PURPOSE: DC cardioversion is the treatment choice for atrial fibrillation and flutter. Because of the high voltage power across the thorax, most patients suffer some degree of superficial erythema or burn at the pad site. 2nd or 3rd degree burn and muscle necrosis is very rare after shock. We experienced one case of 3rd degree burn with ulceration after DC cardioversion. METHODS: A 44-year-old male was admitted to local hospital with the presenting palpitation and atrial fibrillation on ECG. During radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillatoin, DC cardioversion was performed. The patient did not complain of any pain or discomfort at the pad site during or immediately after the procedure. Approximately 14 days after the shock, he had blisters at the pad site. But he received simple dressing treatment at the local hospital for 6 months. When he visited our burn clinic, there was 3x5 cm sized 3rd degree burn with eschar and necrotic fat tissue at the pad site of right back. Surgical removal of a necrotic tissue was performed on the patient by STSG (Split thickness skin graft) with Matriderm(R). RESULTS: Muscle fascia was exposed after debridement of the necrotic skin and fat tissue. The skin graft was well taken within 2 weeks after operation. CONCLUSION: In case of using monophasic 360 J, approximately 3,000 V energy is discharged. The energy is sufficient to cause burn injury to skin. Damage may result both thermal burn and electrical burn. The burn degree in the electric circuit is proportional to amperage and time, is inversely proportional to pad site area. We therefore suggest that in order to reduce deep burn, DC cardioversion is started with lower energy shocks, proper pad placement and correct pad application is important. And we give a notice that deep pad burn possibly occur after the cardioversion procedure.
Adult ; Atrial Fibrillation ; Bandages ; Blister ; Burns ; Catheter Ablation ; Debridement ; Electric Countershock ; Electrocardiography ; Erythema ; Fascia ; Humans ; Male ; Muscles ; Necrosis ; Shock ; Skin ; Thorax ; Transplants ; Ulcer

PURPOSE: In cases of high voltage electrical burns, a wound occurs as current enters or leaves the body and is accompanied by deep tissue injury. If upper extremity amputation is inevitable, consideration should be given to the residual limb functions, secondary reconstruction, and wearing of an upper prosthesis. Our hospital has achieved satisfactory outcomes through the use of a pedicled latissimus dorsi (LD) flap in patients undergoing transhumeral amputation and shoulder disarticulation due to upper extremity damage from high voltage electrical burns. METHODS: The study was targeted to five patients who suffered high voltage electrical burns, underwent above-elbow amputation, and were reconstructed in the acute and secondary phases using a pedicled LD flap from January 2005 to December 2011. All patients underwent equilateral pedicled LD flap surgery, with primary closure at the donating site. RESULTS: The average age of patients was 49.6 years (38~64); they were all male. One patient underwent sublayer skin grafting after a pedicled muscular LD flap, and four patients had a pedicled myocutaneous LD flap: one patient among the four had a forearm flap after the pedicled myocutaneous LD flap. All flaps were well adhered, and post-surgical flap reduction and local flaps were performed for adequate sizing and aesthetic improvement. CONCLUSION: In cases of upper arm amputation due to wide upper extremity damage caused by electrical burns, the use of the pedicled LD flap and adequate amputation length made subsequent wearing of a prosthesis possible. The pedicled LD flap procedure allowed reconstruction of a relatively large area of soft tissue and the surgery to the donating site was unproblematic.
Amputation ; Amputation Stumps ; Arm ; Burns ; Disarticulation ; Extremities ; Forearm ; Humans ; Male ; Prostheses and Implants ; Shoulder ; Skin Transplantation ; Upper Extremity

