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Sample records for burn scar contracture

  1. Post-burn scars and scar contractures

    PubMed Central

    Goel, Arun; Shrivastava, Prabhat

    2010-01-01

    The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management. PMID:21321660

  2. Prevalence of scar contractures after burn: A systematic review.

    PubMed

    Oosterwijk, Anouk M; Mouton, Leonora J; Schouten, Hennie; Disseldorp, Laurien M; van der Schans, Cees P; Nieuwenhuis, Marianne K

    2017-02-01

    Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the prevalence, course, and determinants is essential. A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar contracture assessment, point prevalence, and possible determinants. Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38-54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity. The prevalence of burn scar contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar contractures, their evolvement over time, and risk factors. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  3. The neck burn scar contracture: a concept of effective treatment.

    PubMed

    Akita, Sadanori; Hayashida, Kenji; Takaki, Satoshi; Kawakami, Yoshihisa; Oyama, Takuto; Ohjimi, Hiroyuki

    2017-01-01

    A neck scar contracture can severely and negatively affect the function of mastication, phonic, or breathing and result in neck pain and issues with esthetics. The best way is of course to avoid such contracture by means of non-surgical treatment such as use of a growth factor. The basic fibroblastic growth factor is clinically well proven in decreasing scar formation and improving healing. There are numerous reconstructive methods for neck contracture, especially when the lesions are relatively limited in part of the neck. However, a very severe and full circumferential scar contracture requires extensive reconstruction. The thin groin flap is one of the answers and well matches with the tissue texture and maintains the flexibility. Even with extensive burns and delayed reconstructions due to resuscitation first, the groin area is well preserved and can be safely harvested by dual vasculature systems of the superficial circumflex iliac artery and superficial epigastric artery, which warrant more reliability compared to the perforator flaps in this area. More demanding and stringent forms of the neck burn scar contracture are the sequelae of radiation. A radiation burn or radiation injury can be progressing and hard to heal. Adipose-derived stem cells can reverse the scar contracture as the surrounding tissue is softened and can accelerate wound healing. In this review, different types of neck burn scar contracture and reconstructive methods are summarized, including innovative use of bFGF and ADSCs in the management of difficult wound healing and scar contracture.

  4. The Stanford-ReSurge Burn Scar Contracture Scale for Neck: Development and Initial Validation for Burn Scar Contracture.

    PubMed

    Cai, Lawrence; Puri, Vinita; Dangol, Mohan Krishna; Mannan, Iftekhar Ibne; Khundkar, Shafquat Hussain; Le Thua, Trung-Hau; Muguti, Godfrey; Rai, Shankar Man; Karanas, Yvonne; Chang, James

    2016-11-01

    Burn contractures can cause significant disability, particularly in patients in resource-limited settings. However, a gap exists in our ability to measure outcomes in patients with burn contractures of the neck. The objective of this study was to develop and validate the Stanford-ReSurge Burn Scar Contracture Scale-Neck to longitudinally assess functional status and measure functional improvement following contracture release of the neck. A literature review was performed to identify scales used in neck assessment and burn assessment. Items were then removed from the pool based on redundancy, feasibility, cultural appropriateness, and applicability to patients in international resource-limited environments. Remaining items were administered to patients with burn contracture of the neck. The initial literature review found 33 scales that were combined to create an initial pool of 714 items, which was first reduced to 40 items. Feedback from field testing then yielded a 20-item outcome tool to assess appearance, activities of daily living, somatosensation, satisfaction, and range of motion, with a floor of 20 and a ceiling score of 100 points. Preliminary testing with 10 patients showed an average preoperative score of 58 points and an average 1-month postoperative score of 42 points. The authors have created an outcome tool for measuring functional status following burn contracture release of the neck, which can easily be implemented in resource-limited settings where the burden of burn injuries and morbidities is disproportionately high. Ongoing work includes a multicountry study to evaluate validity and reliability.

  5. Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes (ACT)

    DTIC Science & Technology

    2011-10-01

    Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes (ACT) Mr. Reginald Richard American Burn...and Rehabilitation Treatment Time Related to Patient Outcomes, conveniently referred to as the ACT representing Acuity, Contractures and Time, is...wound leading to scar contracture begins almost immediately after the burning process stops. Rehabilitation treatment delivered prior to beginning

  6. Pressure therapy in treatment of hypertrophic scar, burn contracture and keloid: the Kenyan experience.

    PubMed

    Haq, M A; Haq, A

    1990-11-01

    A preliminary report of the results of pressure therapy for hypertrophic scar, burn contracture and keloid is presented. Thirty four patients over a four year period were treated with four types of pressure therapy. Results showed over 50% improvement in 21 (61.8%) cases. This method obviated the need for repetitive surgery and no recurrence was noted. Pressure therapy is advocated as an adjunct measure for all cases of hypertrophic scarring, burn contracture and keloid.

  7. Perforator-based flaps for the treatment of burn scar contractures: a review.

    PubMed

    Stekelenburg, C M; Marck, R E; Verhaegen, P D H M; Marck, K W; van Zuijlen, P P M

    2017-01-01

    Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising; however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial; ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.

  8. A systematic review on burn scar contracture treatment: searching for evidence.

    PubMed

    Stekelenburg, Carlijn M; Marck, Roos E; Tuinebreijer, Wim E; de Vet, Henrica C W; Ogawa, Rei; van Zuijlen, Paul P M

    2015-01-01

    Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

  9. Burn Patient Acuity Demographics, Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes (ACT)

    DTIC Science & Technology

    2014-10-01

    Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes, conveniently referred to as the ACT for representing Acuity...acute and intermediate phases of burn rehabilitation through the collection of daily treatment information for analysis. In particular, the ACT is...primarily interested in investigating the influence that time spent receiving rehabilitation treatments has on patient outcomes as a reflection of

  10. Identification of cutaneous functional units related to burn scar contracture development.

    PubMed

    Richard, Reginald L; Lester, Mark E; Miller, Sidney F; Bailey, J Kevin; Hedman, Travis L; Dewey, William S; Greer, Michelle; Renz, Evan M; Wolf, Steven E; Blackbourne, Lorne H

    2009-01-01

    The development of burn scar contractures is due in part to the replacement of naturally pliable skin with an inadequate quantity and quality of extensible scar tissue. Predilected skin surface areas associated with limb range of motion (ROM) have a tendency to develop burn scar contractures that prevent full joint ROM leading to deformity, impairment, and disability. Previous study has documented forearm skin movement associated with wrist extension. The purpose of this study was to expand the identification of skin movement associated with ROM to all joint surface areas that have a tendency to develop burn scar contractures. Twenty male subjects without burns had anthropometric measurements recorded and skin marks placed on their torsos and dominant extremities. Each subject performed ranges of motion of nine common burn scar contracture sites with the markers photographed at the beginning and end of motion. The area of skin movement associated with joint ROM was recorded, normalized, and quantified as a percentage of total area. On average, subjects recruited 83% of available skin from a prescribed area to complete movement across all joints of interest (range, 18-100%). Recruitment of skin during wrist flexion demonstrated the greatest amount of variability between subjects, whereas recruitment of skin during knee extension demonstrated the most consistency. No association of skin movement was found related to percent body fat or body mass index. Skin recruitment was positively correlated with joint ROM. Fields of skin associated with normal ROM were identified and subsequently labeled as cutaneous functional units. The amount of skin involved in joint movement extended far beyond the immediate proximity of the joint skin creases themselves. This information may impact the design of rehabilitation programs for patients with severe burns.

  11. Changes in burn scar contracture: utilization of a severity scale and predictor of return to duty for service members.

    PubMed

    Niedzielski, Lt Stephanie; Chapman, Maj Ted

    2015-01-01

    A medical records review of Operation Iraqi Freedom and Operation Enduring Freedom burn injury survivors admitted to the U.S. Army Institute of Surgical Research Burn Center from April 2003 to August 2005 was conducted. The study proposed the use of a newly developed scale, the Burn Scar Contracture Severity Scale, to potentially provide standardization in quantifying burn scar contracture severity. Changes in the active range of motion from in-patient discharge to out-patient follow-up of individuals with upper extremity burn injuries were compared. Changes in the impairment via American Medical Association impairment scores and perceived disability using the disabilities of the arm, shoulder, and hand questionnaire scores from the in-patient discharge to the out-patient follow-up were also compared. A weak, yet positive correlation (r = .417, .451, P ≤ .001) between the proposed scale and the disabilities of the arm, shoulder, and hand questionnaire and the American Medical Association impairment scores was found, respectively. A receiver operating characteristic curve analysis revealed a cut-off score of 6.5 for the burn scar contracture severity scale, indicating that individuals scoring below a 6.5 returned to duty and those scoring above 6.5 did not return to duty. Results suggest that the burn scar contracture severity scale is able to discriminate between the individuals who returned to duty and those who did not return to duty.

  12. Shoulder adduction contracture after burn: anatomy and treatment with quadrangular local scar subcutaneous pedicled flap, a new approach.

    PubMed

    Grishkevich, Viktor M

    2013-11-01

    Axillary adduction contracture is caused by scars that tightly surround the shoulder joint impairing the function of the upper limb. Due to severe scar surface deficiency, contracture release presents a challenge for surgeons since a method of release is transfer of tissue in the form of a large pedicled or free flap(s). Thus, development of simpler, less traumatic techniques, using local tissues, persists. Anatomic studies of shoulder adduction contractures after burn (pre-operative, during surgery, post-reconstruction) were done in 346 pediatric and adult patients. All were divided into three groups according to contracture types: with edge contractures (80%), medial (6%) and total (14%). Anatomical study covered peculiarities of total contractures and possibilities for their treatment using local scarred tissue. Total contractures (48 patients) were caused by scars tightly surrounding the joint on three sides: anterior, posterior, and axillary. There were two specific forms of contracture: (a) shoulder close to the chest wall (22 of 48 patients) which was treated with thoracic pedicled or free flaps; (b) in 26 out of 48 patients a flat scar and skin graft surface laid along the shoulder and chest wall, in axillary projection, which were used for contracture release in the form of a subcutaneous pedicled quadrangular flap. The flap was mobilized only peripherally, descending to the apex of the axilla, forming the central axillary zone, and suspension of the axilla on a normal level. Wounds aside the flaps were covered with skin graft. Acceptable functional and cosmetic results were achieved in all 26 patients. Total shoulder adduction contractures have two forms: (a) shoulder close/fused with the chest wall; and (b) along the chest wall and shoulder there is a flat surface, the tissue of which can be used for reconstruction in a form of scar subcutaneous pedicled quadrangular flap. Based on this flap, a new technique is described which is relatively easy to

  13. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    DTIC Science & Technology

    2015-10-01

    is documented from information in the subject’s medical record.   3.  Ethnicity  is selected as either “Non‐Hispanic” or “Hispanic/ Latino.” “Unknown...dd-year) __________________ Size of original burn (%TBSA) ____________________ Ethnicity : Non-Hispanic (01) Hispanic/Latino (02) Unknown...Click’ and hold  depressed  LEFT mouse button to outline a burn area returning to original beginning  curser position; release Left button and

  14. Skin regeneration for children with burn scar contracture using autologous cultured dermal substitutes and superthin auto-skin grafts: preliminary clinical study.

    PubMed

    Fujimori, Yasushi; Ueda, Koichi; Fumimoto, Hiromichi; Kubo, Kentaro; Kuroyanagi, Yoshimitsu

    2006-10-01

    We have evaluated a novel treatment of burn scar contracture in children. This method involves the application of an autologous cultured dermal substitute (CDS), followed by a graft of superthin split-thickness skin. In the first operation, the autologous CDS was applied to the skin defect that had occurred after releasing the scar contracture. In the second operation, a superthin thickness skin graft (4 approximately 6/1000 inches) was applied 5 approximately 12 days after the first operation. The autologous CDS was applied to 10 sites of 5 children. On 8 sites, the skin grafts were contracted to some extent at an early stage. However, these skin grafts were stretched gradually to a range from 60% to 100% of an original size. At 2 sites, the skin grafts had stretched from 110% to 130% of the original size. This strategy may be useful for the treatment of burn scar contracture in children.

