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Coverage of a 4(th) Degree Contact Burn of Scalp and Calvarium Using a Fasciocutaneous Transposition Flap: A Case Report.

Gun Hyung AHN ; Hong Sil JU ; Soo A LIM ; Jin Kyung SONG ; Seong Yoon LIM

Journal of Korean Burn Society.2016;19(2):88-91.

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

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Myoelectric Hand Rehabilitation in the Bilateral Upper Extremity Amputee of Burn Patients: Two Cases Report.

Yun Jae JUNG ; Won Yong PARK ; Jeong Hyeon MUN ; Jong Hyun JEON ; Ju Youn LEE ; Ki Un JANG ; Cheong Hoon SEO

Journal of Korean Burn Society.2012;15(2):137-141.

Bilateral upper extremity amputee is rare and also complex, difficult process to apply the prosthesis to daily life. In Korea, there is no case report of bilateral myoelectric hand training, which is installed to bilateral upper extremity amputee due to electrical burn. We present usual 2 cases, who underwent bilateral transradial amputee, were fitted with a bilateral myoelectric prosthetic hand with an adaptive grip. It's not just long-term issues like the prosthesis prescription, but it is important functional problem whether or not to use actually. Especially the unique features of hand grasp function and writing can be the scale that measure recovery of the patient. The development of modern science and technology applications in clinical medicine cause the innovation of a prosthetic hand. In our two cases, good acceptance and functional improvement were noted. The information obtained in this case would be expected to be helpful in the bilateral amputee prosthetic prescription and training for their welfare.
Amputees ; Burns ; Clinical Medicine ; Hand ; Hand Strength ; Humans ; Korea ; Prescriptions ; Prostheses and Implants ; Upper Extremity ; Writing

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Chemical Burn due to Mustard: A Case Report.

Kyung Han YU ; Soo A LIM ; Dong Lark LEE ; Yong Il YOON

Journal of Korean Burn Society.2012;15(2):134-136.

PURPOSE: Mustard (Brassica spp.) has been used as a home remedy to cure various diseases like garlic, but its side effects like contact dermatitis due to local application at skin cannot be ignored. As a chemical burn due to local application of mustard has never been reported in Korea up to now, we will present a case in which who got a deep second degree burn due to local application of mustard. METHODS: A 56 year-old female patient who had pain at right wrist, knee, ankle, applied mustard paste for 5 hours. After one day, she visited hospital with bullous lesion with pain at wrist, knee, ankle and we confirmed that she got second degree chemical burn wound. During 3 days after admission, we performed foam dressing. And 4 days after admission, the burn wound was considered as deep second degree burn wound, we performed dressing with cultured allogenic keratinocyte (KaloDerm(R), Tegoscience, Seoul, Korea). RESULTS: After dressing with cultured allogenic keratinocyte, while exudate was being secreted by the lesion, saline wet dressing was applied. Exudate secretion decreased 7 days after application of cultured allogenic keratinocyte, and it stopped after 9 days. And it took about 10 days to remove dressing materials from the wound. When the dressing material had been removed, epithelialization was completed. CONCLUSION: Local application of pungent material like mustard or garlic as a traditional treatment is widely known, and side effect such as chemical burn due to garlic or contact dermatitis due to mustard also has been reported. We had another 2 cases of chemical burn due to garlic in addition to this case, and all 3 patients had local application for longer time than recommended time in traditional treatment. So, even if local application of them is effective in various disease, we should be aware that abuse of this traditional treatment should be avoided.
Animals ; Ankle ; Bandages ; Blister ; Burns ; Burns, Chemical ; Dermatitis, Contact ; Exudates and Transudates ; Female ; Garlic ; Humans ; Keratinocytes ; Knee ; Korea ; Medicine, Traditional ; Mustard Plant ; Skin ; Wrist

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A Case of Pumpless Extracorporeal Interventional Lung Assist Application in a Patient with Severe ARDS Who Is Severe Burn with Inhalation Lung Injury: A Case Report.

