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Reconstruction of Soft Tissue Defect on Scleroderma Using STSG & Artificial Dermis (Terudermis(R)).

Ha Min SUNG ; Kyoung Seok TAK ; In Suck SUH ; Hoon Bum LEE ; Geon CHO ; Kyoung Min MOON ; Min Su JUNG

Journal of Korean Burn Society.2011;14(1):43-46.

Scleroderma is a rare disease characterized by hard and thick skin, due to fibrosis of tissue with excessive deposition of collagen and extracellular matrix. It is well known that sclerodermatous skin does not heal well after trauma and also difficult to select proper reconstruction method. This article presents a treatment of skin and soft tissue defect with tendon exposure in a scleroderma patient using artificial dermis and STSG. A 67-year old woman, diagnosed as localized scleroderma in 2001, had contact thermal burn on her right hand 2 months ago. She was referred due to 9x5 cm sized skin and soft tissue defect with inflammation and necrosis on the dorsum of her right hand. Necrotic and inflammated tissues were excised under local anesthesia and, on postoperative day 13, debridement & artificial dermis (Terudermis(R)) was applied under general anesthesia. Her cutaneous lesion was spread so widely that we couldn't find appropriate donor site. After 16 days, wound was covered with STSG donated from sclerodermatous skin on right thigh. Artificial dermis was taken without inflammation or other specific complications, and she had uneventful post-operative course after STSG.
Anesthesia, General ; Anesthesia, Local ; Burns ; Collagen ; Debridement ; Dermis ; Extracellular Matrix ; Female ; Fibrosis ; Hand ; Humans ; Inflammation ; Necrosis ; Rare Diseases ; Scleroderma, Localized ; Skin ; Tendons ; Thigh ; Tissue Donors

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Emergence Agitation after Sevoflurane Anesthesia in Burn Injured Children.

Young Ho JANG ; Sang Kyu KIM ; Yong Hoon SON ; Joon Mo PARK ; Mi Young LEE

Journal of Korean Burn Society.2011;14(1):39-42.

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

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Extremity Operation by a Use of Fibrin Sealant in Burn Patient.

Yong Suk CHO ; Hyeong Tae YANG ; Hae Jun LIM ; Dohern KIM ; Jun HUR ; Wook CHUN ; Jong Hyun KIM ; Byoung Chul LEE ; Cheong Hoon SEO ; Jung Tae CHOI

Journal of Korean Burn Society.2011;14(1):35-38.

PURPOSE: The surgical treatment of burn patient is associated with substantial blood loss. Therefore, multiple hemostatic techniques have been proposed for this problem. Unfortunately, a clear conclusion as to the best hemostatic agent cannot be made. Then, we present our experience of using Fibrin sealant (TISSEEL(TM)) in extremity operation. METHODS: We reviewed the medical records of 10 patients treated in our burn center who conducted the extremity operation using Fibrin sealant from January 2010 to December 2010. RESULTS: The mean tourniquet time is within 60 minutes and no need of transfusion during the operation in all patients. The average take rate for skin graft is over the 98%. No one has nerve injury and other problems. CONCLUSION: Fibrin sealant is a human derived factors that are designed to reproduce the final step of the physiologic coagulation cascade of a stable fibrin clot. In addition, Fibrin sealant has the advantage of being biocompatible and biodegradable, without inducing inflammation, foreign body reaction, and tissue necrosis. Fibrin sealant is shown to be effective methods to achieve hemostasis for the extremity burn surgery.
Burn Units ; Burns ; Extremities ; Fibrin ; Fibrin Tissue Adhesive ; Foreign-Body Reaction ; Hemostasis ; Hemostatic Techniques ; Humans ; Imidazoles ; Inflammation ; Medical Records ; Necrosis ; Nitro Compounds ; Skin ; Tourniquets ; Transplants

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Antimicrobial Central Venous Catheter Dose Not Reduce Catheter-related Bacteremia in Major Burn Injured Patients.