  15. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    DTIC Science & Technology

    2015-10-01

    STANDARD POSITION  Testing Position: Sitting upright with thoracic and lumbar  spine  supported,  cervical   spine  should have 0 degrees of  rotation or...Passively  extend  cervical   spine .  AMA normative value: 50 degrees                  Version #1  8 August 2015    42    Appendix D:  Randomization Table...questions concerning the validity of standard GM as a measure of patient functional outcome for patients after burn injury . The current research

  16. Ankle dorsiflexion postburn scar contractures: anatomy and reconstructive techniques.

    PubMed

    Grishkevich, Viktor M

    2012-09-01

    Postburn ankle scar contractures cause functional limitations of all lower extremities and create a serious cosmetic defect, not allowing patients to use normal foot wear, and, therefore, needing surgical reconstruction. The anatomic features of ankle dorsiflexion contractures and their treatment have been covered in the literature far less than other joint contractures, and their treatment is still a challenge for many surgeons. A common treatment method is incisional release of the contracture and defect resurfacing with skin graft. Rarely, distally based sural or free flaps and Ilizarov fixator are used. Anatomy of postburn ankle scar contractures in 55 patients was studied and contractures were surgically treated using a specific approach and technique. Follow-up results were observed from 6 months to 16 years. According to the anatomic features, dorsiflexion scar contractures were divided into three types: edge, medial, and total. Edge contractures were caused by burns and scars located on the lateral or medial ankle surface and were characterized by the presence of the fold along the anterior edge ankle; the skin of the anterior ankle surface was not injured. Medial contractures were caused by scars located on the anterior ankle surface and were characterized by the presence of the fold along the medial ankle line. Total contractures were caused by scars tightly surrounding the ankle. In fold's sheets of edge and medial contractures there is a trapeze-shaped surface deficit in length (cause of contracture) and a surface surplus in width which allows contracture release with local trapezoid flaps. For total contractures, wide scar excision and skin grafting were indicated. Three anatomic types of ankle dorsiflexion scar contractures were identified: edge, medial, and total. An anatomically justified technique for edge and medial contractures is trapeze-flap plasty; total contractures are effectively eliminated with scar excision and skin grafting. Copyright

  17. Burn Patient Acuity Demographics, Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes: The ACT Study.

    PubMed

    Richard, Reg; Santos-Lozada, Alexis R

    In 2008, the U.S. Department of Defense funded a rehabilitation study through the American Burn Association titled "Burn patient acuity demographics, scar contractures, and rehabilitation treatment time related to patient outcomes," commonly known at the ACT study. The ACT was a multi-institutional, prospective, observational, and quasirandomized investigation of the acute hospital course of 307 patients. The ACT specifically emphasized the capture of factors that may impact the physical outcome of patients with burn injury including burn severity, daily rehabilitation interventions such as mobility and splinting, and detailed skin grafting episodes. In particular, the effect that the amount of daily rehabilitation time patients received as it related to range of motion measured at the time of acute hospital discharge of areas affected by the burn injury was analyzed. The information contained herein is intended to give the interested reader an overview of the extent and breadth of the ACT dataset in terms of parameters available for further investigation. This information is also intended to be used as a basic reference for conduct of the ACT study in future reports.

  18. Perforator-Based Interposition Flaps Perform Better Than Full-Thickness Grafts for the Release of Burn Scar Contractures: A Multicenter Randomized Controlled Trial.

    PubMed

    Stekelenburg, Carlijn M; Jaspers, Mariëlle E H; Jongen, Sandra J M; Baas, Dominique C; Gardien, Kim L M; Hiddingh, Jakob; van Zuijlen, Paul P M

    2017-02-01

    Burn scar contractures remain a significant problem for the severely burned patient. Reconstructive surgery is often indicated to improve function and quality of life. Skin grafts (preferably full-thickness grafts) are frequently used to cover the defect that remains after scar release. Local flaps are also used for this purpose and provide healthy skin subcutaneous tissue. The vascularization and versatility of local flaps can be further improved by enclosing a perforator at the base of the flap. Until now, no randomized controlled trial has been performed to determine which technique has the best effectiveness in burn scar contracture releasing procedures. A multicenter randomized controlled trial was performed to compare the effectiveness of perforator-based interposition flaps to full-thickness skin grafts for the treatment of burn scar contractures. The primary outcome parameter was change in the surface area of the flap or full-thickness skin graft. Secondary outcome parameters were width, elasticity, color, Patient and Observer Scar Assessment Scale score, and range of motion. Measurements were performed after 3 and 12 months. The mean surface area between flaps (n = 16) and full-thickness skin grafts (n = 14) differed statistically significantly at 3 months (123 percent versus 87 percent; p < 0.001) and 12 months (142 percent versus 92 percent; p < 0.001). In terms of the secondary outcome parameters (specifically, the Patient and Observer Scar Assessment Scale observer score and color), interposition flaps showed superior results compared with full-thickness skin grafts. Perforator-based interposition flaps result in a more effective scar contracture release than full-thickness skin grafts and should therefore be preferred over full-thickness skin grafts when possible. Therapeutic, I.

  19. Scar contractures, hypertrophic scars, and keloids.

    PubMed

    Brissett, A E; Sherris, D A

    2001-11-01

    A scar contracture is the result of a contractile wound-healing process occurring in a scar that has already been reepithelialized and adequately healed. Keloids and hypertrophic scars (HTSs) are fibrous tissue outgrowths that result from a derailment in the normal wound-healing process. The exact incidence of keloids and HTSs remains unknown. Beyond the common belief that trauma is the initiating event of keloid and hypertrophic scar formation, the remainder of the process remains uncertain. A combination of biochemical factors, skin tension, endocrinologic factors, and genetic factors are the likely culprits. Treatment begins by educating the patient about the etiology of the scarring process. All treatment protocols are individualized, but the standard approach to keloids and HTSs begins with corticosteroid injection followed by surgical excision, pressure dressings, and long-term follow-up.

  20. Scar contractures of the hand.

    PubMed

    Hegge, Theresa; Henderson, Megan; Amalfi, Ashley; Bueno, Reuben A; Neumeister, Michael W

    2011-10-01

    This article discusses scar contracture of the hand. It contains a brief outline of the anatomy of the hand and upper extremities and the types of injuries involved. Hand reconstruction, including examination, nonoperative treatment, surgery, excision and skin grafting, flaps, postoperative management, and complications, are covered. 2011 Elsevier Inc. All rights reserved.

  1. [Surgical strategy for postburn cervical scar contracture].

    PubMed

    Feng, Shaoqing; Su, Weijie; Xi, Wenjing; Min, Peiru; Pu, Zheming; Zhang, Yan; Zhang, Yixin

    2015-08-01

    To explore the surgical strategy for postburn cervical scar contracture. Sixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i.e. lower lip vermilion border-supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i.e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps. All patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence. Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first

  2. An implant-supported removable partial denture for a patient with post-inflammatory scar contracture caused by burn complications: a clinical report

    PubMed Central

    Kim, Jee-Hwan

    2012-01-01

    The scars and contracture around the oral-facial region may cause difficulty in prosthodontic treatment to restore esthetics and function for the patients, who suffered severe burns. This article presents a technique that uses a fixed partial denture prepared with a conventional milling technique and an attachment to support anterior cantilever removable partial denture, thereby providing a more esthetically acceptable and functional result. PMID:22439102

  3. Burn Patient Acuity Demographics, Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes (ACT)

    DTIC Science & Technology

    2015-12-01

    Patient Outcomes (ACT ) PRINCIPAL INVESTIGATOR : Reginald Richard , MS , PT CONTRACTING ORGANIZATION : American Burn Association Chicago, IL 60606 REPORT...ORGANIZATION REPORT NUMBER American Burn Association 311 S. Wacker Drive Suite 4150 Chicago, IL 60606 9.SPONSORING I MONITOR ING AGENCY NAME(S...captured in cutaneous functional units (CFUs).  CFUs are defined as “fields of the skin that are  involved in the joint range of motion and  associated

  4. [Retrospective analysis of effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side].

    PubMed

    Chunsheng, Hou; Qingye, Liu; Hongfei, Hao; Yuying, Dong; Feng, Wang; Jin, Lei

    2015-06-01

    To analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively. A total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with

  5. California Burn Scars

    Atmospheric Science Data Center

    2014-05-15

    article title:  Burn Scars Across Southern California     ... California between October 21 and November 18, 2003. Burn scars and vegetation changes wrought by the fires are illustrated in these ... and Nov 18, 2003 Images:  California Burn Scars location:  United States region:  ...

  6. Surgical treatment of severe or moderate axillary burn scar contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients--A clinical experience of 15 cases.

    PubMed

    Chen, Baoguo; Xu, Minghuo; Chai, Jiake; Song, Huifeng; Gao, Quanwen

    2015-06-01

    Axillary burn scar contracture is common and troublesome. With the aim of restoring the function of the upper extremities, a proper local flap with minor damage and preclusion from recurrence should be developed to guarantee satisfactory results. A minor webbed scar contracture was rectified by Z-plasty. However, severe or moderate contracture must be constructed by a local flap. An island scapular flap has been used in pediatric patients for repairing axillary contracture. However, no detailed description of the use of a transverse island scapular flap (TISF) was reported to correct the deformity. Moreover, an expanded transverse island scapular flap (ETISF) used for increasing the volume of skin for severe axillary contracture in adults and developing children was also not presented. From 2006 to 2013, TISFs were harvested for 12 pediatric patients (5-12 years of age) with 15 sides of severe or moderate axillary burn scar contractures. Four ETISFs were designed for two adult patients (38 and 32 years of age). The flap size was between 10 cm×5 cm and 20 cm×10 cm. In one pediatric patient, a cicatrix was observed on the surface of the flap's donor site. Handheld Doppler was applied to detect the pedicle. The patients were required to lift their upper arms regularly each day after the operation. All 19 flaps survived completely. Axillary burn scar contractures were corrected successfully in 11 patients with no expander implantation. The lifting angle was enhanced considerably with 1-3 years of follow-up in the 11 patients. Only one pediatric patient with cicatrix on the donor site displayed tight skin on the back and a little restraint on the shoulder. The patient's parents were told to intensify the chin-up movement on the horizontal bar. She was in the process of a 3-month follow-up. The lifting angle was also improved significantly in the latter three cases of expander implantation although they were followed up for a short duration of 3 months. Due to poor

  7. Management of scar contractures, hypertrophic scars, and keloids.

    PubMed

    Sherris, D A; Larrabee, W F; Murakami, C S

    1995-10-01

    Aberrant fibrous tissue formation after surgery or trauma still presents a challenge to surgeons. Current research hopes to identify the characteristics of the population of fibroblasts that lead to hypertrophic or keloid scar formation. Surgical procedures and laser therapy followed by intralesional steroid treatments still are the foundation of treatment; but new modalities are being applied. The pathogenesis and management of hypertrophic scars, keloids, and scar contractures are discussed in this article.

  8. [Curative effects of kinesitherapy in combination with self-made simple orthosis in treatment of scar contracture of burned hand in children].

    PubMed

    Lei, Fang; Tang, Youling; Chen, Pei; Luo, Hao; Wang, Juan; Xie, Weiguo

    2014-12-01

    To survey the curative effects of kinesitherapy in combination with self-made simple orthosis (SO) in treatment of scar contracture of burned hand in children. Fifty-eight children with burns of unilateral hand and received treatment in our rehabilitation center from January 2012 to January 2014 were divided into common rehabilitation (CR) and SO groups according to the random number table, with 29 cases in each group. After the wounds were healed, patients in group CR were treated with kinesitherapy combined with hand game exercises and pressure gloves, while patients in group SO were treated with kinesitherapy combined with hand game exercises and self-made SO, which was composed of finger web dividing belt, self-adhesive bandage, and infusion set fixing plate. Before treatment and 16 weeks after treatment, scar condition was assessed with the Vancouver Scar Scale (VSS); hand function was evaluated by the Jebsen Test of Hand Function, and the completion time was recorded; and the activities of daily life (ADL) was measured by the modified Barthel Index. Sixteen weeks after treatment, the range of motion was measured with the Total Active Movement (TAM) method. Data were processed with t test and chi-square test. The score of VSS in group SO was (12.2 ± 1.3) points before treatment and (6.7 ± 2.2) points 16 weeks after treatment, and the improvement score was (5.6 ± 1.8) points. The score of VSS in group CR was (12.0 ± 1.4) points before treatment and (7.0 ± 1.8) points 16 weeks after treatment, and the improvement score was (5.0 ± 1.0) points. There was no obvious difference in improvement score of VSS between the two groups (t = 1.452, P = 0.152). The ratio of excellent and good results according to TAM method in group SO was 75.9% (22/29) , while it was 37.9% (11/29) in group CR (t = 8.507, P = 0.004). The completion time for the Jebsen Test of group OS was (8.2 ± 1.6) min before treatment and (7.1 ± 1.4) min after treatment, and the improvement time

  9. The cost of post-burn scarring

    PubMed Central

    Mirastschijski, U.; Sander, J.T.; Zier, U.; Rennekampff, H.O.; Weyand, B.; Vogt, P.M.