Chang Min SONG ; Yang hwan CHOI ; Cheon Je YUN ; Yun Cheol JANG

Journal of Korean Burn Society.2012;15(2):131-133.

A 35 year old male patient with inhalation injury including 45% body surface area burn was transferred to the hospital. After 2 days of hospitalization lung protective ventilation was supported due to acute respiratory distress occurrence. Fifth day the patient suffered hypercapnea which was uncontrollable with mechanical ventilators. Interventional lung assist (iLA) was proceeded on the tenth day, and the patients hypercapnia symptom was compatible with lung protective ventilation at the time, but the patient eventually suffered death after 12 days of treatment and care in the hospital.
Body Surface Area ; Burns ; Hospitalization ; Humans ; Hypercapnia ; Inhalation ; Lung ; Male ; Ventilation ; Ventilators, Mechanical

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Skin Allograft Using Donor Antigen-pulsed Dendritic Cell Therapy.

Seok Chan EUN

Journal of Korean Burn Society.2012;15(2):127-130.

PURPOSE: To treat burn and burn scar contracture, many types of skin grafts have been developed. Skin allograft is a recently introduced option for reconstruction of skin defects. The science of skin allotransplanation is rooted in progressive thinking by surgeons, fueled by innovative solutions, and aided by understanding the immunology of tolerance and rejection. METHODS: This study assesses the effect of dendritic cell pretreatment in induction of survival increase in a rat skin allograft model. Recipient derived dendritic cells were harvested from rat whole blood and cultured with GM-CSF and IL-4 for 2 weeks. Then donor-specific alloantigen pulsed dendritic cells were reinjected into subdermal tissue before skin graft. Rat left dorsal skin allografts were transplanted in 3 subgroups. Groups: I) untreated, II) FK-506 (2 mg/kg), III) dendritic cell pretreatment and FK-506. Graft appearance and histologic analysis were assessed postoperatively. RESULTS: The group III showed longest graft survival rate than other groups. CONCLUSION: Donor antigen pulsed host dendritic cell combined with short-term immunosuppression prolong skin allograft survival and has potential therapeutic application for induction of tolerance.
Animals ; Burns ; Cicatrix ; Contracture ; Dendritic Cells ; Graft Survival ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Immunosuppression ; Interleukin-4 ; Isoantigens ; Rats ; Skin ; Tacrolimus ; Thinking ; Tissue Donors ; Transplantation, Homologous ; Transplants

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Clinical Benefit of Cryoderm in Full Thickness Burns.

Young Min KIM ; Hyeong Tae YANG ; Hae Jun LIM ; Dohern KIM ; Jun HUR ; Jong Hyun KIM ; Yong Suk CHO ; Wook CHUN

Journal of Korean Burn Society.2012;15(2):121-126.

PURPOSE: CryoDerm (CGbio) is derived donated human skin. After removing epidermis and fibroblast of dermal layer, it preserved with cryo-preservation technique using control rate freezer system. To prevent post burn joint contracture in massive burns, we have used CryoDerm in acute stage. METHODS: From January of 2010 to July of 2012, 50 patients who undergone CryoDerm graft with split thickness skin graft were reviewed. The operative method was as follows: 1) Early wound excision and or cadaveric allograft skin coverage was performed within 5 days after burn injury 2) 2~3 weeks after wound excision, split thickness skin graft was performed with CryoDerm graft. Then graft take rate was investigated by inspection. Follow up duration was 3~32 months. RESULTS: Mean age of patients was 42.2 (2~70) years. Mean percentage of total body surface area burned was 27.22% (1~61%). Among 50 patients, 98 joints was operated including 14 hands, 4 wrists, 10 shoulders, 23 elbows, 4 necks, 3 hip joints, 31 knee joints and 9 ankles and feet. Total used graft size of Cryoderm was 10,945 cm2. Average take rate was near 100%. CONCLUSION: Cryoderm graft with split thickness skin graft can be used as a safe and effective operative method for one stage operation in acutely burned patients.
Animals ; Ankle ; Body Surface Area ; Burns ; Cadaver ; Contracture ; Elbow ; Epidermis ; Fibroblasts ; Follow-Up Studies ; Foot ; Hand ; Hip Joint ; Humans ; Joints ; Knee Joint ; Neck ; Shoulder ; Skin ; Transplantation, Homologous ; Transplants ; Wrist

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The Role of PCR Waveform by Plethysmography in Electric Burns.