Young Ho JANG ; Yong Hoon SON ; Sang Kyu KIM ; Joon Mo PARK ; Mi Young LEE

Journal of Korean Burn Society.2011;14(1):30-34.

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

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Fiber-optic Bronchoscopic Classification of Inhalation Injury: Is That Consistent with Pathologic Findings?.

Hyeong Tae YANG ; Hae Jun LIM ; Dohern KIM ; Jun HUR ; Wook CHUN ; Jong Hyun KIM ; Yong Suk CHO ; Cheol Hong KIM ; Young Hee CHOI ; Jung Tae CHOI

Journal of Korean Burn Society.2011;14(1):26-29.

PURPOSE: Fiber-optic bronchoscopy is widely used for early diagnosis of inhalation injury. The aim of the study was to ascertain whether a correlation could be shown between bronchoscopic and pathologic grading. METHODS: One hundred seventy patients who underwent bronchoscopy with suspicious inhalation injury were review retrospectively from January 2008 to December 2009. The patients were divided into four groups (normal, mild, moderate, severe) according to bronchoscopic and pathologic findings respectively. RESULTS: Diagnosis of an inhalation burn was confirmed in 142/170 patients, of whom upon initial assessment an inhalation trauma was suspected. Bronchoscopic grading was noted: mild (n=109), 56 ALI (51.4%), 18 ARDS (16.5%); moderate (n=31), 22 ALI (71.0%), 13 ARDS (41.9%); severe (n=2), 2 ALI (100%). Pathologic grading was noted: mild (n=131), 77 ALI (58.8%), 27 ARDS (20.6%); moderate (n=4), 2 ALI (50%), 1 ARDS (25%); severe (n=1), 1 ALI (100%). Consistency of two groups was not significant (P<0.05). CONCLUSION: Any burn patient highly suspicious for inhalation injury should receive an early bronchoscopy for diagnosis and treatment. Fiber-optic bronchoscopy is a safe and effective method for early diagnosis of inhalation injuries. The consensus of classification about inhalation injury will be developed.
Bronchoscopy ; Burns ; Burns, Inhalation ; Consensus ; Early Diagnosis ; Humans ; Inhalation ; Retrospective Studies

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Efficacy of Duoderm(R) CGF in Split-thickness Skin Graft Donor Site Management.

Young Joon KIM ; Min Suk PARK ; Hoon KIM ; Sang Hyun NAM ; Young Woong CHOI

Journal of Korean Burn Society.2011;14(1):21-25.

PURPOSE: The optimal treatment of the split-thickness skin graft donor sites remains an unresolved issue. The donor sites have been treated with various and plenty of dressing techniques and materials. Medifoam(R) is a polyurethane foam dressing material and this is widely used in treatment of burn wounds and split-thickness skin graft donor sites. But sometimes there are exudates collections or hematomas on the surface of donor sites and these would delay the wound healing. We have performed a prospective study to evaluate the efficacy of Duoderm(R) CGF for removing the exudates or hematomas from donor sites. METHODS: This prospective study is based on 10 patients who had undergone split-thickness skin graft and had severe exudates or hematoma collections on donor sites from September 2010 to February 2011. All cases were harvested with same dermatome, and thickness is between 0.005 and 0.010 inch. We applied Duoderm(R) CGF to remove on postoperative day 3 in almost cases. We compared no problem area and exudates or hematomas existing area with complete healing day. RESULTS: The mean compete healing day of two areas were 8.6 and 10.0 days. The difference between no problem area and exudates or hematomas existing area was 1.4 days. There was no infection or inflammation on donor sites after using Duoderm(R) CGF. CONCLUSION: Duoderm(R) CGF dressing is a safe and effective management to remove exudates collections or hematomas on the surface of split-thickness skin graft donor sites during treatment.
Bandages ; Burns ; Exudates and Transudates ; Hematoma ; Humans ; Inflammation ; Polyurethanes ; Prospective Studies ; Skin ; Skin Transplantation ; Tissue Donors ; Transplants ; Wound Healing

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Effectiveness of Thick Acellular Dermal Matrix (Allocover(R)) in Burn and Burn Scar Contracture.