    2015-01-01

    Summary Deep burns lead to scarring and contractures for which there is little or no published data on treatment costs. The purpose of this study was to fill this gap by analysing treatment costs for burn sequelae. To do this, German-DRG for in-patient treatment was collected from the Burn Centre Lower Saxony. DRG-related T95.-coding served as a tool for burn-associated sequelae. Data on scar occurrence, plastic-reconstructive surgery and sick leave were collected by a questionnaire. The findings showed that 44.6% patients reported post-burn scarring and 31% needed surgical intervention. The expected risk for readmission was significantly higher (p=0.0002) with scars compared to without. Significantly higher costs for pressure garments were noted for scarred patients (p=0.04). No differences were found for ointments, silicone dressings or pain medication. Treatment costs for patients with scars were 5.6 times higher compared with no scar assessed by G-DRG. No differences were stated subsuming multiple readmissions for post-burn treatment per individual. Significantly higher costs (p=0.03) were noted for patients with burn sequelae other than scars with regard to individual readmissions. It has been revealed that treatment of scars causes higher costs than for other burn sequelae because of multiple surgical interventions. To reduce post-burn scarring and costs, specialized burn centres provide optimal and state-of-the-art treatment. As well as this, more emphasis should be laid on promoting research for the development of novel anti-scarring therapies. PMID:27279810

  10. The cost of post-burn scarring.

    PubMed

    Mirastschijski, U; Sander, J T; Zier, U; Rennekampff, H O; Weyand, B; Vogt, P M

    2015-09-30

    Deep burns lead to scarring and contractures for which there is little or no published data on treatment costs. The purpose of this study was to fill this gap by analysing treatment costs for burn sequelae. To do this, German-DRG for in-patient treatment was collected from the Burn Centre Lower Saxony. DRG-related T95.-coding served as a tool for burn-associated sequelae. Data on scar occurrence, plastic-reconstructive surgery and sick leave were collected by a questionnaire. The findings showed that 44.6% patients reported post-burn scarring and 31% needed surgical intervention. The expected risk for readmission was significantly higher (p=0.0002) with scars compared to without. Significantly higher costs for pressure garments were noted for scarred patients (p=0.04). No differences were found for ointments, silicone dressings or pain medication. Treatment costs for patients with scars were 5.6 times higher compared with no scar assessed by G-DRG. No differences were stated subsuming multiple readmissions for post-burn treatment per individual. Significantly higher costs (p=0.03) were noted for patients with burn sequelae other than scars with regard to individual readmissions. It has been revealed that treatment of scars causes higher costs than for other burn sequelae because of multiple surgical interventions. To reduce post-burn scarring and costs, specialized burn centres provide optimal and state-of-the-art treatment. As well as this, more emphasis should be laid on promoting research for the development of novel anti-scarring therapies.

  11. [Effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand].

    PubMed

    Zhu, C; Yi, N; Shi, M N; Liang, Y Y; Zhou, Y B; Dang, R; Qi, Z S; Zhao, H Y

    2017-07-20

    Objective: To observe the effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand. Methods: Forty-six patients with scar contracture after deep partial-thickness or full-thickness burn injury of dorsal hand hospitalized in our department from March 2013 to February 2015 were divided into routine training group (RT, n=18) and comprehensive training group (CT, n=28) according to their willingness. Two weeks after the wounds were healed, patients in group RT were treated with functional training of hands and self-made pressure gloves, while patients in group CT were treated with self-made hand flexing training band (consisting of nylon strap, flexing band, and velcro) on the basis of those in group RT. All patients were treated for 3 months. Before and after treatment, scar condition of affected hands was assessed with Vancouver Scar Scale (VSS). The range of motion of joints of affected hands was measured by Total Active Movement (TAM) Scale. The function of affected hands was evaluated by Carroll Upper Extremity Function Test. Data were processed with t test, chi-square test, and Mann-Whitney U test. Results: (1) The score of VSS in patients of group RT was (10.0±1.9) points before treatment and (4.4±1.4) points after treatment, with the improved score of (5.6±1.0) points. The score of VSS in patients of group CT was (10.5±1.8) points before treatment and (4.6±1.4) points after treatment, with the improved score of (5.9±1.2) points. There was no statistically significant difference in the improved score of patients between the two groups (t=0.834, P>0.05). The score of VSS in patients of groups RT and CT after treatment was significantly lower than that before treatment (with t values respectively 14.014 and 10.003, P values below 0.01). (2) Before treatment, the ratios of excellent and good results according to TAM were 2/9 in patients of group RT and 3/14 in group CT

  12. Burn scar carcinoma.

    PubMed

    Huang, Chun-Yuan; Feng, Chung-Ho; Hsiao, Yen-Chang; Chuang, Shiow Shuh; Yang, Jui-Yung

    2010-11-01

    Since Jean-Nicolas Marjolin reported carcinoma arising in post-traumatic scars in 1828, the term 'Marjolin ulcer' has been applied to malignant changes in burn scars. Although many papers have been published already in this field, there are few reports from Oriental people. From 1989 to 2008, there were 11 cases noted as burn scar carcinoma in Chang Gung Memorial Hospital. Ten were reported as squamous cell carcinoma (SCC) and the one was verrucous carcinoma. Most of the cases occurred in the extremities (10/11). Ten cases underwent an operation initially with wide excision and skin graft or local flap for coverage. Forefoot amputation was performed in one patient. One patient received above-knee amputation and adjuvant therapy because recurrent verrucous carcinoma occurred 2 years later. One patient suffered from a new lesion 8 years later and another case had inguinal lymph node metastasis 8 months later. Five patients were lost to follow-up and six cases were tumor-free during the follow-up period. Most scar malignancies are SCC while other cell types are rarer. The casual association between burn injuries and a later risk of basal cell carcinoma is questionable. Owing to poor prognosis in advanced scar cancer, the best treatment for scar carcinoma is to prevent the scar from developing repeated ulceration by performing aggressive initial burn wound care: early grafting by surgeons and daily scar care with regular follow-up for patients. This may be why a lower incidence has been noted in recent years.

  13. First web space post-burn contracture types: contracture elimination methods.

    PubMed

    Grishkevich, Viktor M

    2011-03-01

    First web space adduction contractures are a common consequence of hand burns. Many reconstructive techniques are used and investigation for more effective methods continues. Effective hand reconstruction usually considers anatomy as its foundation. Based on the experience of over 500 web space contracture elimination cases, three anatomical types of thumb adduction contractures were identified: edge, medial and total. Edge contractures (80% of all thumb adduction contractures) are caused by a fold in which only one sheet is scarred, either the palmar or dorsal surface. The contraction is caused by a trapeze-shaped length deficiency of the scar sheet, which has a surface surplus in width. Reconstruction consists of surface deficiency compensation with trapezoid flap prepared from the non-scarred side and skin-fat tissues of the web space. In most cases, the small scar-fat trapezoid flaps should be prepared from the non-scarred side to cover the donor wounds on both sides of the main flap. Medial contractures (10% of thumb adduction contractures) are caused by the fold, both sheets of which are scarred and have trapeze-shaped surface deficiency in length and surplus in width. Both fold sheets are converted into one or several pairs of trapezoid scar-fat flaps by radial incisions. The oppositely located flaps are transposed towards each other. As a result of the counter flaps transposition, the contracture is eliminated; the web space's shape and depth are restored by the use of flaps alone or in combination with skin grafting. The trapeze-flap plasty is very simple and effective with the length gain of up to 100-200%. Neither flap loss nor re-contracture occurs. Total contractures (about 10% of all) have no fold. Reconstruction consists of the creation of the central zone of the first web space depth with the rectangular subdermal pedicle flap; the wounds on both sides of the flap are skin grafted. The flap sustains normal web depth and prevents the contracture

  14. [Burn scars: rehabilitation and skin care].

    PubMed

    Rochet, Jean-Michel; Zaoui, Affif

    2002-12-15

    Burn rehabilitation main goal is to minimize the consequences of hypertrophic scars and concomitant contractures. The treatment principles rely on the association of joint posture, continuous pressure completed with range of motion to prevent joint fusion (which happens to adults but not to children). Throughout the different treatment phases and wound evolution, reassessment is necessary to review rehabilitation goals and activities. During the acute phase the alternance of positioning is prioritized in order to keep the affected extremities in antideformity position using splint or other devices. At the rehabilitation phase, treatment is focussed on active/passive range of motion (skin posture) strengthening exercises and use of dynamic splint is introduced to correct contractures. After their discharge home, patients benefit from outpatient rehab until scar maturation (approximately 18 months). The treatment consists mainly on active/passive range of motion, scar massage, strengthening exercise and endurance retraining. Also modalities (such as thermal bath and high pressure water spray) are used to address itching problems and for scar softening. Finally, reconstructive surgery can be performed to correct excessive scarring or joint contracture for better functional or cosmetic outcome.

  15. Longitudinal burn scar quantification.

    PubMed

    Nedelec, Bernadette; Correa, José A; de Oliveira, Ana; LaSalle, Leo; Perrault, Isabelle

    2014-12-01

    Quantitative studies of the clinical recovery of burn scars are currently lacking. Previous reports validate the objective, precise, diagnostic capabilities of high-frequency ultrasound to measure thickness, the Cutometer(®) to measure pliability and the Mexameter(®) to measure erythema and pigmentation of scars. Thus, we prospectively quantified clinical characteristics of patient-matched, after burn hypertrophic scar (HSc), donor site scar (D) and normal skin (N) using these instruments. One investigator measured 3 sites (HSc, D, N) in 46 burn survivors at 3, 6, and 12 months after-burn. A mixed model regression analysis, adjusting p-values for multiplicity of testing, was used to compare means among sites and time points. Participants were 41.2±13.5 years old, 87% males, predominantly Caucasian, with an average of 19.5% body surface area burned. HSc thickness decreased significantly between 3 and 6, 6 and 12, and 3 and 12 months (all p<0.0001), but remained thicker than D and N skin (all p<0.0001). Pliability differed significantly between HSc, D and N sites at all time points (all p<0.0001), with HSc and D increasing between 3 and 12 months (p<0.05) but not reaching normal. HSc and D sites were significantly more erythematous than normal skin (p<0.05) at 3 and 6 months but D sites approached normal by 12 months. The only time points at which pigmentation significantly differed were the HSc and D sites at 6 months. Thickness, pliability, erythema and pigmentation of N skin remained similar over the 12 months. We found that post-burn HSc thickness, pliability and erythema differed significantly from D and N skin at 3, 6, and 12 months and does not return to normal by 12 months after-injury; however, significant improvements towards normal can be expected. Donor sites are redder than normal skin at 3 and 6 months but can be expected to return to normal by 12 months. Although the color of HSc and D sites change markedly with time these color changes are

  16. Ablative fractional laser resurfacing helps treat restrictive pediatric scar contractures.

    PubMed

    Krakowski, Andrew C; Goldenberg, Alina; Eichenfield, Lawrence F; Murray, Jill-Peck; Shumaker, Peter R

    2014-12-01

    Conventional management of debilitating pediatric scar contractures, including hand therapy and surgery, may often be beset by delayed treatment, suboptimal results, and additional surgical morbidity. Ablative fractional laser resurfacing is an emerging adjunctive procedural option for scar contractures because of its promising efficacy and safety profile. However, its use to improve function has not been studied in the pediatric population. Herein we report 2 pediatric patients with recalcitrant scar contractures, causing persistent functional deficits, treated with an ablative fractional laser protocol. Both patients experienced rapid and cumulative subjective and objective improvements in range of motion and function as measured by an independent occupational therapist without reported complications. We highlight ablative fractional laser resurfacing as a novel and promising tool in the management of function-limiting scar contractures in children and propose that the technique be incorporated into existing scar treatment paradigms, guided by future research.

  17. An extraordinary case of axillary contracture: trapped healthy skin and its adnexes under contracted scar.

    PubMed

    Nisanci, Mustafa; Sahin, Ismail; Guzey, Serbulent

    2014-01-01

    Although striking improvements have been achieved in overall management of burn injury, postburn contractures are still an ongoing challenge to burn surgeons. Axillary adduction contracture is one of the most common types of these disabling postburn complications that usually result from suboptimal treatment after acute burns. An unusual and complicated case of axillary contracture in which the unburned, healthy axillary dome skin was trapped as a cystic mass under the scarred area was reconstructed by transfer of a big (17×13-cm) thoracodorsal artery perforator flap after contracture release. The result was satisfactory in terms of function and acceptable cosmetically. The underlying reasons for the inadequate treatment the patient received after surviving a severe electrical injury were discussed.