Kyoung Don KANG ; Chang Hae PYO ; Hyun Chul KIM

Journal of Korean Burn Society.2012;15(2):109-120.

PURPOSE: A vast array of injuries result from high voltage electrical damage. The compartment syndrome of forearm prone to have high risk of major amputations, especially in arc burn. Early decompressing fasciotomy has been recommended for the prevention of limb amputations. There are controversies about the effect of fasciotomy. We tried to Pressure Cuff Recording (PCR) wave forms of Plethysmography for the monitoring early signs of vascular compromises in decision of early selective fasciotomy. We investigated the role of PCR wave forms to reduce major amputation rate. METHODS: We reviewed 875 burned limb of 520 electric current damage victims (fasciotomy or amputation were performed, PCR wave forms evaluated) during the last 14 years (from Jan. 1, 1996 to Jun. 30, 2009). We analysed the differences of amputation rates by the currency, input/output, burn types, effects of PGE1 adminstration, fasciotomy time, converting of PCR wave forms. RESULTS: There was no major amputations among low tension victims (minor amputation rate; 0.3%). The minor and major amputation rate were 19.5% and 27.0 in high tension injury. The flash burns rarely made the amputations, but arc burns had 12.1% of minor and 41.2% of major amputations. The direct contact burns had 24.7% of minor and 21.3% of major amputations. Most of the victims had their hand as input and foot as output. The minor and major amputation rate were 26.2% and 10.9% in none-fasciotomy, 8.8% and 48.0% in within 8 hours, 10.0% and 52.9% in 8-24 hours, 9.3% and 63.0% in over 24 hours fasciotomy group. Final normal type (N type) of PCR result had only 3.1% of minor amputations and 3.1% of major amputations. Final obstructive type (O type) had 37.6% of minor amputations, 60.8% of major amputations. Initial stenotic type (S type) of converted to N type had 6.6% amputation, but to O type had 98.7% amputation. CONCLUSION: The early selective fasciotomy are essential to reduce major amputations in high tension injuries, especially in arc burns. The PCR wave form converting to obstructive type could be helpful to predict the possible amputation. The PCR wave form is a good tool to monitor early signs of vascular compromise around fasciotomy. It plays as the index of immediate fasciotomy decision.
Alprostadil ; Amputation ; Burns ; Burns, Electric ; Compartment Syndromes ; Extremities ; Foot ; Forearm ; Hand ; Organothiophosphorus Compounds ; Plethysmography ; Polymerase Chain Reaction

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Analysis of Serum Zinc Level in Major Burn Patient.

Young Min KIM ; Hyeong Tae YANG ; Hae Jun LIM ; Dohern KIM ; Jun HUR ; Wook CHUN ; Jong Hyun KIM ; Yong Suk CHO

Journal of Korean Burn Society.2012;15(2):106-108.

PURPOSE: Burn is one of the most severe traumatic conditions. In spite of advances in burn treatment, Complications like wound infection have a significant effect on morbidity and mortality. Therefore, we have an effort to find the methods of improving wound healing. There are many factors to improve in wound healing. Among them, Zn is one of the important factors to wound healing. The aim of study is to evaluate serum Zn level to major burn patient. METHODS: This study was carried out in 31 burn patients retrospectively from August 2010 to March 2011 admitted to Hangang Sacred Heart Hospital Burn Intensive care unit, Hallym University. We checked initial serum Zn level within 7 days of admission without parenteral or enteral Zn supplement. The patients were divided by % TBSA burn, ABSI score and inhalation events. RESULTS: There were significant differences between the patients groups in their serum Zn level, except of inhalation events. The serum Zn level was below the normal range in large percentage of TBSA burned patients. CONCLUSION: It is recommended that the supplement of Zn should be initiated at the early stage of treatment in major burn patients.
Burns ; Heart ; Humans ; Inhalation ; Intensive Care Units ; Reference Values ; Retrospective Studies ; Wound Healing ; Wound Infection ; Zinc