PURPOSE: In order to rehabilitate patients with replanted fingers or reconstructed ones with free flap, the warm therapy is cost-effective, clean, and easy to use. However, the risk of thermal burn in patients with replanted fingers or reconstructed ones with free flap is not clearly identified yet and only few clinical prognosis exist. For that reason, this study was designed to evaluate the incidence, characteristics and risk factors of thermal burn in patients with replanted fingers or reconstructed ones with free flap. METHODS: We reviewed all the medical records of patients retrospectively, especially who showed clinically important thermal burn of replanted fingers or reconstructed ones with free flap from February 2010 to March 2011. RESULTS: 10 patients out of 370 with successfully replanted fingers or reconstructed ones with free flap presented clinically important thermal burn. (2.70% incidence). The causes of thermal burn were warm therapy (4 cases) and touching hot bowls such as a coffee cup, hot pot or hot grill (6 cases). Among them, 7 patients suffered superficial 2nd degree burn with bullae, 1 patient deep 2nd degree burn, 1 patient 4th degree burn and another 1, 1st degree burn with mild erythema. All of them except two cases were treated with conventional dressing with antibiotic ointment, while one was treated by skin graft and another one by 2nd toe pulp free flap. On the other hand, there were only 3 thermal burn cases among 7,010 patients who had undergone the hand surgeries other than replantation and free flap (0.04% incidence). And 2 were by warm therapy and 1 by hot pot. All of them were superficial 2nd degree burn with bullae and treated with conventional dressing with antibiotic ointment for about 1 week. CONCLUSION: These results suggest that patients with replanted fingers or reconstructed ones with free flap are more likely to have thermal burn than any other. Therefore we should be aware of the possibility of thermal burn for these patients, paying more attention to prevent it during the warm therapy and letting them always keep an appropriate distance from anything that can cause thermal burn.
Bandages ; Blister ; Burns ; Coffee ; Erythema ; Fingers ; Free Tissue Flaps ; Hand ; Humans ; Incidence ; Linear Energy Transfer ; Medical Records ; Prognosis ; Replantation ; Retrospective Studies ; Risk Factors ; Skin ; Toes ; Transplants

PURPOSE: Defensins are important components of innate immune system. These peptides have antimicrobial activity against a wise variety of pathogens that associated with burn wound infection. In particular, human beta-defensins are expressed in normal epidermal region and showed differential expression of some skin disease. We investigated that expression of human beta-defensin by in vitro and ex-vivo by thermal condition. METHODS: To investigate the expression of human beta-defensins in acute burn condition, we cultured keratinocytes and used to rat's skin at this experiment. After thermal condition, we showed the expression of beta-defensins-2 (hBD-2), -3 (hBD-3), keratins, keratinocyte differentiation and junction protein levels by RT-PCR and immunohistochemistry (IHC). RESULTS: HBD-2 & involucrin were down-regulated from 1 hr to 8 hrs in mRNA level. But others were not changed in mRNA level. In protein level, hBD-3 was decreased but pan-cytokeratin and beta-catenin were not changed. CONCLUSION: HBD-2 was down-regulated in thermal injury. Because thermal injury could induce the influence of keratinocyte differentiation and the decrease of skin protection ability. Our results suggested that human beta-defensins plays an important role in protection by several injury.
beta Catenin ; beta-Defensins ; Burns ; Defensins ; Humans ; Immune System ; Immunohistochemistry ; Keratinocytes ; Keratins ; Peptides ; Protein Precursors ; RNA, Messenger ; Skin ; Skin Diseases ; Wound Infection

PURPOSE: Split thickness skin graft is a frequently used reconstructive technique in burn wound, but the ideal dressing material of the donor site is yet to be developed. The donor sites have been managed with various dressing materials. The aim of this study is to compare four different dressing materials for management of the donor site in a prospective trial. METHODS: This study is based on 85 patients who had undergone split thickness skin graft from September 2011 to February 2012. The grafts harvested with a same manner and the donor sites were managed with one of the four dressing materials: Aquacel Ag(R), Mepitel(R), Bactigra(R), Op-Site(R). We compared post-operative pain scale, the time required epithelialization, ease of application, post-operative infection and number of dressings. RESULTS: Aquacel Ag(R) was the more painless dressing materials in post-operative day 1, 4, 7, 10 than Mepitel(R), Bactigra(R), Op-Site(R). Number of dressings was more lower for Aquacel Ag(R) with Mepitel(R). Ease of application was more higher for Aquacel Ag(R) with Mepitel(R). But Aquacel Ag(R) was not earliest epithelialization. The incidence of infection was not low in Aquacel Ag(R). CONCLUSION: Aquacel Ag(R) dressing is better than other dressing materials for split thickness skin graft donor site in the number of dressings, ease of application, post-operative pain.
Bandages ; Burns ; Carboxymethylcellulose Sodium ; Humans ; Incidence ; Occlusive Dressings ; Prospective Studies ; Skin ; Skin Transplantation ; Tissue Donors ; Transplant Donor Site ; Transplants