  18. An Extraordinary Case of Axillary Contracture: Trapped Healthy Skin and Its Adnexes Under Contracted Scar

    PubMed Central

    Nisanci, Mustafa; Sahin, Ismail; Guzey, Serbulent

    2014-01-01

    Although striking improvements have been achieved in overall management of burn injury, postburn contractures are still an ongoing challenge to burn surgeons. Axillary adduction contracture is one of the most common types of these disabling postburn complications that usually result from suboptimal treatment after acute burns. An unusual and complicated case of axillary contracture in which the unburned, healthy axillary dome skin was trapped as a cystic mass under the scarred area was reconstructed by transfer of a big (17 × 13-cm) thoracodorsal artery perforator flap after contracture release. The result was satisfactory in terms of function and acceptable cosmetically. The underlying reasons for the inadequate treatment the patient received after surviving a severe electrical injury were discussed. PMID:25058781

  19. MALIGNANT DEGENERATION IN BURN SCARS

    PubMed Central

    Castañares, Salvador

    1961-01-01

    The malignant potential of burn scars has been recognized since Marjolin's classical description of cancer arising in several types of post-traumatic scars. With improved burn therapy since the last war, there has been a higher survival rate of severe burns with proportionate increase in cancer associated with burn scars. This will create increasing problems of permanent disability and compensation. The younger the patient at the time of the burn, the longer the time required for the cancer to develop. Acute cancer development in burn scars has been reported after a four-week interval. Cancer may develop from six weeks to fifty years or more. The etiology of cancer in burn scars is not known. The most important clinical finding is the fact that most of the burn cancers occur in areas which were not grafted. The most common type of cancer encountered in burn scars is squamous cell carcinoma, which forms in Marjolin ulcers. Basal cell carcinoma may develop in the most superficial of burn scars. Treatment should be directed primarily to prompt and adequate skin grafting in all deep burns in order to prevent malignant degeneration of the burn scars. Once it has developed the treatment is the same as for other malignancies which are not associated with burns. Wide surgical excision with block dissection of the regional lymph nodes when they are involved is the treatment of choice. The prognosis of burn scar cancer is poor, once the process has extended because of early and distant metastasis. ImagesFigure 1.Figure 2.Figure 2.Figure 3.Figure 3.Figure 4. PMID:13691372

  20. [Effectiveness of dorsal metacarpal island flap for treating scar contracture of finger web].

    PubMed

    Qian, Jun; Rui, Yongjun; Zhang, Quanrong; Xue, Mingyu; Zhang, Zhihai

    2011-11-01

    To investigate the effectiveness of dorsal metacarpal island flap for treating scar contracture of the finger web. Between June 2009 and December 2010, 10 patients with scar contracture of the finger web were treated. There were 6 males and 4 females with an average age of 30 years (range, 14-57 years). Scar contracture was caused by injury in 8 cases, by burn in 1 case, and by operation in 1 case. The locations were the 1st web space in 1 case, the 2nd web space in 3 cases, the 3rd web space in 5 cases, and the 4th web space in 1 case. The disease duration was 3 to 9 months with an average of 5 months. The maximum abduction was 10-20 degrees. After web space scar release, the dorsal metacarpal island flap (3.5 cm x 1.2 cm-4.0 cm x 2.0 cm in size) was used to reconstruct web space (2.0 cm x 1.0 cm-3.0 cm x 1.8 cm in size). The donor site was directly sutured or repaired with local flaps. At 2 days after operation, necrosis occurred in 1 flap, which healed by extractive treatment. The other flaps survived and wound healed by first intention; all the flaps at donor sites survived and incision healed by first intention. Ten patients were followed up 6 to 15 months (mean, 9 months). The reconstructed web space had good appearance, the maximum abduction was 80 degrees in 1 case of the 1st web space scars contracture, and the maximum abduction was 35-45 degrees (mean, 40 degrees) in the other 9 cases. In 8 scar patients causing by injury, no scar contracture recurred during follow-up. It can achieve good results in appearance and function to use dorsal metacarpal island flap for treating scar contracture of the finger web.

  1. Burn Scars Across Southern California

    NASA Image and Video Library

    2003-11-26

    Brush fires consumed nearly 750,000 acres across Southern California between October 21 and November 18, 2003. Burn scars and vegetation changes wrought by the fires are illustrated in these false-color images from NASA Terra spacecraft.

  2. Surgical management of burn flexion and extension contractures of the toes.

    PubMed

    Chang, Jessica B; Kung, Theodore A; Levi, Benjamin; Irwin, Todd; Kadakia, Anish; Cederna, Paul S

    2014-01-01

    Burn contracture of the toes is a devastating sequela of thermal injury to the foot. Without proper treatment of toe burn contractures, patients suffer from significant functional and social limitations, including difficulties with activities of daily living. The authors classify the severity of toe burn scar contractures (TBSCs) by considering important characteristics of the deformity and tailor definitive surgical treatment based on the individual needs of the patient's condition. A retrospective review was performed on 20 patients who underwent a total of 32 reconstructive operations involving 275 TBSC procedures from 2000 to 2010. Multiple clinical, functional, and anatomic criteria were used to describe each patient's contracture as mild, moderate, or severe. Mild TBSC involved scarring of the superficial tissues only with no functional impairment; these were treated with scar release or local tissue rearrangement. Moderate TBSC involved soft tissue shortages requiring skin grafts and occasional closed joint capsulotomy. Severe TBSC caused the greatest impairment in function and involved burn injury to deeper structures. For these difficult contractures, a patient-specific technique was paramount to optimal reconstruction. There were six, three, and 11 patients with mild, moderate, and severe TBSC, respectively. The mean number of primary procedures per toe increased with increasing burn complexity from 1.1 procedures for mild, 1.5 for moderate, and 1.8 for severe groups, with severe TBSC undergoing more primary procedures overall (13.7 in severe vs 2.8 in mild TBSC). Complication rates per toe were highest for severe TBSC (59.0%). Only severe TBSC received secondary operations, and overall contracture recurrence was 35%. An individualized surgical approach based on TBSC severity is recommended for addressing burn contracture of the toes. Careful analysis of the clinical, functional, and anatomic characteristics of the burned foot determines the severity of

  3. Burns, hypertrophic scar and galactorrhea.

    PubMed

    Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro

    2013-07-01

    An 18-year-old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected.She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients.

  4. Burns, hypertrophic scar and galactorrhea

    PubMed Central

    Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro

    2013-01-01

    Abstract: An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected. She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. PMID:23456048

  5. A systematic review of the psychometric properties of self-reported scales assessing burn contractures reveals the need for a new tool to measure contracture outcomes.

    PubMed

    Ehanire, Tosan; Vissoci, Joao Ricardo Nickenig; Slaughter, Keimun; Coêlho, Rafael; Bond, Jennifer; Rodrigues, Clarissa; Pietrobon, Ricardo; Levinson, Howard

    2013-01-01

    Approximately 40% of burn patients develop scar contractures. It is unknown which scar contracture therapy best optimizes activities of daily living (ADL).The appropriateness of self-reported outcome tools in measuring anti-scar contracture therapies has not been assessed. We conducted a systematic review to determine the quality of existing self-reported scales in measuring ADL among burn patients by analyzing and comparing psychometric properties-factor analysis, validity, reliability, and responsiveness. EMBASE, LILACS, American Psychological Association PsycNET databases were searched for relevant articles. Forty-one articles discussing 10 burn and non-burn-specific scales met eligibility criteria of ADL assessment, and available psychometric analyses. A common strength in most scales was good overall reliability. Common weaknesses were insufficient data on factor analyses, content validity specific to ADL assessment, and responsiveness. The psychometric analyses studies on these scales had poor sample variability. There is insufficient data on the dimensionality and responsiveness of existing scales to support their use for measuring ADL in burn patients. Existing scales do not comprehensively measure ADLs as an isolated parameter. A psychometrically valid, comprehensive self-reported burn contracture scale that measures ADLs among a diverse group of burn patients needs to be developed to optimize burn contracture treatments and develop new therapies.

  6. Contracture deformity (image)

    MedlinePlus

    A contracture is a fixed tightening of muscle, tendons, ligaments, or skin. It prevents normal movement of the associated ... injury such as a severe burn can cause contracture of the skin. The skin becomes scarred and ...

  7. Dupuytren’s contracture following burn injury of the hand: A case report and review of literature

    PubMed Central

    Balakrishnan, Chenicheri; Sugg, Kristoffer B; Huettner, William; Jarrahnejad, Payam

    2008-01-01

    In burn patients, scar contractures adjacent to or across the joints lead to disabling deformities. In Dupuytren’s disease, the proliferative process involves the fascia of the palm and fingers, resulting in disabling flexion contractures of the fingers and the palm. A single insult involving the hand or even a more proximal injury may lead to Dupuytren’s disease. PMID:19554166

  8. [EFFECTIVENESS OF DIFFERENT FLAPS FOR REPAIR OF SEVERE PALM SCAR CONTRACTURE DEFORMITY].

    PubMed

    Pang, Mengru; Xiao, Haitao; Wang, Huaisheng; Liu, Xiaoxue; Chen, Junjie; Cen, Ying

    2016-03-01

    To evaluate the effectiveness of different flaps for repair of severe palm scar contracture deformity. Between February 2013 and March 2015, thirteen cases of severe palm scar contracture deformity were included in the retrospective review. There were 10 males and 3 females, aged from 14 to 54 years (mean, 39 years). The causes included burn in 9 cases, hot-crush injury in 2 cases, chemical burn in 1 case, and electric burn in 1 case. The disease duration was 6 months to 6 years (mean, 2.3 years). After excising scar, releasing contracture and interrupting adherent muscle and tendon, the soft tissues and skin defects ranged from 6.0 cm x 4.5 cm to 17.0 cm x 7.5 cm. The radial artery retrograde island flap was used in 2 cases, the pedicled abdominal flaps in 4 cases, the thoracodorsal artery perforator flap in 2 cases, the anterolateral thigh flap in 1 case, and the scapular free flap in 4 cases. The size of flap ranged from 6.0 cm x 4.5 cm to 17.0 cm x 7.5 cm. All flaps survived well. Venous thrombosis of the pedicled abdominal flaps occurred in 1 case, which was cured after dressing change, and healing by first intention was obtained in the others. The mean follow-up time was 8 months (range, 6-14 months). Eight cases underwent operation for 1-3 times to make the flap thinner. At last follow-up, the flaps had good color, and the results of appearance and function were satisfactory. Severe palm scar contracture deformity can be effectively repaired by proper application of different flaps.

  9. The running Y-V plasty for treatment of linear and cord-like burn contractures.

    PubMed

    Arasteh, Ehsan; Yavari, Masoud

    2012-01-01

    Linear and cord-like burn scar contractures are commonly treated by severing the scar in a transverse direction and skin grafting or performing Z-plasties. However, skin grafts may result in suboptimal take and contract gradually and the Z-plasty requires undermining flaps in scarred skin which may lead to the distal tip necrosis. In this article the authors present their experience with multiple Y-V plasty technique. From May 2005 to September 2009, 44 linear and narrow cord-like burn contractures in various regions of upper and lower extremities of 32 patients were treated by multiple Y-V plasty technique. The contracted scars were treated successfully in all of the patients. No major post-operative complications or contracture recurrence were observed during the follow up period of 6 to 24 months in this series of patients. By creating a longer length, running Y-V plasty can relax the contracted scar. Considering the advantages and excellent results in the treated patients in this study group, and also other presented series, multiple Y-V plasty can be recommended as a very useful and safe technique for the treatment of linear and cordlike burn contractures.

  10. Reconstruction of cervical scar contracture using axial thoracic flap based on the thoracic branch of the supraclavicular artery.

    PubMed

    Ma, Xianjie; Li, Yang; Wang, Lu; Li, Weiyang; Dong, Liwei; Xia, Wei; Su, Yingjun

    2014-09-01

    Cervical scar contracture causes both physical and psychological distress for burn patients. Many pedicle flaps or skin grafting have been suggested for reconstruction of cervical scar contracture with variable results in the literature. The authors present the axial thoracic flap based on the thoracic branch of the supraclavicular artery (TBSA) for reconstruction of cervical scar contracture. Postburn scar contractures in anterior neck region of 66 patients had been reconstructed with the axial pattern thoracic flaps based on the TBSA, including 1 expanded and 10 nonexpanded pedicle flaps, and 9 expanded and 46 nonexpanded island pedicle flaps, during 1988 through 2012. After removing and releasing the cervical scar contracture, the flap was designed in the thoracic region. The axial artery of the flap is the TBSA bifurcating from the intersection point of sternocleidomastoid muscle and omohyoid muscle with several concomitant veins as the axial veins. The flap can be designed in a large area within the borders of the anterior border of the trapezius muscle superiorly, the middle part of the deltoid muscle laterally, the midsternal line medially, and the level 3 to 4 cm below nipples inferiorly. After incisions were made along the medial, inferior, and lateral border, dissection was performed toward the pedicle. Donor site was closed directly in expanded cases and with skin grafting in nonexpanded cases. Cervical scar contractures were repaired with good functional and cosmetic results in 64 cases among this cohort. Flap tip necrosis in other 2 cases, caused by postoperative hematoma, was repaired by skin grafting. The color and texture of all flaps were fitted with those of the surrounding skin. The donor sites all healed primarily. The flap sensation in the thoracic region regained in the early stage postoperatively and that in cervical area recovered completely after 6 months according to the report of the patients. With reliable blood supply based on the

  11. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach.

