups. In the cases of Parkland formula, there was no significant difference in the fluid requirement between control group (4.26+/-1.29 ml/kg/%burn) and ascorbic acid group (3.53+/-0.87 ml/kg/%burn). However, in the cases of modified hypertonic formula, there was significant difference in the fluid requirement between control group (3.31+/-0.95 ml/kg/%burn) and ascorbic acid group (2.34+/-0.35 ml/kg/%burn). CONCLUSION: High-dose ascorbic acid reduces fluid requirement at early fluid resuscitation in severely burned patients managed with modified hypertonic formula.
Ascorbic Acid ; Body Surface Area ; Burns ; Fluid Therapy ; Free Radicals ; Humans ; Oxygen ; Resuscitation

This paper presents our clinical experiences for reconstruction of the linear depressed postburn scar band by rhombus subcutaneous pedicle skin flap (RSPF). We report new RSPF, it’s versatility, and effectiveness for correction of the mild to moderate linear depressed postburn scar band. To correct the postburn scar band, we have newly designed the Rhombus Subcutaneous Pedicle Skin Flap (RSPF), which is made as rhombus-shaped skin flap on the inside of scar band. After excision of burn scar band, the each vertex of RSPF flap is advanced into the skin defects at apex of extended skin incision, which is starting from the upper and lower portion of the removed burn scar band at a near right angle. This flap can add more extra skin to adjacent superior and inferior area of excised scar band. We have experienced 2 cases of RSPF for reconstruction of linear depressed postburn scar band deformities in lower extremity. After 3 weeks to 3 months postoperative follow ups, relatively satisfactory results were obtained in all cases. We had successfully reconstructed the linear depressed postburn scar postburn band of lower extremity using the rhombus subcutaneous pedicle skin flap. For the correction of mild to moderate sized linear depressed postburn scar band deformities in extremity, the RSPF is simple, and very effective without donor morbidity.

PURPOSE: Inofoam(R) is a hydrocellular material developed recently for wound dressing. In the present study, the efficacy of Inofoam(R) for donor site dressing after split thickness skin graft (STSG) was evaluated and compared with that of Medifoam(R). METHODS: The study was conducted on 15 patients with third degree of burn underwent STSG from Nov. 2011 to Feb. 2012. Donor sites were divided into groups of Inofoam(R) and Medifoam(R). The duration of wound healing, pain score and exudate absorption ratio were compared between the two groups. RESULTS: The duration of wound healing time was 10.7+/-2.2 days in Inofoam(R) group, 10.5+/-2.0 days in Medifoam(R) group (P>0.05). On postoperative 1 day, the exudate absorption ratio in was 341.6+/-59.3% in Inofoam(R) group and 349.0+/-41.8% in Medifoam(R) group. There were no significant differences in wound healing duration, swelling ratio, and pain score between the two groups (P>0.05). CONCLUSION: The present study shows that the efficacy of a recently used polyurethane foam Inofoam(R) for donor site dressing is as effective as that of Medifoam(R).
Absorption ; Bandages ; Burns ; Exudates and Transudates ; Humans ; Polyurethanes ; Skin ; Tissue Donors ; Transplants ; Wound Healing

PURPOSE: Central venous catheterization is associated with infection. We evaluated the colonization rate in the two different kinds of central venous catheter (CVC) in patients with major burn injuries. METHODS: Eighty four burn patients with over 20% of total body surface were randomly assigned to undergo catheterization with standard CVC (STD group) or antimicrobial Vantex(R) CVC (VTX group). Following catheter removal, the distal tip was aseptically removed and cultured. Burn injured skin was also cultured. RESULTS: There was no significant difference in characteristic of patients and catheterization, and the severity of burn between the two groups. The overall CVC colonization rate was significantly decreased in VTX group (40.0%, 29.9 in 1,000 catheter-days) compared to STD group (64.1%, 43.9 in 1,000 catheter-days) (P=0.031). In case of the distance between the catheterization site and burn injured skin was less than 10 cm, the CVC colonization rate was higher in STD group compared to VTX group (P=0.015). CONCLUSION: Central venous catheterization with antimicrobial Vantex CVC lowered catheter-related colonization in major burn patients. The decrease in colonization rate with Vantex CVC compared with standard catheter is more dramatic when the distance between burn injured skin and CVC placement site is closer.
Burns ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Colon ; Humans ; Skin