PURPOSE: The optimal initial treatment for burn wound is generally applying cold running tap water of temperature 12~18degrees C for approximately 20 minutes. But most of the patients are not susceptible to this initial treatment because they are likely to get embarrassed in such situation. According to statistics of our hospital, 92.2% of patients who visited ER (emergency room) had less than 10 minutes of water cooling. In this study, our aim was to find out the clinical effect of biocellulose sheet (Bestian M(R) pack) as an emergent treatment. METHODS: Between November 2010 and October 2011, 93 patients with burn wound showing first or superficial second degree at first inspection were evaluated in our study. Biocellulose sheet (Bestian M(R) pack) was applied at the wound as soon as possible for 25 minutes and second inspection was done. Routine moisture dressing was done thereafter and patients were followed as outpatient. RESULTS: Among 93 patients, 28 were male and 65 were female. Scalding burn, contact burn, flame burn and other causes were 78, 6, 4 and 5 patients respectively. Average complete healing time was 7.99 days and average follow-up time was 5.49. CONCLUSION: Biocellulose sheet has the effect of cooling down the skin temperature up to 6~8degrees C after 10 minutes of its application. Recent studies reported that appropriate cooling in burn wound improves the zone of stasis and zone of erythema histologically eventually reducing the chance of skin graft. Therefore, biocellulose sheet has the effect of improving initial pain, histologic status, healing time and cost in patients with burn wound whose depth is not deep. Furthermore it reduces the risk of scar formation.
Bandages ; Burns ; Cicatrix ; Cold Temperature ; Erythema ; Female ; Follow-Up Studies ; Humans ; Male ; Running ; Skin ; Skin Temperature ; Transplants ; Water

PURPOSE: Facial abrasions have been treated by moist occlusive dressing for many years. But previous dressing methods have several disadvantages such as difficulty of fixation due to varied contours, too frequent dressing changes with pain, discomfort due to volume of the dressing materials. The authors applied dried bovine amniotic membrane (Amnisite BA(R)) to facial abrasions as a new therapeutic option and compared its efficacy with previous foam dressing treatments. METHODS: From June 2010 to May 2011, thirty two patients suffering from facial abrasions were included in this study, with a mean age of 32.4. Patients were divided into two groups by patient preference. One group was treated with dried bovine amniotic membrane while the other group was treated with ointment and foam dressings. Subjects were followed by regular outpatient clinic visits until complete epithelization. Healing time, treatment costs, scar formation, skin elasticity and moisture content were evaluated to compare the efficacy of dried bovine amniotic membrane in comparison to foam dressing groups. RESULTS: All of thirty two patients were well healed after appliance of dried bovine amniotic membrane or foam dressing without any complication. The healing time for patients treated with dried bovine amniotic membrane was significantly shorter (P<0.05) and no significant difference between the two groups regarding treatment costs, scar formation, skin elasticity or moisture content was shown. CONCLUSION: Facial abrasion can be effectively treated with dried bovine amniotic membrane with a shortening of epithelization period and similar effectiveness as previous foam dressings. In addition, dried bovine amniotic membranes have several benefits. easy appliance to any parts of face, reducing the frequency of dressing changes, early adaptation to social life and so on, These presented benefits make this material a new standard for treatment of facial abrasion.
Ambulatory Care Facilities ; Amnion ; Bandages ; Biological Dressings ; Cicatrix ; Elasticity ; Health Care Costs ; Humans ; Occlusive Dressings ; Patient Preference ; Skin ; Stress, Psychological ; Treatment Outcome