    PubMed

    Grishkevich, Viktor M; Grishkevich, Max; Menzul, Vasiliy

    2015-01-01

    One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous, leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients remains a challenge for surgeons. Eleven children (aged 5 to 14 years) with postburn neck anterior contractures were studied to develop a new approach for reconstruction that would employ the use of local scar-fascial flaps. The new approach and technique for postburn pediatric contracture treatment was developed which is especially effective in the treatment of children who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration. The technique consists of two trapezoid scar-fascial flaps mobilization which includes all the anterior neck surfaces and consists of scars, fat layer, platysma, and deep cervical fascia. Counter transposition of flaps with tension elongated neck anterior surface was 100 to 200%. The contracture was fully eliminated, and neck contours, mentocervical angle, and head movement were restored. In case of severe contracture, residual wound in submandibular region and above clavicles were skin-grafted. The full range of head motion (functional results) was achieved in all the 11 patients. The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.

  12. Implementation of a burn scar assessment system by ultrasound techniques.

    PubMed

    Du, Yi-Chun; Lin, Chih-Ming; Chen, Yung-Fu; Chen, Chung-Lin; Chen, Tainsong

    2006-01-01

    Tissue injury and its ensuing healing process cause scar formation. In addition to physical disability, the subsequent disfigurements from burns often bring negative psychological impacts on the survivors. Scar hypertrophy and contracture limit the joint motion and body function of the patient. With fast development of the current available technologies regarding the scar therapies, not only the process of wound healing has to be focused, but also the cosmetic and functional outcomes need to be emphasized. Therefore, proper evaluation and assessment of the healing process to nil scar status is highly recommended. However, the currently employed tools for scar evaluation are mostly subjective. For example, Vancouver General Hospital (VGH) scar index uses color, pigmentation, vascularity, pliability, and depth of the scar as dependent variables for scar evaluation. These parameters only estimate the superficial surface of the scar, but they can not evaluate the deeper tissue within dermis. Ultrasound is a safe, inexpensive, and multifunctional technique for probing tissue characteristics. In addition, its resolution is not inferior to other measurement techniques. Although 3D-ultrasound is available in clinical application, it's still not widely used in scar evaluation because of its high cost. In this study, we proposed a system for scar assessment using B-mode ultrasonic technique. By utilizing the reconstruction methods to search the scar border, many characteristic parameters, including depth, area and volume, can be estimated. The proposed method is useful in assisting the clinician to evaluate the treatment effect and to plan further therapeutic strategy more objectively. In this report, the quantitative assessment system was used to evaluate the scar of a seriously burned patient. In order to verify the reliability of systematic reconstruction method, we constructed a phantom to imitate the scar tissue. The results show that it can achieve more than 90% in

  13. Pedicled fasciocutaneous flaps for correcting scar contracture in pediatric patients-a retrospective study of 22 cases.

    PubMed

    Chen, Baoguo; Song, Huifeng; Gao, Quanwen; Xu, Minghuo

    2016-07-01

    Pediatric scar contractures in rapidly-growing regions require timely correction. Compared to flaps, skin grafts are characterized by scarring and retraction. More complex reconstructions are especially challenging in pediatric cases. Pedicled fasciocutaneous flaps are simple, durable, and able grow with the patient. A series of 22 pediatric burn scar cases, with an average age of 6years, underwent treatment with pedicled fasciocutaneous flaps. They comprised 17 patients with scars involving the chest and axilla, and 5 patients with scars involving the groin and perineum. Patient follow-up ranged from 3months to 2years, and included every patient. In total, 25 flaps were performed, comprising 4 lateral thoracic flaps, 5 superficial inferior epigastric artery flaps, and 16 scapular/expanded scapular flaps. Adjunctive skin grafts were used in 3 cases; the remaining 19 cases' donor sites were closed primarily. No flap loss or necrosis was observed. Pedicled fasciocutaneous flaps are robust treatment options for burn scar contractures. Accompanied by tissue expander, it can be raised to repair larger area of contracture. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Treating burn-associated joint contracture: results of an inpatient rehabilitation stretching protocol.

    PubMed

    Godleski, Matthew; Oeffling, Amy; Bruflat, Angela K; Craig, Emily; Weitzenkamp, David; Lindberg, Gordon

    2013-01-01

    The prevention and treatment of scar contracture is critical after significant burn injuries to avoid functional impairment. However, descriptions of specific contracture treatment interventions and outcomes are limited. Our objective is to provide detailed information and range of motion outcomes regarding the use of an intensive stretching protocol for burn-associated contracture. As part of a quality improvement measure, all patients admitted to inpatient rehabilitation with burn injury were treated with at least 1 hour of daily stretching by experienced therapists and were tracked with standardized range of motion measurements. Eighty-eight joint contractures were treated across nine patients for up to 4 weeks. The average weekly improvement in range of motion was 8.2 degrees (95% confidence interval [CI], 6.5-9.9). The largest gains were seen in the first week of treatment with an average improvement of 11.2 degrees (95% CI, 8.7-13.6). Eighteen digit contractures were treated across four patients. The average weekly improvement in flexion was 7.2 mm (95% CI, 5.2-9.1) again with larger gains in the first week of treatment-12.8 mm (95% CI, 10.3-15.4). Thumb opposition improved across five patients in the first week with an average improvement of 1.4 on the opposition scale (95% CI, 0.4-2.5). Intensive stretching by experienced therapists yielded significant improvements in joint range of motion for patients with burn-associated joint contracture. Defining specific burn contracture interventions remains a key goal in advancing burn rehabilitation in the future.

  15. Double combined Z-plasty for wide-scar contracture release.

    PubMed

    Yotsuyanagi, Takatoshi; Yamashita, Ken; Gonda, Ayako; Kato, Shinji; Sugai, Asuka; Yamada, Tetsuo; Kayama, Musashi; Ikeda, Kanae; Yamauchi, Makoto; Saito, Tamotsu

    2013-05-01

    Z-plasty is one of the most widely employed techniques in plastic surgery and mainly serves the following purposes: elongation along the axis of the scar, dispersal of the scar followed by breaking up the straight-line scar and realigning the scar within the lines of minimal tension. It is useful especially to release linear-scar contracture, yet difficult for wide scars. This report describes a novel technique to release contracture effectively for any wide scars using a new design called double combined Z-plasty. The design is simple. The main limb is set to incise the wide scar, and this main limb is shared as a peripheral limb by two other Z-plasty designs. From the main limb, each central limb is designed along the margin of the scar in the opposite direction. The main and central limbs have 90° between them. Other peripheral limbs are then designed facing laterally to the intact skin to make 60° for the central limb. After skin incision, two triangular intact skin flaps could be inserted into the wide scar from both sides, making it possible to release contracture. We performed this technique on eight patients. All wounds healed well and scar contracture was satisfactorily released. This procedure is very useful for wide-scar contracture, compared to conventional Z-plasty. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. The use of noncellularized artificial dermis in the prevention of scar contracture and hypertrophy.

    PubMed

    Téot, Luc; Otman, Sami; Trial, Chloé; Brancati, Antonio

    2011-09-01

    Abnormal scarring occurring after wounds and burns remains a major source of functional and cosmetic disorders. The dermal part of the skin is recognized as playing a major role in the contraction process. The skin dermis may be involved in superficial wounds, but when the basal membrane and the sources of keratinocytes, like hair follicles and adnexa, are left intact, little visible scarring is observed. The skin elasticity may be preserved, even when the extracellular matrix is somehow altered. On the opposite extreme, in wounds of extended depth, the loss of dermal component results in the absence of elasticity and fibroblastic cell proliferation, leading to hypertrophy and contracture. These phenomena may be explained either by differences in cell populations, by extracellular matrix reactions to different stimuli, or by chemical control of interactions between cells and matrix. © 2011 by the Wound Healing Society.

  17. [Evaluation of Cepan Cream after 15 years of treatment of burn scars].

    PubMed

    Stozkowska, Wiesława

    2002-01-01

    Cepan Cream is used for the topical treatment of scars and keloids resulting from burns, post-operative scars, and contractures. Cepan Cream makes scars more elastic, softer and paler. Plant extracts, heparin and allantoin in Cepan act on the biochemical processes in the developing connective tissue, preventing the formation of hyperplastic scars. These active ingredients enhance swelling, softening and loosening of connective tissue. It exerts softening and smoothing action on indurated and hyperplastic scar tissue, improving collagen structure. It promotes tissue regeneration and reduces exuberant granulation. Cepan is well tolerated.

  18. Thermal Injury Model in the Rabbit Ear with Quantifiable Burn Progression and Hypertrophic Scar.

    PubMed

    Friedrich, Emily E; Niknam-Bienia, Solmaz; Xie, Ping; Jia, Sheng-Xian; Hong, Seok Jong; Mustoe, Thomas A; Galiano, Robert D

    2017-04-01

    Hypertrophic scar is a major clinical outcome of deep-partial thickness to full thickness thermal burn injury. Appropriate animal models are a limitation to burn research due to the lack of, or access to, animal models which address the endpoint of hypertrophic scar. Lower species, such as rodents, heal mainly by contracture, which limits the duration of study. Higher species, such as pigs, heal more similarly to humans, but are associated with high cost, long duration for scar development, challenges in quantifying scar hypertrophy, and poor manageability. Here we present a quantifiable deep-partial thickness burn model in the rabbit ear. Burns were created using a dry-heated brass rod for 10 s and 20 s at 90°C. At the time of eschar excision on day 3, excisional wounds were made on the contralateral ear for comparison. Burn wound progression, in which the wound size expands over time is a major distinction between excisional and thermal injuries, was quantified at 1 h and 3 d after the injuries using calibrated photographs and histology and the size of the wounds was found to be unchanged from the initial wound size at 1 h, but 10% in the 20 s burn wounds at 3 d. A quantifiable hypertrophic scar, measured by histology as the scar elevation index, was present in both 20 s burn wounds and excisional wounds at day 35. ImageJ measurements revealed that the 20 s burn wound scars were 22% larger than the excisional wound scars and the 20 s burn scar area measurements from histology were 26% greater than in the excisional wound scar. The ability to measure both burn progression and scar hypertrophy over a 35-day time frame suits this model to screening early intervention burn wound therapeutics or scar treatments in a burn-specific scar model. This article is protected by copyright. All rights reserved.

  19. Marjolin ulcer of the scalp: intruder of a burn scar.

    PubMed

    Calikapan, Gaye Taylan; Akan, Mithat; Karaca, Mustafa; Aköz, Tayfun

    2008-07-01

    Childhood burn accidents are still a problem all over the world. Besides the contractures and hypertrophic scar conditions, malignant transformation in the burn scar is one of the primary concerns later in adulthood. Marjolin ulcer, commonly seen after burn scar, is a neoplastic change in the scar tissue. The scalp region necessitates additional attention because of the inevitable structures it protects. The long-standing ulcers with malignant transformation may cause invasion of different layers of the scalp. As the cranium is invaded, reconstruction after wide excision of these tumors becomes more difficult to deal with. Scalp invasion of Marjolin ulcers with different levels is presented in the following study. Consistent with the literature, histopathology of the tumors was squamous cell carcinoma in most patients. Although rare, mesenchymal tumor is involved in 2 of 9 patients. The latent period of the tumor is inversely proportional to the age at the time of burn injury. As the patient is younger at the time of injury, the occurrence of the ulcer is longer than expected. Lag period as long as 81 years is detected in the study. The delayed diagnosis due to social considerations such as financial limitations increases the likelihood of cranial invasion. A single huge scalp flap is often sufficient for soft tissue defects, and cranioplasty with methyl methacrylate is an appropriate option for reconstruction.

  20. Marjolin's ulcer and chronic burn scarring.

    PubMed

    Akgüner, M; Barutçu, A; Yilmaz, M; Karataş, O; Vayvada, H

    1998-03-01

    Marjolin's ulcer is a term used to describe squamous cell carcinomas which develop in chronic wounds. These carcinomas may also develop at the site of long-standing irritation, such as unstable burn scars. Development times for burn scar carcinomas of more than 30 years have been noted. This evaluation describes the treatment of 10 patients with burn scar carcinomas who have been treated using wide excision and closure of the defect with skin grafts or flaps, plus regional lymph node dissection if required. Results indicate a mean carcinoma development time of 26 years. Local recurrence occurred in only one patient.