Juyong KWON ; Seok Chan EUN ; Rong Min BAEK

Journal of Korean Burn Society.2011;14(1):16-20.

PURPOSE: To treat burn and burn scar contracture, many types of dermal substitutes have been manufactured and used recently. Allogenic dermis is known to have best cellular affinity to the host, but it is the thinnest product among artificial dermis. Processed thick allogenic dermis (Allocover(R)) has been developed and applied to overcome the problems of preexisting materials as a permanent dermal substitute. METHODS: From June 2007 to May 2009, we have grafted thick acellular human dermal allograft with thin split-thickness skin graft on burn wound and burn scar contracture of feet and legs in 14 patients who had hypertrophic scar, joint contracture and various skin defect areas. Intraoperatively, we fixed spilt thickness skin graft to artificial dermis with suture fixation for avoiding the mobilization between them. RESULTS: Thirteen patients out of 14 patients had no problem. One patient underwent partial skin loss and secondary healing process. During the 18 months of follow up period, no contracture recurrence or skin loss was observed. CONCLUSION: The thick acellular human dermal allograft (Allocover(R)) could be very useful in the management of skin loss and burn scar contractures. Its vascularization has occurred fast enough that wounds can be covered in an adequate layer of dermal augmentation with minimal contracture and good cosmetic results.
Acellular Dermis ; Burns ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Cosmetics ; Dermis ; Follow-Up Studies ; Foot ; Humans ; Joints ; Leg ; Recurrence ; Skin ; Sutures ; Transplantation, Homologous ; Transplants

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Chemical Burn due to Garlic: A Case Report.

Jae Hyun KIM ; Kyoung Seok TAK ; In Suck SUH ; Chan Min CHUNG

Journal of Korean Burn Society.2009;12(1):76-78.

PURPOSE: Garlic (Garlic: Allium sativum), throughout history, has long been used as a method to cure various diseases in different cultures. Although the intake or local application of garlic in order to treat skin disease and antibacterial effects is gradually increasing, its possible side effects cannot be neglected. As a chemical burn case due to local application of garlic has never been reported in Korea up to now, the following paper will present a case in which who suffered a partial layer second degree burn due to the local application of garlic. METHODS: A 53 year-old female patient was experiencing a partial layer second degree burn. The vesicobullous lesion was accompanied by erythema with a size of 20x7 cm and severe pain. Two days earlier, the patient spread ground garlics on her left arm and had wrapped it in order to remove the black spots. Unfortunately, due to her carelessness, the garlic had stayed there for 12 hours. She was treated with potadine soaked gauze every day. As soon as the erythema had worn out, she was treated by wet dressing using Hydrocolloid (Comfeel plus transplant dressing(R), Coloplast A/S and Denmark). RESULTS: Epithelialization of the injured area began from the 5th day since the burn. Complete epithelialization took seven days, and the outpatient's progress is currently being observed. CONCLUSION: Local application of garlic as a folk remedy is widely known, and the side effect such as contagious skin disease is also known to some extent. Patients today tend to rely more on organic remedies, let alone garlic. Moreover, they seek traditional methods or alternative medicine rather than conventional treatment. Thus, it is crucial to acknowledge the side effects of such folk remedies and to be aware whether they have been preceded.
Allium ; Arm ; Bandages ; Burns ; Burns, Chemical ; Colloids ; Complementary Therapies ; Erythema ; Female ; Garlic ; Humans ; Korea ; Linear Energy Transfer ; Medicine, Traditional ; Skin Diseases ; Transplants

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Efficacy of Versiva(R) (Convatec, UK) Dressing in Treatment of Pediatric Facial and Neck Burn.