PURPOSE: Hypertrophic scars after burn wound management remain a difficult problem for many burn surgeons despite of new treatment option is developed. After burn wound healed with scarring or pigmentation, the patient suffer in daily life with the cosmetic results and scar symptoms. Dermastamp(R) is new treatment modality on burn scar management in our burn center. Dermastamp(R) is stamp shaped and it contains 0.8 mm or 2.1 mm long multiple stainless steel needles. Dermastamp(R) was simply pressed down on the scar 3~4 times and makes 200~300 holes on 1 cm2 scar area. Dermastamping breaks the dense collagen fiber and fibroblast in the scar tissue and rearranges collagen fiber and fibroblast in the scar tissue. METHODS: The 51 patients were selected. The group consisted of 26 male and 25 female patients. 21 patients were adult and 30 patients were children. Stamping area of the 18 patients was below 25 cm2, 6 patients were in 25 to 100 cm2, and 27 patients were above 100 cm2, stamping area. They received Dermastamp(R) treatment 3 to 23 times in every 1 or 2 weeks interval at least 2 months. The 33 patients received Dermastamp(R) under local anesthesia and other 18 patients received under volatile induction anesthesia. Hypertrophic scar is evaluated with Vancouber Scar Scale (VSS) score by two surgeons and scar height using Sonography (17 patients). And pathologic study (17 patients) was done on volunteer cases. RESULTS: Clinically improvements with VSS score (1 to 6 points down) were noted in all patients group. Scar height was lowered (0.8 to 3.6 mm) on sonography and pathologic report revealed collagen fiber rearrangement and scar height thinning in examined group. CONCLUSION: Microneedling procedure is a effective modality of management on hypertrophic scarring and pigmentation. Microneedling induces collagen fiber rearrangement on scar tissue and thinner the scar height in pathology and improves clinical evaluating with VSS score and patients symptoms.
Adult ; Anesthesia ; Anesthesia, Local ; Burn Units ; Burns ; Child ; Cicatrix ; Cicatrix, Hypertrophic ; Collagen ; Cosmetics ; Female ; Fibroblasts ; Humans ; Male ; Needles ; Pigmentation ; Stainless Steel

PURPOSE: Sevoflurane is a well accepted anesthetic in children but results high incidence of undesirable emergence agitation (EA). We investigated the EA in burn injured children. METHODS: In 219 un-premedicated burn injured children aged 2~8 years, mask induction with sevoflurane was performed. On arriving operating room, modified Yale preoperative anxiety scale (m-YPAS) was checked. In the postanesthesia care unit, EA scale was recorded as follows; EA1 (no EA), EA2 (mild EA) and EA3 (marked EA). RESULTS: The incidence of EA was 50.2%. The m-YPAS was significantly higher in EA2 and EA3 compared to EA1 (P<0.001). Burn surface area was significantly wider in EA3 compared to EA1 (P<0.05). In deep second-degree burned children, the incidence of EA1 was greatest, whereas EA3 was the greatest in third-degree burned children. CONCLUSION: The incidence of EA after sevoflurane anesthesia in burn injured children was higher as the burn surface areas was greater. In addition, the symptoms of EA in third-degree burned children were more severe than in second-degree burned children.
Aged ; Anesthesia ; Anxiety ; Burns ; Child ; Dihydroergotamine ; Humans ; Incidence ; Masks ; Methyl Ethers ; Operating Rooms

PURPOSE: We previously reported that antimicrobial central venous catheter (CVC) reduced catheter colonization in major burn patients. In this study, we investigated whether antimicrobial CVC could reduce catheter-related blood stream infection (CRBSI) in major burn patients. METHODS: Burn patients with over 20% of total body surface area were randomly assigned to undergo catheterization with standard CVC (STD group, n=50) or antimicrobial Vantex(R) CVC (VTX group, n=50). Upon removal of CVC, bacterial cultures for wound, catheter tip, and blood were performed. RESULTS: Colonization rate was significantly decreased in VTX group (42%) compared to STD group (64%) (P<0.05). Colonization rate was higher in the case of the distance between the catheterization and burn wound was less than 10 cm in STD group (P<0.05). However, there was no statistical difference in CRBSI rate between the two groups (P>0.05). CONCLUSION: Even though the antimicrobial CVC could reduce the catheter colonization, the CRBSI rate was not reduced by antimicrobial CVC in major burn patients.
Bacteremia ; Body Surface Area ; Burns ; Catheter-Related Infections ; Catheterization ; Catheters ; Central Venous Catheters ; Colon ; Humans ; Rivers ; Sepsis

TCA is widely used in cosmetic treatments such as chemical peels, tattoo removal, and also in gynecological procedures for managing cervical intraepithelial neoplasia. However, storage of high concentration of TCA in a gynecology office is a potential hazard, as it may accidentally cause severe chemical burns. We report a case of deep dermal TCA chemical burn on genital area, which occured accidentally and resulted from misuse of high concentration (90%) of TCA coated vaginal gauze packing dressing during gynecological procedures.