  1. Management of complex pediatric burn scars in a humanitarian collaboration.

    PubMed

    Bassetto, F; Staffieri, A; Reho, F; Facchin, F; Shehata, J; Maged, D; Tiengo, C

    2015-03-31

    Burn scars still represent a challenge to the reconstructive surgeon. Their management requires a specific expertise and set up involving the possibility of long term rehabilitation and follow up. Cases encountered in humanitarian missions present additional issues. Often the local environment is not suitable for an appropriate treatment plan, requiring the case to be transferred to a foreign country for surgical care as part of an integrated international and multidisciplinary management. We present the case of a three year-old patient injured in a bomb explosion during the Arab Spring and suffering from severe scar contracture limiting thoracic and upper limb movement. After initial consultation at distance, transfer to our country was organized and an intensive surgical and rehabilitative program was carried out over three months. After five months, the patient returned to his home country where a supportive network had been set up for continued rehabilitation, ensuring follow up for over a year and ultimate success.

  2. Management of complex pediatric burn scars in a humanitarian collaboration

    PubMed Central

    Bassetto, F.; Staffieri, A.; Reho, F.; Facchin, F.; Shehata, J.; Maged, D.; Tiengo, C.

    2015-01-01

    Summary Burn scars still represent a challenge to the reconstructive surgeon. Their management requires a specific expertise and set up involving the possibility of long term rehabilitation and follow up. Cases encountered in humanitarian missions present additional issues. Often the local environment is not suitable for an appropriate treatment plan, requiring the case to be transferred to a foreign country for surgical care as part of an integrated international and multidisciplinary management. We present the case of a three year-old patient injured in a bomb explosion during the Arab Spring and suffering from severe scar contracture limiting thoracic and upper limb movement. After initial consultation at distance, transfer to our country was organized and an intensive surgical and rehabilitative program was carried out over three months. After five months, the patient returned to his home country where a supportive network had been set up for continued rehabilitation, ensuring follow up for over a year and ultimate success. PMID:26668562

  3. Scars

    MedlinePlus

    ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ...

  4. Airway management in patients with burn contractures of the neck.

    PubMed

    Prakash, Smita; Mullick, Parul

    2015-12-01

    Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. The anesthesiologist should have a pre-planned strategy for intubation of the difficult airway. The choices advocated for airway management of such patients include awake fiberoptic-guided intubation, use of intubating laryngeal mask airway, intubation without neuromuscular blocking agents, intubation with neuromuscular blocking agents after testing the ability to ventilate by mask, pre-induction neck scar release under local anesthesia and ketamine or sedation followed by direct laryngoscopy and intubation and video-laryngoscope guided intubation, amongst others. Preparation of the patient includes an explanation of the proposed procedure, sedation, administration of antisialogogues and regional anesthesia of the airway. The various options for intubation of patients with PBC neck, intraoperative concerns and safe extubation are described. Back-up plans, airway rescue strategies and a review of literature on this subject are presented. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  5. Ablative fractional resurfacing for the treatment of traumatic scars and contractures.

    PubMed

    Uebelhoer, Nathan S; Ross, E Victor; Shumaker, Peter R

    2012-06-01

    After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course. Copyright © 2012. Published by

  6. Contracture of skin graft in human burns: effect of artificial dermis.

    PubMed

    Hur, Gi-Yeun; Seo, Dong-Kook; Lee, Jong-Wook

    2014-12-01

    Skin grafts with an artificial dermis have been widely used as a part of the efforts to minimize contractures and reduce donor-site scars. We conducted a prospective randomized clinical trial to study the effect of a dermal substitute by measuring the size of the graft after surgery for months. The artificial dermis (Matriderm, Dr. Suwelack Skin and Health Care AG, Billerbeck, Germany) was applied in combination with a split-thickness autograft in 40 patients with acute burn wounds or scar reconstruction. Demographic and medical data were collected on each patient. We directly measured the graft size by using a transparent two-ply film (Visitrak Grid, Smith & Nephew Wound Management, Inc, Largo, FL, USA) intraoperatively and 1, 2, 3, and 6 months postoperatively. For effective data comparison, the size of the graft at the time of surgery was taken to be "100%." Then, the size in each phase was estimated in percentage (%). During the 1st month, the average size was 89%. The figure decreased to 86% and 82% in the 2nd and 3rd months, respectively. In the 6th month, it slightly rebounded to 85% but failed to return to the original state. The size of patients with acute burns was smaller than the size of scar patients as follows: 85-91% in the 2nd month, 81-87% in the 3rd month, and 85-96% in the 6th month. This study examined the progress of skin grafts through the measurement of graft size in the human body. The grafted skin underwent contracture and remodeling for 3-6 months. In terms of skin contraction, an acute burn was more serious than scar reconstruction. The use of an artificial dermis that contains elastin is very effective from the functional and esthetic perspective by minimizing contractures and enhancing skin elasticity. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  7. Burn Scar Biomechanics Following Pressure Garment Therapy

    PubMed Central

    Kim, Jayne Y.; Willard, James J.; Supp, Dorothy M.; Roy, Sashwati; Gordillo, Gayle M.; Sen, Chandan K.; Powell, Heather M.

    2015-01-01

    Background The current standard of care for the prevention and treatment of scarring following burn injury is pressure garment therapy (PGT). Although this therapy has been used clinically for many years, controversy remains regarding its efficacy. The purpose of this study was to evaluate the efficacy of PGT in a female Red Duroc pig (fRDP) burn model where wound depth could be tightly controlled. Methods Full-thickness burn wounds were generated on fRDPs. At day 28 post-burn, PGT was applied to half of the wounds (10 mmHg), with control wounds covered with garments exerting no compression. Scar area, perfusion, hardness, and elasticity were quantified at days 0, 28, 42, 56, and 72 using computerized planimetry, Laser Doppler and torsional ballistometry. Scar morphology was assessed at days 28, 56 and 76 using histology, immunohistochemistry and transmission electron microscopy. Results Pressure garment therapy significantly hindered scar contraction with control scars contracting to 64.6 + 13.9% original area at day 72 while PGT scars contracted to 82.7 + 17.9% original area. PGT significantly reduced skin hardness and increased skin strength by 1.3X. No difference in perfusion or blood vessel density was observed. Average collagen fiber diameter was greater in control burns than PGT. Conclusions PGT was effective at reducing scar contraction and improving biomechanics compared to control scars. These results confirm the efficacy of pressure garments and highlight the need to further investigate the role of pressure magnitude and time of therapy application to enhance their efficacy for optimal biomechanics and patient mobility. PMID:25989300

  8. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

    PubMed

    van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

    2012-01-01

    Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p < 0.001) improvement in scar quality at 12 months compared with the 3- and 6-month data. Predictors for severe scarring are depth of the wound (p < 0.001) and total body surface area burned (p < 0.001). Etiology (p = 0.753) and age (p > 0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively.

  9. [Application of distal palm perforator mini-flap in repair of scar contracture of digital web-spaces].

    PubMed

    Zhou, Xiao; Xu, Yajun; Rui, Yongjun; Shou, Kuishui; Yao, Qun

    2011-02-01

    To discuss the effectiveness of distal palm perforator mini-flap in the treatment of scar contracture of digital web-spaces. Between August 2008 and March 2010, 6 cases of scar contracture of digital web-spaces were treated, including 4 males and 2 females and aging 16-68 years (mean, 45 years). The causes were burn injury, twisting injury, and crush injury in 2 cases, respectively. The disease duration was from 3 months to 3 years. The affected digital web-spaces were from index finger to middle finger in 2 cases, from middle finger to ring finger in 3 cases, and from ring finger to small finger in 1 case. The maximum abduction degree of digital web-spaces was 5-10 degrees. The sizes and the depths of reshape of digital web-spaces disappeared. The defect size ranged from 20 mm x 8 mm to 30 mm x 13 mm after opening digital web-spaces. The size of the distal palm perforator mini-flap ranged from 25 mm x 10 mm to 35 mm x 15 mm. The donor sites were sutured directly. All 6 flaps survived and got primary healing. Incisions at donor sites healed by first intention. All patients were followed up 6-12 months. The reconstructed digital web-spaces had good appearance and soft texture. The range of motion of metacarpophalangeal joint was normal. The sizes and the depths of reshape of digital web-spaces were similar to normal ones. The maximum abduction degree of digital web-spaces was 40-60 degrees. There was no scar contracture of incision of palm. The shape of flaps and function of the fingers were satisfactory after 6-12 months of follow-up. It is an ideal method to treat scar contracture of digital web-spaces with distal palm perforator mini-flap.

  10. Management of scar contractures of the hand using Z advancement rotation flap.

    PubMed

    Gümüş, Nazım; Yılmaz, Sarper

    2013-08-01

    Functional consequences of hand contractures may lead to extreme impairment in hand functions so repair of the contractures can solve the problems related to hand functions. Different forms of z plasties have widely been used for the release of scar contractures. In this study, a useful z plasty technique, z advancement rotation flap (ZAR) was adapted for the release of hand contractures in the way of using only local tissues. Fourteen consecutive patients who had hand contractures, were treated successfully with z advancement rotation flap technique. They suffered from hand contractures for at least one year which were localized in wep spaces, flexor surfaces of the digits, first wep space, palmar area and extensor surface of the hand. Contractures are all in mild severity, restricting some of the hand motions moderately. In all patients, hand contractures released completely and clinically normal joint motions were achieved, improving extension, flexion and abduction ranges of fingers without any difficulty. All advanced and rotated flaps healed uneventfully. No major complications appeared such as infection, hematoma, suture dehiscence, flap congestion or necrosis. When dealing with this technique for release of hand contractures, it may offer a versatile alternative to well known z-plasty methods used particularly for hand contractures.

  11. Nondestructive measurements of the properties of healing burn scars.

    PubMed

    Chu, B M; Brody, G

    1975-01-01

    A testing protocol and the requisite instrumentation have been developed to nondestructively monitor the temporal and mechanical properties of maturing scar. The maturing scar can become progressively and unpredictably adherent or contractured, producing varying degrees of functional impairment. By plotting these mechanical changes as a temporal function of limb motion history, more accurate prediction and control of the ultimate scarring may result. These same techniques could also be used to study normal skin aging. Extrapolation could be made to connective tissue scars in tendons, ligaments, and other structural elements. Scar contractures may develop slowly along lines of tension or areas of maximum skin defect in large maturing scars once the patient has recovered sufficiently to exercise the underlying joints. Since the present endeavor to monitor potential contractures requires measurement of the "in-plane" stresses and strains, we have chosen to utilize an in situ strip biaxial test configuration.

  12. Orofacial contracture management outcomes following partial thickness facial burns.

    PubMed

    Clayton, N A; Ward, E C; Maitz, P K M

    2015-09-01

    To examine clinical outcomes following non-surgical exercise for contracture management post partial thickness orofacial burn. A cohort of 229 patients with partial thickness orofacial burn was recruited over 3 years. Orofacial contracture management combining exercise and stretching was initiated within 48h of admission and continued until functional goals were consistently achieved. A second cohort of 120 healthy controls was recruited for normative comparison. Vertical and horizontal mouth opening measures were recorded at the start and completion of orofacial intervention for patients and once only for controls. At commencement of intervention, participants with orofacial burns had significantly (p<0.001) reduced vertical and horizontal mouth opening. Treatment duration averaged 30.7 days (SD=52.3). Post treatment significant (p<0.001) improvements in vertical and horizontal opening were noted. At treatment conclusion, a significant (p<0.01) difference remained between the burns cohort and control group for vertical mouth opening, though horizontal mouth opening was now statistically comparable to the controls. This study supports positive outcomes following orofacial contracture management for patients with partial thickness orofacial burn. Despite this, some functional loss remained with patients demonstrating persistent reduced vertical mouth opening at conclusion of treatment compared to their healthy counterparts. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  13. Contractures in burn injury part II: investigating joints of the hand.

    PubMed

    Schneider, Jeffrey C; Holavanahalli, Radha; Helm, Phala; O'Neil, Carina; Goldstein, Richard; Kowalske, Karen

    2008-01-01

    This study prospectively examines the incidence and severity of hand contractures after burn injury and determines predictors of contracture development. Data were collected prospectively from 1993 to 2002 for adult burn survivors admitted to a regional burn center. Demographic and medical data were collected on each subject. Primary outcome measures include presence of contractures, number of contractures, and the severity of contractures at each of the hand joints at hospital discharge. The metacarpal-phalangeal, proximal inter-phalangeal (PIP), and distal inter-phalangeal joints of all digits and the wrist joints are included in this study. Regression analysis was performed to determine predictors of the presence, severity, and number of contractures. Of the 985 study patients, 23% demonstrated at least one hand contracture at hospital discharge. Those with a contracture averaged ten contractures per person. Most contractures were mild (48%) or moderate (41%) in severity. The wrist was the most frequently affected joint (22%). Statistically significant predictors of contracture development include concomitant medical problems, total body surface area grafted and presence of hand burn and hand grafting (P < .05). Predictors of the number of contractures include length of stay, concomitant medical problems, burn size and presence of hand burn and grafting (P < .05). Contractures of the hand are a significant complication of burn injury. Clinicians can use the contracture predictors to help target interventions for those patients most at risk of developing hand contractures. Given the functional importance of the hand in daily living, the burn care community is challenged to find new ways of preventing and treating hand contractures.

  14. Multiple seagull flaps for digital contractures in electrical burns.

    PubMed

    Matthews, R N; Morgan, B D

    1987-01-01

    Following legislation in the early 1970s, electrical bar fire burns are much less common in the UK than 20 years ago. However, their long-term effects are still encountered as microdactyly, syndactyly and digital flexion contractures. A case is described in which multiple seagull flaps were used as a single stage procedure to achieve sustained improvement in function in a severely affected hand, 10 years after injury, without prolonged postoperative daytime splintage.

  15. Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review.

    PubMed

    Clayton, Nicola A; Ward, Elizabeth C; Maitz, Peter K

    2017-02-01

    Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes. Outline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns. Two men (54 and 18 years) with full-thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Therapy was prescribed, consisting of scar stretching, splinting and pharyngeal swallow tasks. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features, functional swallowing outcomes and related distress, were collected at baseline and routinely until dysphagia resolution and scar stabilisation. At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia and moderate dysphagia related distress. Therapy adherence was high. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment, and nil dysphagia related distress was achieved by 222 and 77 days post injury respectively. VROM and HROM achieved normal range by 237 and 204 days. Active rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  16. The use of AlloDerm on major burn patients: AlloDerm prevents post-burn joint contracture.

    PubMed

    Yim, Haejun; Cho, Yong Suk; Seo, Cheong Hoon; Lee, Boung Chul; Ko, Jang Hyu; Kim, Dohern; Hur, Jun; Chun, Wook; Kim, Jong Hyun

    2010-05-01

    In efforts to prevent and reduce joint contracture and scar formation after burn, we used the acellular human dermis (AlloDerm) as a dermal replacement in the acute stage. A total of 64 patients received AlloDerm graft selectively on joint areas during the study period from March, 2005 to July, 2007. From January to March, 2008, a total of 31 patients returned to our burn center to examine the functional results by measuring range of motion of joints. Additionally, the quality of grafted skin condition criteria of skin elasticity, scar thickness, trans-epidermal water loss, melanin and erythema level was measured in a total of 11 patients among them. By analyzing the limitation level of 55 joints excluding hand areas, we found that 24 joints (43.6%) showed no limitations, 12 joints (21.8%) showed limitations below 10%, 16 joints (29.1%) showed limitations between 10 and 19% and 3 joints (5.5%) showed limitations over 20%. The scar thickness of non-AlloDerm applied areas was 2.5+/-0.9 mm and AlloDerm applied areas was 1.8+/-0.7 mm (p = 0.396). Trans-epidermal water loss for non-AlloDerm applied areas was 20.9+/-7.7 g/h/m(2) and AlloDerm applied areas was 10.8+/-3.4 g/h/m(2) (p<0.001). Erythema value for non-AlloDerm applied areas was 436.1+/-65.8, whereas AlloDerm applied area was 394.4+/-61.2 (p<0.001). Acellular dermal matrix is a good option for treating major burns to prevent scar formation after burn and loss of joint function. Copyright 2009 Elsevier Ltd and ISBI. All rights reserved.

  17. Adolescent scar contracture scoliosis caused by back scalding during the infantile period

    PubMed Central

    Wang, S. F.; Wang, B.; Wu, L.; Zhu, F.

    2007-01-01

    The study design was a retrospective study in adolescent scar contracture scoliosis caused by back scalding during the infantile period. The objective of the study was to investigate the pathogenesis, clinical manifestation and treatment of adolescent scar contracture scoliosis caused by back scalding during the infantile period. This condition seldom occurs and is not reported in current English literature. One patient was first treated with skin expansion, back scar excision and skin flap transfer, followed by anterior correction with TSRH instrumentation. Two patients were first treated with back scar excision and anterior spinal release. One patient was treated with posterior correction with TSRH instrumentation, and thoracoplasty was performed after 50 days in halo-wheelchair traction. The other patient was treated with posterior correction with TSRH instrumentation. No management of scalding was performed on the fourth patient. Anterior release and posterior correction were performed at an interval of 3 weeks. The deformities of four patients were well corrected. Trunk balance was restored and the pelvis leveled. The skin incision wounds healed well. Minor loss of correction was recorded during the last follow-up. Severe scar contracture caused by back scalding during the infantile period could lead to adolescent scoliosis. Its pathogenesis and clinical manifestation are different from the typical adolescent idiopathic scoliosis. The treatment of this kind of scoliosis should be individualized. PMID:17497186

  18. Electrophysiological and histological changes in extrinsic muscles proximal to post burn contractures of hand.

    PubMed

    Bhattacharya, V; Purwar, Shammi; Joshi, D; Kumar, M; Mandal, S; Chaudhuri, G R; Bhattacharya, S

    2011-06-01

    Burn scar hand contractures of variable degree are frequently encountered. Although the forearm is apparently spared, it was clinically observed that there was disuse atrophy in the unburnt extrinsic forearm muscles. Usually the clinicians do not give much importance to this fact. The girth at the midforearm was significantly reduced as compared to normal side. The flexion of the hand joints are governed by two components (a) intrinsic and (b) extrinsic muscles. The intrinsic muscles are directly involved in the contracted tissue. Therefore it was thought essential to evaluate the extrinsic group of muscles for their contribution in the final functional recovery following corrective surgery. Thirty patients having unilateral post thermal burn contracture sparing forearm were studied. A detailed clinical evaluation was made including grade of contracture and reduction in the forearm girth. The forearm unburnt muscles were evaluated by preoperative electrophysiological studies. Intraoperative biopsies were taken from these muscles for histopathological examination. On histopathological examination, there were significant abnormal changes in the form of muscle fiber atrophy, fibrolipomatous tissue replacement of atrophic muscle fibers and sarcolemmal changes. These changes were directly proportional to the severity of contractures. The electrophysiological studies showed proportionate changes in the form of reduction in amplitude, duration and interference. This study suggests that if these changes are mild and in reversible stage, they will favourably affect the functional recovery following surgery. However if these changes are of severe grade and irreversible, in spite of adequate surgery, splinting and physiotherapy, the functional recovery may not be complete. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  19. Postburn contractures of the hand.

    PubMed

    Fufa, Duretti T; Chuang, Shiow-Shuh; Yang, Jui-Yung

    2014-09-01

    Several functionally limiting sequelae can follow deep thermal injury to the hand. Despite appropriate initial management, contractures are common. Whereas acute burn care is often managed by multidisciplinary, specialized burn units, postburn contractures may be referred to hand surgeons, who should be familiar with the patterns of burn contracture and nonsurgical and operative options to improve function and expected outcomes. The most common and functionally limiting sequelae are contractures of the webspace, hand, and digits. Webspace contractures and postburn syndactyly are managed with scar excision and local soft tissue rearrangement or skin grafting. The burn claw hand presents as extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstays of management of these contractures include complete surgical excision of scar tissue and resurfacing of the resultant soft tissue defect, most commonly with full-thickness skin grafts. If scar contracture release results in major exposure of the tendons or joints, distant tissue transfer may be required. Early motion and rehabilitative modalities are essential to prevent initial contracture formation and recontracture after surgical release.

  20. Non-ablative fractional resurfacing in the treatment of scar contracture.

    PubMed

    Finney, Robert; Torbeck, Richard; Saedi, Nazanin

    2016-02-01

    A 28-year-old female presented with extensive scarring after a traumatic injury to her right lower extremity. She had been hit by a vehicle one year prior to presentation and had several open fractures with extensive overlying cutaneous damage, which required multiple surgeries and skin grafts. She had limited range of motion of the affected limb secondary to scar contracture. The patient received 6 treatments with a non-ablative fractional resurfacing (NAFR) device with two wavelengths (Fraxel DUAL, Solta Medical, Hayward, CA) spaced 4-8 weeks apart. The patient received two treatments with the 1927 nm NAFR thulium laser (10 mJ, 30% density, 8 passes) and two treatments with the 1550 nm NAFR laser (40 mJ, 17-26% density, 8 passes). Before and after treatment photographs were taken, as well as range of motion measurements with respect to her right ankle. The patient had 50-75% improvement in the texture and discoloration. There was both subjective and objective improvement in the range of motion of her right lower extremity. The patient experienced mild erythema and edema, both of which resolved after 7-10 days. Recent studies have shown great functional improvement in scar contractures with ablative fractional laser treatments; however, these treatments are accompanied by significant downtime along with risk of further scarring and infection. NAFR is an accessible treatment with a low side effect profile and to our knowledge has not been reported as efficacious in the treatment of scar contracture. This case report is novel in its demonstration of the utility of a dual wavelength NAFR in the treatment of scar contracture and functional impairment. © 2015 Wiley Periodicals, Inc.

  1. Linear Hand Burn Contracture Release under Local Anesthesia without Tourniquet.

    PubMed

    Prasetyono, Theddeus O H; Koswara, Astrid F

    2015-10-01

    The objective of this report is to present a case of hand burn linear contracture release performed under local anesthesia. It also introduces the one-per-mil tumescent solution consisted of 0.2% lidocaine and 1:1.000.000 epinephrine as a local anesthesia formula, which has the potential of providing adequate anesthesia as well as hemostatic effect during surgery of the hand without tourniquet. The surgery was performed on a 19 year-old male patient with multiple thumb and fingers flexion linear contracture for 105 minutes without any obstacle. The patient did not complain any pain and discomfort during the procedure; while bloodless operative field was successfully achieved. At four-month follow up, the patient could fully extend his thumb, middle and ring finger, while the index was limited by 10° at the DIP joint. Overall, the patient was satisfied with the outcome.

  2. Positioning, Splinting, and Contracture Management

    DTIC Science & Technology

    2011-01-01

    scar contracture is a pathologic condition. Burn scar contracture is defined as a loss of motion of a joint or anatomic structure as a result of...to be a possible cause of the inextensibility seen in burn scar. With joint movement, skin or scar needs to accommodate to a change in limb length.5,6...preconditioning of tissue can be clinically deter- mined when a patient’s ROM about a given joint ceases to increase with repeated repetitions. When preparing to

  3. Bastrop County Complex Fire Burn Scar

    NASA Image and Video Library

    2017-09-27

    NASA image acquired September 12, 2011 To view more images from this event go to: earthobservatory.nasa.gov/NaturalHazards/event.php?id=52029 The Bastrop County Complex Fire in southern Texas started on September 4, 2011. By September 13, 2011, the fire was 70 percent contained, but had scorched 34,068 acres (13,787 hectares). The Advanced Land Imager (ALI) on NASA’s Earth Observing-1 (EO-1) satellite captured this image of the affected region on September 12, 2011. This false-color image shows a wide-area view of the fire. Vegetation is bright green, and sparsely vegetated or bare land is green-yellow. The burn scar appears in shades of red and orange. The burn scar is far from uniform; burned areas are separated by unburned expanses. As of September 13, a re-entry plan had been established for residents of the region, the Incident Information System reported. Residents were warned, however, that they might see vegetation still smoldering or burning. Ongoing drought set the stage for severe fires in Texas in the slate summer of 2011. In early September, Tropical Storm Lee, which drenched other parts of the United States, brought strong winds to Texas, worsening the fires. NASA Earth Observatory image created by Jesse Allen and Robert Simmon, using EO-1 ALI data provided courtesy of the NASA EO-1 team. Caption by Michon Scott. Instrument: EO-1 - ALI Credit: NASA Earth Observatory NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

  4. Reverse-flow anterolateral thigh perforator: an ad hoc flap for severe post-burn knee contracture.

    PubMed

    Ismail, H A; El-Bassiony, L E

    2016-03-31

    We evaluate function outcomes of the reverse-flow ALT perforator flap to reconstruct severe post-burn knee contracture. Between October 2012 and December 2014, 10 patients with severe post-burn knee contracture were subjected to reconstruction with 10 ipsilateral reversed-flow ALT perforator flaps. All the patients were male. Ages ranged from 15 to 47 years (mean = 32 years). Time from burn injury to patient presentation ranged from 2-8 months. All patients demonstrated post-burn flexion contracture of the knee joint, ranging from 35 to 75 degrees. Flap sizes ranged from 8×16 to 12×26 cm. The flaps and skin grafts were carried out without major complications. Only minor complications occurred, such as transient, mild congestion immediately after inset in two flaps. Two flaps developed superficial necrosis at the distal edge. One case sustained partial skin graft loss due to haematoma. One case complained of skin hyperpigmentation and hypertrophic scars around the graft. Secondary debulking procedures were required in two cases. The entire donor sites were closed by partial thickness skin graft with acceptable appearance, except one case that was closed primarily. Eight out of ten patients (80%) demonstrated gradual improvement in range of knee motion after a specialized rehabilitation program. Two patients (20%) did not get back full range of motion. RALT perforator flap is the cornerstone for the reconstruction of soft-tissue defects around the knee with acceptable aesthetic and functional results provided that the following items are fulfilled: inclusion of muscle cuff around the pedicle, the pivot point, prevention of pedicle compression after transfer and early surgical intervention on the post-burn knee contracture.