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Analysis of Serum Vitamin C Level Prescribing 1,000 mg of Vitamin C Daily in Major Burn Patient.

Yong Jun JEON ; Hyeong Tae YANG ; Hae Jun LIM ; Dohern KIM ; Jun HUR ; Wook CHUN ; Jong Hyun KIM ; Yong Suk CHO

Journal of Korean Burn Society.2012;15(2):102-105.

PURPOSE: Vitamin C (ascorbic acid) is an well known antioxidant capable of scavenging oxygen free radicals. However, suitable amount of vitamin C level in major burn patients is not established until now. The aim of this study was to investigate the serum level of vitamin C with prescribing 1,000 mg of vitamin C daily to the burn patients in the burn intensive care unit. METHODS: A total of thirty eight patients were enrolled retrospectively from August 2010 to March 2011 admitted to Hangang Sacred Heart Hospital Burn Center, Hallym University. The patients were divided by TBSA (total burn surface area), ABSI (abbreviated burn severity index), and the discharge state whether they survived or not. We checked the serum vitamin C level with prescribing 1,000 mg of vitamin C daily. RESULTS: There were no significant differences between the patients groups in their serum vitamin C level. However, the serum vitamin C level was below the normal range in the all patients groups. CONCLUSION: Higher daily dosage of vitamin C than 1,000 mg should be considered to major burn patients.
Ascorbic Acid ; Burn Units ; Burns ; Free Radicals ; Heart ; Humans ; Critical Care ; Oxygen ; Reference Values ; Retrospective Studies ; Vitamins

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The Therapeutic Effect of Porcine Placenta Extract for Improvement Sequelae of Burn.

Hong Shin KIM ; Jung Hee LEE ; Cheon Jae YEON ; Jung Suk LEE

Journal of Korean Burn Society.2012;15(2):96-101.

PURPOSE: Burn injury cause pruritis, pain, psychological and functional sequelae. The one of burn injury sequelae is the hypertrophic scar. It is difficult to control devastating fibrotic condition for hypertrophic scar. The objective of this study was to investigated the therapeutic effect on burn hypertrophic scar and wound healing for sequelae of burn injury by Porcine placenta extract (PPE). METHODS: To investigate the effect of PPE, we performed in vitro cell cytotoxity test (MTT assay), antioxidant activity assay (SOD like activity), melanin content assay, cell migration asssay and RT-PCR. RESULTS: As a result of cell cytotoxity test (MTT assay), PPE showed above 80% cell viability. From Antioxidant activity assay (SOD like activity), this effect was similar to vitamin C. In the melanin content assay, melanin synthesis was inhibited 23% on PPE treatment than control. PPE enhanced cell migration on human fibroblast and decreased the expression of hypertropic scar related gene (a-SMA and P311). CONCLUSION: Our data showed anti-oxidant effect, diminution of melanin and decrease of the expression of hypertropic scar related gene on the treatment of PPE. These results may provide the insight into the potential use of porcine placenta extract as support to control skin fibrosis related to burn hypertrophic scar and alternative medicine for burn sequelae.
Antioxidants ; Ascorbic Acid ; Burns ; Cell Migration Assays ; Cell Movement ; Cell Survival ; Cicatrix ; Cicatrix, Hypertrophic ; Complementary Therapies ; Fibroblasts ; Fibrosis ; Humans ; Melanins ; Placenta ; Pruritus ; Skin ; Wound Healing

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