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: We designed our study to find optimal timing for tracheostomy, and to determine the effects of early tracheostomy on clinical courses in flame burned patients with inhalation injury. METHODS: A retrospective chart review was completed for adult patients admitted to Hangang Sacred Heart Hospital Burn Center, Hallym University Medical Center, Seoul, Korea, between March 1, 2004 and February 28, 2009, who were diagnosed with flame burn with inhalation injury and who underwent tracheostomy during their hospitalization. One hundred eighteen patients were enrolled in this study. Patients were assigned to one of three groups based on the timing of tracheostomy: postburn days (PBD) 0 to 7 [Early tracheostomy (ET) group], 8 to 12 [Intermediate tracheostomy (IT) group], and greater than 13 [Late tracheostomy (LT) group]. We compared incidence of pneumonia, duration on mechanical ventilation, length of stay in intensive care unit (ICU LOS), and survival between groups. To assess the effect of tracheostomy on pulmonary function, we analyzed changes of PaO2/Fio2 (P/F) ratio. RESULTS: There were 46 patients in the ET group, 47 in the IT group and 25 in the LT group. Tracheostomy day (PBD) was 5.2+/-1.7 in ET group, 10.0+/-1.5 in IT group, and 14.8+/-1.9 in LT group (P<0.01). Statistics did not show the correlation between the timing of the tracheostomy and the incidence of pneumonia. Also mortality rate in each group showed no significant differences. There were significant differences between groups for duration on mechanical ventilation and ICU LOS (P<0.01). P/F ratio correlated with time flow showed no significant differences (P=0.10). Also there were no differences between groups in changes of P/F ratio (P=0.08). CONCLUSION: In flame burned patients with inhalation injury who require prolonged mechanical ventilation, performing tracheostomy within PBD 7 may shorten the duration on mechanical ventilation and length of stay in intensive care unit.
Academic Medical Centers ; Adult ; Burn Units ; Burns ; Heart ; Hospitalization ; Humans ; Incidence ; Inhalation ; Intensive Care Units ; Korea ; Length of Stay ; Pneumonia ; Respiration, Artificial ; Retrospective Studies ; Tracheostomy

PURPOSE: The use of the Ondol, which is a traditional Korean floor heating system, has made the electric heating pad popular in Korea. Although the surface temperature of electric pads is around 45 degrees, rarely they can cause severe contact burns. Because an electric pad is usually used while sleeping, the skin could be exposed to heat and pressure for a prolonged period. The purpose of this study was to investigate the epidemiology and clinical features of these types of burns and to advise caution in the use of electric heating pads. METHODS: We performed a retrospective analysis of 58 cases identified from March 2007 to March 2012 at the Hangang Sacred Heart Hospital plastic surgery department. Collected data included sex, age, seasonal variation, distribution and extent of the burn, underlying disease, related factors, and treatment. RESULTS: Patients (23 females and 10 males) were predominantly in their twenties, with an average age of 40.7 years (range, 14~83). The majority of the burns occurred during winter (51.5%). According to the patients' histories, sleeping in a drunken state was the most common associated factor, with taking hypnotics and lying under spinal anesthesia being the second and third factors, respectively. Eight patients had diabetes mellitus and four patients had hypoesthesia after spinal cord injury and cerebral stroke. The lower extremity was the most commonly involved site (42.4%), followed by the buttocks (33%). The extent burn areas accounted for less than 2% of the total body surface area. But deep second degree and third degree burns were sustained that required surgical intervention. CONCLUSION: Unconsciousness and hypoesthesia were the primary factors that provoked contact burns related to the use of electrical pads. Although the percentage of body surface area burns is often small, the burns caused by electric pads can cause deep thermal injuries, necessitating the use of skin grafts and local flaps. These injuries could be prevented by taking precautions when using electric pads and by educating the public.
Anesthesia, Spinal ; Body Surface Area ; Burns ; Buttocks ; Deception ; Diabetes Mellitus ; Female ; Floors and Floorcoverings ; Heart ; Heating ; Hot Temperature ; Humans ; Hypesthesia ; Hypnotics and Sedatives ; Korea ; Lower Extremity ; Retrospective Studies ; Seasons ; Skin ; Spinal Cord Injuries ; Stroke ; Surgery, Plastic ; Transplants ; Unconsciousness