  5. A novel immune competent murine hypertrophic scar contracture model: a tool to elucidate disease mechanism and develop new therapies.

    PubMed

    Ibrahim, Mohamed Magdy; Bond, Jennifer; Bergeron, Andrew; Miller, Kyle J; Ehanire, Tosan; Quiles, Carlos; Lorden, Elizabeth R; Medina, Manuel A; Fisher, Mark; Klitzman, Bruce; Selim, M Angelica; Leong, Kam W; Levinson, Howard

    2014-01-01

    Hypertrophic scar (HSc) contraction following burn injury causes contractures. Contractures are painful and disfiguring. Current therapies are marginally effective. To study pathogenesis and develop new therapies, a murine model is needed. We have created a validated immune-competent murine HSc model. A third-degree burn was created on dorsum of C57BL/6 mice. Three days postburn, tissue was excised and grafted with ear skin. Graft contraction was analyzed and tissue harvested on different time points. Outcomes were compared with human condition to validate the model. To confirm graft survival, green fluorescent protein (GFP) mice were used, and histologic analysis was performed to differentiate between ear and back skin. Role of panniculus carnosus in contraction was analyzed. Cellularity was assessed with 4',6-diamidino-2-phenylindole. Collagen maturation was assessed with Picro-sirius red. Mast cells were stained with Toluidine blue. Macrophages were detected with F4/80 immune. Vascularity was assessed with CD31 immune. RNA for contractile proteins was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Elastic moduli of skin and scar tissue were analyzed using a microstrain analyzer. Grafts contracted to ∼45% of their original size by day 14 and maintained their size. Grafting of GFP mouse skin onto wild-type mice, and analysis of dermal thickness and hair follicle density, confirmed graft survival. Interestingly, hair follicles disappeared after grafting and regenerated in ear skin configuration by day 30. Radiological analysis revealed that panniculus carnosus doesn't contribute to contraction. Microscopic analyses showed that grafts show increase in cellularity. Granulation tissue formed after day 3. Collagen analysis revealed increases in collagen maturation over time. CD31 stain revealed increased vascularity. Macrophages and mast cells were increased. qRT-PCR showed up-regulation of transforming growth factor beta, alpha smooth muscle

  6. A novel immune competent murine hypertrophic scar contracture model: A tool to elucidate disease mechanism and develop new therapies

    PubMed Central

    Ibrahim, Mohamed Magdy; Bond, Jennifer; Bergeron, Andrew; Miller, Kyle J; Ehanire, Tosan; Quiles, Carlos; Lorden, Elizabeth R; Medina, Manuel A; Fisher, Mark; Klitzman, Bruce; Selim, M Angelica; Leong, Kam W; Levinson, Howard

    2014-01-01

    Hypertrophic scar (HSc) contraction following burn injury causes contractures. Contractures are painful and disfiguring. Current therapies are marginally effective. To study pathogenesis and develop new therapies, a murine model is needed. We have created a validated immune-competent murine HSc model. A third-degree burn was created on dorsum of C57BL/6 mice. Three days postburn, tissue was excised and grafted with ear skin. Graft contraction was analyzed and tissue harvested on different time points. Outcomes were compared with human condition to validate the model. To confirm graft survival, green fluorescent protein (GFP) mice were used, and histologic analysis was performed to differentiate between ear and back skin. Role of panniculus carnosus in contraction was analyzed. Cellularity was assessed with 4′,6-diamidino-2-phenylindole. Collagen maturation was assessed with Picro-sirius red. Mast cells were stained with Toluidine blue. Macrophages were detected with F4/80 immune. Vascularity was assessed with CD31 immune. RNA for contractile proteins was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Elastic moduli of skin and scar tissue were analyzed using a microstrain analyzer. Grafts contracted to ∼45% of their original size by day 14 and maintained their size. Grafting of GFP mouse skin onto wild-type mice, and analysis of dermal thickness and hair follicle density, confirmed graft survival. Interestingly, hair follicles disappeared after grafting and regenerated in ear skin configuration by day 30. Radiological analysis revealed that panniculus carnosus doesn't contribute to contraction. Microscopic analyses showed that grafts show increase in cellularity. Granulation tissue formed after day 3. Collagen analysis revealed increases in collagen maturation over time. CD31 stain revealed increased vascularity. Macrophages and mast cells were increased. qRT-PCR showed up-regulation of transforming growth factor beta, alpha smooth

  7. Extensive Burn Scars in Russia's Amur Region

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Vast areas of southeastern Russia have been scorched by fires over the last few weeks. All across Siberia fires have been raging, and this Moderate Resolution Imaging Spectroradiometer (MODIS) image from May 15, 2002, shows extensive, dark burn scars along with actively burning fires (red dots) on the north side of the Amur River, which separates Russia (north) and China (south). The southern Amur region is largely devoted to farming and other agriculture, and these fires may have been set intentionally to prepare the land for the growing season. Fire is often used to clear land of unwanted vegetation, and to return the nutrients stored in vegetation back to the soil. However, fires that are too frequent or severe can devastate the soil, eventually making it unsuitable for farming or grazing. Fires can also escape control and spread into protected areas. In this image, fires are mostly concentrated in a lowland area within the drainage basin of the Zeya River, which drains from the frozen lake at the top of the image. Image courtesy Jacques Descloitres, MODIS Land Rapid Response Team at NASA GSFC

  8. Extensive Burn Scars in Russia's Amur Region

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Vast areas of southeastern Russia have been scorched by fires over the last few weeks. All across Siberia fires have been raging, and this Moderate Resolution Imaging Spectroradiometer (MODIS) image from May 15, 2002, shows extensive, dark burn scars along with actively burning fires (red dots) on the north side of the Amur River, which separates Russia (north) and China (south). The southern Amur region is largely devoted to farming and other agriculture, and these fires may have been set intentionally to prepare the land for the growing season. Fire is often used to clear land of unwanted vegetation, and to return the nutrients stored in vegetation back to the soil. However, fires that are too frequent or severe can devastate the soil, eventually making it unsuitable for farming or grazing. Fires can also escape control and spread into protected areas. In this image, fires are mostly concentrated in a lowland area within the drainage basin of the Zeya River, which drains from the frozen lake at the top of the image. Image courtesy Jacques Descloitres, MODIS Land Rapid Response Team at NASA GSFC

  9. [Application of the fibreoptic intubating laryngeal mask airway CTrach in face and neck scar contracture patients].

    PubMed

    Yang, Dong; Deng, Xiao-Ming; Tong, Shi-Yi; Liu, Ju-Hui; Sui, Jing-Hu; Zhang, Yan-Ming; Liu, Jian-Hua; Wei, Ling-Xin; Xu, Kun-Lin

    2009-02-01

    To evaluate the feasibility of the fibreoptic intubating laryngeal mask airway (LMA) CTrach (CTrach) in anticipated difficult airway caused by face and neck scar contracture. Totally 33 patients undergoing selective face and neck scar plastic surgery and requiring general anesthesia were enrolled in our study. After anesthesia induction, the CTrach was inserted and the viewer was attached, which allowed fibreoptic visualization of the larynx before and during passage of the tracheal tube through the vocal cords. The duration and the success rates of CTrach insertion, tracheal intubation, and CTrach removal were recorded. The view of glottis on viewer and the adjusting maneuvers for improving the laryngeal view were recorded. Noninvasive blood pressures and heart rates were recorded before and after anesthesia induction and at CTrach insertion, tracheal intubation, and CTrach removal. The CTrach was successfully inserted in all patients, among whom 4 patients succeeded at the second attempt. The full view of glottis were shown in 10 patients, while partial view and no view of glottis were shown in 8 and 15 patients, respectively. The good view of glottis was achieved by adjusting manoeuvres. Tracheal intubation via the CTrach was successful in 27 patients at the first attempt and in 6 patients at the second attempt. Hemodynamic changes during the performance with the CTrach were minimal. The CTrach can be easily inserted, with clear view and high success rate of tracheal intubation. Therefore, it is an effective way to resolve difficulty intubation caused by face and neck scar contracture.

  10. What is the prevalence of hypertrophic scarring following burns?

    PubMed

    Bombaro, Kristine M; Engrav, Loren H; Carrougher, Gretchen J; Wiechman, Shelly A; Faucher, Lee; Costa, Beth A; Heimbach, David M; Rivara, Frederick P; Honari, Shari

    2003-06-01

    Hypertrophic scarring after burns remains a major problem and is considered to be "common". Pressure garments are commonly used as treatment even though there is little sound data that they reduce the prevalence or magnitude of the scarring. In 1999 we began a study of the efficacy of pressure garments on forearm burns. After studying 30 patients, mainly white adults, we found no hypertrophic scar in either those treated with pressure or without. This prompted us to review the literature on the prevalence of hypertrophic scarring after burns and found only four articles with a relatively small number of patients and only three geographical locations. It became clear that the prevalence of hypertrophic scarring is really unknown. We then did a retrospective study of 110 burn survivors and counted all hypertrophic scars of all sizes and locations in all races and found the prevalence hypertrophic scarring to be 67% which conflicts with the published reports and our prospective study and suggests that further research is necessary. We concluded that a worldwide, prospective survey is necessary to establish the prevalence of hypertrophic scarring after burns. In this article we are calling for and offering to organize this survey.

  11. Expanded thoracoacromial artery perforator flap for reconstruction of full-perioral scar contracture.

    PubMed

    Wang, Qianwen; Wang, Jiaqi

    2015-03-01

    Various types of anterior chest flaps can be recruited in the reconstruction of faciocervical region. Most of them were created based on the internal mammary artery and the lateral thoracic artery, and the thoracoacromial artery (TAA) is usually used in pectoralis major musculocutaneous flap. An anterior chest flap with TAA perforator (TAAP) will have no sacrifice of the pectoralis major muscle, but less reports, especially expanded pedicled one, can be reviewed. Here, we reported a case using expanded pedicled TAAP flap to reconstruct the perioral scar contracture. In this technique, expanded TAAP flap could be easily harvested without the sophisticated microsurgical technology. Acceptable esthetic and functional results were achieved.

  12. Reliable scar scoring system to assess photographs of burn patients

    PubMed Central

    Mecott, Gabriel A.; Finnerty, Celeste C.; Herndon, David N.; Al-Mousawi, Ahmed M.; Branski, Ludwik K.; Hegde, Sachin; Kraft, Robert; Williams, Felicia N.; Maldonado, Susana A.; Rivero, Haidy G.; Rodriguez-Escobar, Noe; Jeschke, Marc G.

    2015-01-01

    Background Several scar-scoring scales exist to clinically monitor burn scar development and maturation. Although scoring scars through direct clinical examination is ideal, scars must sometimes be scored from photographs. No scar scale currently exists for the latter purpose. Materials and methods We modified a previously described scar scale (Yeong et al., J Burn Care Rehabil 1997) and tested the reliability of this new scale in assessing burn scars from photographs. The new scale consisted of three parameters: scar height, surface appearance, and color mismatch. Each parameter was assigned a score of 1 (best) to 4 (worst), generating a total score of 3 to 12. Five physicians with burns training scored 120 representative photographs using the original and modified scales. Reliability was analyzed using coefficient of agreement, Cronbach’s alpha, intraclass correlation coefficient, variance, and coefficient of variance. Analysis of variance was performed using the Kruskal-Wallis test. Color mismatch and scar height scores were validated by analyzing actual height and color differences. Results The intraclass correlation coefficient, the coefficient of agreement, and Cronbach’s alpha were higher for the modified scale than the original scale. The original scale produced more variance than the modified scale. Sub-analysis demonstrated that, for all categories, the modified scale had greater correlation and reliability than the original scale. The correlation between color mismatch scores and actual color differences was 0.84 and between scar height scores and actual height was 0.81. Conclusions The modified scar scale is a simple, reliable, and useful scale for evaluating photographs of burn patients. PMID:26092214

  13. Reliable scar scoring system to assess photographs of burn patients.

    PubMed

    Mecott, Gabriel A; Finnerty, Celeste C; Herndon, David N; Al-Mousawi, Ahmed M; Branski, Ludwik K; Hegde, Sachin; Kraft, Robert; