Thermal injury to free flap site can be severe and distressing injuries both for the patients and the surgeon. Thermal injuries to insensate free flaps are known complications often reported. But thermal injuries to free flaps are also occurred in the perioperative period. This study focused on the various factors associated with these injuries. We reported a 36-years old male patient with scalding burn in using warmed saline irrigation who underwent anterolateral thigh perforator free flap due to diabetic foot ulcer on dorsum of left foot. The clinical characteristics of thermal injuries during the free tissue transters are 1) Warmed saline irrigation is often too hot and a temperature excess 48degrees C should be considered very hot saline during the operation. 2) The direct exposure of the microscope light often causes iatrogenic burn, so copiously irrigating the surgical field and readjusting the light source's position or its output intensity are important. Surgeon must be aware that warmed saline irrigation & surgical microscope can cause thermal injury to free flap during the free tissue transfer.
Burns ; Diabetic Foot ; Foot ; Free Tissue Flaps* ; Humans ; Male ; Perioperative Period ; Thigh ; Ulcer

PURPOSE: Reconstruction for post-radiation scar on periorbital area including upper eyelid takes consider of eyelid function and cosmetic results. It is a challenging procedure to reconstruct the severe radiation induced scars deformities on face around the orbital area in terms of its complicated anatomy and restoration of cosmetic social function. The authors report a reconstruction case of radiation induced severe facial deformities with scars including upper lid and periorbital area using evidence based plastic surgical techniques such as newly designed lower lid orbicularis oculi myocutaneous transposition flap, lateral canthopexy, skin graft, composite graft, fat graft, acellular dermal matrix graft, Z-plasty focusing on cosmetic and functional result. METHODS: A 18 year-old female patient had right upper facial deformities caused by radiation induced wide scars around the right periorbital, upper lid and temporal area after treatment for hemangioma at age of 1. She also showed right facial palsy on forehead, and hypoplasia of left ala nasi. The patient suffered from skin atrophy, wide scar formation, scar contractures on right periorbital area, severe lagophthalmos on right eye, right frontal facial palsy, and small hypoplastic left ala nasi. At the first operation, release of scars and full thickness skin graft, reposition of asymmetric right eyebrow caused by facial palsy using Z-plasty, correction of temporal depression using acellular dermal matrix (AlloDerm(R)) graft, and auricular composite graft for left ala nasi reconstruction were performed. And after 4 months follow-up, the second operations were performed including lower orbicularis oculi muscle transposition flap for upper lid lagophthalmos, lateral canthopexy, and fat graft. RESULTS: Lower lid orbicularis oculi muscle transposition flap and all grafts were successfully survived. After 3 weeks follow-up, she showed good looking facial appearance and facial symmetry, and there were no complications. CONCLUSION: For post-radiation facial scar reconstruction, it showed a better cosmetic outcome using flap transfer rather than skin graft. The newly designed lower eyelid orbicularis oculi muscle transposition flap, canthopexy, fat graft give a good result for reconstruction of radiation induced scars of upper eyelid and periorbital deformities.
Acellular Dermis ; Atrophy ; Cicatrix* ; Congenital Abnormalities ; Contracture ; Depression ; Eyebrows ; Eyelids ; Facial Paralysis ; Female ; Follow-Up Studies ; Forehead ; Hemangioma ; Humans ; Orbit* ; Skin ; Transplants

PURPOSE: The purpose of this study is to build an evidence for adjusting the guideline of our hospital for changing peripheral intravenous catheter interval from 72 hour to 96hour through the checklist based on the Hospital nursing association intravenous infusion therapy practice in burn patients who have special characteristics comparing with other patient. METHODS: From 9 July 2014 to 20 July 2014, 30 burn patients who need a peripheral intravenous catheter were enrolled. The catheter insertion site was observed 3 times a day and it was analyzed by the time passage. Phlebitis scale for Hallym medical center was used for the diagnosis of phlebitis. Phlebitis was reported from phlebitis scale grade 2. RESULTS: Peripheral catheter was removed in 10 patients (34%) for phlebitis scale grade 2. Among the patients, 8 patients had edema and 2 patients had erythema. There were only 5 patients (17%) who had maintained peripheral catheter for more than 96 hours. Most of the patients were given 5% dextrose fluid. Some patients had a high osmolar (883~1058 g) nutritional therapy during early post-burn period. CONCLUSION: In burn patient, peripheral venous catheter is usually inserted to the extremity area of which the vessel is relatively weak due to the burn wound and immobilization. And it was difficult to maintain the peripheral catheter for more than 96 hours. Because the burn patients should receive the hyperosmolar fluid and medications during the early post-burn period. Further investigation through comparing analysis should be performed for developing intravenous infusion therapy practice in burn patients
Burns* ; Catheterization, Peripheral ; Catheters* ; Checklist ; Diagnosis ; Edema ; Erythema ; Extremities ; Glucose ; Humans ; Immobilization ; Infusions, Intravenous ; Nursing ; Phlebitis* ; Wounds and Injuries

PURPOSE: The burn increase the requirement for the antioxidative vitamin C and decrease the plasma concentration of vitamin D due to the loss of skin body surface area. We investigated the vitamin C and D status and the prevalence of vitamin C and D insufficiency in adult burn patients undergoing rehabilitative therapy. METHODS: 256 burn patients admitted to the department of rehabilitation medicine from April 2013 to September 2014 were tested for the plasma level of vitamin C and D[25(OH)D]. Vitamin C insufficiency was considered as <26.1micromol/L and vitamin D insufficiency as <20 ng/ml. We compared the mean plasma level of vitamin C and D[25(OH)D] according to burned percent of total body surface area (TBSA). RESULTS: Vitamin C insufficiency in 63.3% and vitamin D deficiency in 87.1%. In burn patients of TBSA> or =20%, mean plasma concentration of vitamin C and vitamin D[25(OH)D] were significantly lower (P=0.023, P<0.001). With adjusting for potential confounder such as age, sex, burn type, mean serum 25 (OH)D levels was significantly decreased 0.07 ng/ml per one percent of burned surface area (beta=-0.07, P<0.001), but with adjusting for age, sex, burn type, length of ICU stay and duration from burn injury to sampling, vitamin C and vitamin D[25(OH)D] were not significantly decreased (P=0.221, P=0.142). CONCLUSION: Vitamin C and D insufficiency were common nutrient problems in burn patients undergoing rehabilitative therapy. Further studies will be needed to establish the effective way to improve vitamin C and D status and prevent nutritional complications.
Adult ; Ascorbic Acid* ; Body Surface Area ; Burns* ; Humans ; Plasma ; Prevalence ; Rehabilitation ; Skin ; Vitamin D ; Vitamin D Deficiency ; Vitamins

PURPOSE: The most commonly used way of keeping airway, during general anesthesia, is endotracheal intubation. However, in case of short and simple surgery like escharectomy of burn wounds with Versajet(R), less invasive method using laryngeal mask airway is recommended rather than using endotracheal tube. The purpose of this study is to compare between laryngeal tube and endotracheal tube in case of escharectomy of burn wounds with Versajet(R), so that it may contribute to improving the ability of surgeon to carry out advanced airway management. METHODS: We selected 60 patients undergoing general anesthesia randomly who were to be given short operation lasting less than one hour and then anestheize each 30 patients by using endotracheal tube and laryngeal mask airway. Patients who underwent escharectomy of deep secondary burn wounds less than 9% of body surface with Versajet(R) were also divided into two groups (laryngeal mask airway, LMA group: 30 people, endotracheal tube, ETT group: 30 people). The size of laryngeal tube and laryngeal mask airway is chosen by body weight and sex. The laryngeal mask airway and endotracheal tube are both properly positioned and the ventilation efficient was not significantly different. We estimated the number of insertion attempts and the insertion time of endotracheal tube and laryngeal mask airway. Proper positioning, effect on cardiovascular system and postoperative airway problems (sore throat, nausea) after the recovery were also recorded. Successful insertion was judged by the Anesthesiologist. RESULTS: Probability of success rate were higher in the LMA group than in the ETT group in the first attempt (P-value= 0.028). Time used in successful insertion in the first attempt with LMA insertion group was significantly shorter than ETT insertion group (P-value= 0.014). Mean dosage of the muscle relaxants used were higher in the ETT group than in the LMA group (P-value= 0.012). No significant differences were observed in incidences of Myalgia between the two groups. There is statistically significant difference in incidences of postoperative sore throat in the two groups (P-value= 0.0058). There is no statistically significant difference in incidences of postoperative nausea or vomiting in the two groups. CONCLUSION: This comparative study suggests that Laryngeal mask airway (LMA) are useful for simple surgery of escharectomy of burn wounds with Versajet(R) and relatively more safer than using endotracheal tube (ETT) in general anesthesia for educated plastic surgeon in case of short and simple surgery like escharectomy of burn wounds.
Airway Management ; Anesthesia, General* ; Body Weight ; Burns* ; Cardiovascular System ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngeal Masks* ; Masks ; Myalgia ; Pharyngitis ; Pharynx ; Postoperative Nausea and Vomiting ; Ventilation ; Vomiting ; Wounds and Injuries

Scalp and calvarium defects are caused by trauma, burn, tumor resection, or congenital diseases. We experienced a few cases of severe electrical burn of scalp and calvarium, but fourth-degree contact burn of scalp and calvarium is a rare case. A 67 years old man was presented with a 25% total body surface area contact burn. A 20 cm×15 cm thick eschar on the patient's scalp was observed. Among various techniques for scalp reconstruction, we planned fasciocutaneous transposition flap with split thickness skin graft for coverage of large defect. Considering aesthetically satisfactory outcome, we designed a fasciocutaneous transposition flap including the hair-bearing areas. We additionally used skin graft for uncovered surrounding areas. There were no flap necrosis, graft loss, or any other surgical complications after the surgical flap and skin graft. At 6-month follow-up, the operation site was stable. The patient satisfied with functional and aesthetical outcomes, so we report this case.
Body Surface Area ; Burns* ; Follow-Up Studies ; Humans ; Necrosis ; Scalp* ; Skin ; Skull* ; Surgical Flaps ; Transplants

PURPOSE: The purpose of this study is to evaluate the effectiveness and validity of the wound dressing using heterogenic type I collagen dressing (Collaheal(R)). METHODS: From January 2010 to April 2010, 46 burn patients with deep second degree or third degree burn wound were treated with Collaheal(R). And we followed up the patients to assess the treatment result with Vancouver scar scale after 6 months. RESULTS: Of the 46 patients, 42 patients had deep second degree burn only and 4 patients had deep second degree burn with third degree burn. It took 18.5 days to re-epithelialize for patients with deep second degree burn and 40.5 days for third degree burn wound. After 6 months, follow-up was performed to assess the wound result. We can observe that 24 patients had mild scar and 5 patients had moderate scar and 2 patients had severe scar. The severity of scar increased as the re-epithelialization period increased. CONCLUSION: It took 18.5 days to re-epithelialize the deep second degree burn wound with collagen dressing. And the long term result was good. Type I collagen dressing can be used for treatment option for the patients with deep second degree burn wound and the patients with small third degree burn wound who cannot be operated.
Bandages ; Burns ; Cicatrix ; Collagen ; Collagen Type I ; Follow-Up Studies ; Humans ; Re-Epithelialization

PURPOSE: This study was designed to compare the quality of life and physical function after group education program in burn rehabilitation program. METHODS: In a prospective clinical trial, group rehabilitation education program was done in 20 burn injury patients. One group pretest-post test design was done. After 2 weeks group education session, we measured stress test, quality of life (Burn specific health scale) and range of motion. Stress status was assessed with objective measurement tools such as heart rate variability. RESULTS: Stress resistance and parameter value was changed significantly (P<0.05). Heart stability increased (P=0.05). Total range of motions were changed significantly (P<0.05). Quality of life evaluation using BSHS does not show significant change (P>0.05). CONCLUSION: Group therapy in burn rehabilitation patients could be an alternative rehabilitation treatment for quality of life. In the future, more studies are yet to come how group education program may affect the burn rehabilitation patients' disability.
Burns ; Exercise Test ; Heart ; Heart Rate ; Humans ; Prospective Studies ; Psychotherapy, Group ; Quality of Life ; Range of Motion, Articular

PURPOSE: The purpose of this research is to evaluate the efficacy and side effect of 5-Fluorouracil (5-FU) and Triamcinolone (TA) as a therapeutic agent in the treatment of burn hypertrophic scars. METHODS: This is a prospective and randomized design. Twenty patients with burn hypertrophic scars of varying size and more than 3 months duration were included in this study. All the patients were given intralesional 5FU and TA in different scars at weekly intervals for 4 weeks. Improvement was assessed by the thickness, melanosis, erythema, pliability, and the side effects experienced were noted at each scar. RESULTS: The thickness score was significantly improved in both TA and 5FU injection, more improvement in 5FU than TA. The melanosis score, erythema score, and pliability score were all reported insignificantly different outcome. The side effects were not encountered in TA group, but melanosis in 40%, slough in 20% were observed in the 5-FU group. CONCLUSION: The efficacy of 5-FU is comparable to TA as a treatment option for burn hypertrophic scar. Its effect on lightening of the lesion was promising with the exception of the incidence of adverse effects of melanosis and slough.
Burns ; Cicatrix ; Cicatrix, Hypertrophic ; Erythema ; Fluorouracil ; Humans ; Incidence ; Melanosis ; Pliability ; Prospective Studies ; Triamcinolone

PURPOSE: The last decade has focused on healing as the major outcome of burn management with little attention paid to other important patient-centered outcomes, such as pain. Traditional standard dressings using silver sulfadiazine cream and vaseline gauze may result in significant pain at dressing change, wound dryness, increase necessity for dressing change, and also traumatizing the skin and wound bed. In this paper we introduce Mepitel(R), a new silicone dressing material showing satisfactory result than previous traditional standard dressings in burn dressing. METHODS: We conducted a prospective, observational study of 15 adult patients with second degree burn. At the arrive, we initially applied Mepitel(R) after bullae aspiration and changed the cover dressing depending on the degree of exudate from burn while still applying Mepitel(R) for 3 days. After dressing change, pain intensity was measured on an 11-point numeric rating scale. RESULTS: Mean time to wound reepithelization was 10.2 days and mean pain scores on a 11-point scale associated with dressing changes was 5.2 while requiring 0.5 intravenous narcotic administrations per dressing change. CONCLUSION: Mepitel(R) is a new grid like silicone coated nylon dressing containing no additional biologic compounds. The advantages of the Mepitel(R) are easy of use, non-adhesion to the wound, very good tolerance, keep moisture of wound and absence of pain during dressing change. This product has been used in our clinics and this paper serves as a report on our experiences with it.
Adult ; Bandages ; Blister ; Burns ; Exudates and Transudates ; Humans ; Nylons ; Petrolatum ; Prospective Studies ; Silicones ; Silver Sulfadiazine ; Skin