Jae Seong MOH ; Young Cheon NA ; Eun Suk HUH

Journal of Korean Burn Society.2009;12(1):73-75.

PURPOSE: Yearly many children attend hospital with burns. Most of them are injured to face and neck. In palliative ways, dressing with vaseline gauze, it is thick and tight to absorb the exdute and maintain, but patients are inconvinient in eating and speaking. Especially, in pediatric face and neck burn patients, cooperation is impossible, so there is increased risk of secondary infection by wound exposure and physician should make dressing more frequently. In case of using dressing material, it is not far different in palliative dressing, we should use a tape or elastic bandage to keep wound surface and dressing material in contact. Versiva(R) is combination dressing materials of hydrocolloid, hydrofiber, a polyurethane foam. Authors have used Versiva(R) in a treatment of pediatric face and neck burn, and we experienced that maintenance of dressing is convenient and nutrition supply is easy through oral feeding. METHODS: Between from 2006 January until 2008 December, we performed dressings with Versiva(R) in 20 pediatric second degree face and neck burn patients. Until postburn 2 nd or 3 rd day, we exchanged dressing daily, and after this, exchanged in 2~3 days according to amount of exudate. RESULTS: Versiva(R) had enough absorbing capacity and adhesive strength at the same time. With this slight and thin dressing material, there was considerable decrease in discomfort of patient, frequency of secondary infection and keeping dressing were convenient. Oral feeding was easy due to waterproof surface of the Versiva(R). In comparison with effort and time in palliative dressing, there was a significant reduction of labor force. CONCLUSION: In Treatment of pediatric second degree face and neck burn patient, Versiva(R) dressing was effective method because of decreased hospital day, convinience, labor reduction, decreased patient discomfort, easy to oral feeding.
Adhesives ; Bandages ; Burns ; Child ; Coinfection ; Colloids ; Compression Bandages ; Eating ; Exudates and Transudates ; Humans ; Neck ; Petrolatum ; Polyurethanes

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Dynamic Elbow Flexion Orthosis for Elbow Flexion Limit in Upper Extremity Burn.

Ki Un JANG ; Ji Soo CHOI ; Joo Yeon LEE ; Cheong Hoon SEO ; Hae Jun YIM ; Yong Suk CHO ; Do Hern KIM ; Jun HUR ; Wook CHUN ; Jong Hyun KIM

Journal of Korean Burn Society.2009;12(1):68-72.

PURPOSE: Patients who have a elbow flexion limitation from burn often contend with a severe functional problem in activity of daily living. Positional splint or serial casting have been invented to prevent from elbow contracture, which splint could not improved the range of motion more than 90 flexion. The purpose of this article is to present a dynamic forced elbow flexion orthosis with limited motion joint to overcome the problem of less effective function of correctability of conventional splints. METHODS: The cases were 3rd degree burned patients of upper extremities who had a elbow joint flexion limitation from the post burn skin or joint contracture. This dynamic elbow flexion brace device was fabricated with the dynamic force of the elbow joint, which was induced by a rubber band or spring device into the orthotic joint. The orthosis kept a lower grade constant corrective force with coustom made design and strong strap fixation with comfortable material. RESULTS: This dynamic elbow flexion brace device was fabricated for two burn patients who had 24% and 37% TBSA in a flame burn with extensive involvement of the upper extremities. They developed hypertrophic scar and skin contracture around both elbow joint. Both patients had moderate to severe elbow joint limitation of motion. Patients with elbow limitation had improved the range of motion more than 90 flexion by this dynamic elbow flexion brace. CONCLUSION: The dynamic forced elbow flexion orthosis with limited motion joint had improved the range of motion more than 90 flexion, however those has some problems which ought to be improved to more effective and comfortable function.
Braces ; Burns ; Cicatrix, Hypertrophic ; Contracture ; Elbow ; Elbow Joint ; Humans ; Joints ; Orthotic Devices ; Range of Motion, Articular ; Rubber ; Skin ; Splints ; Upper Extremity

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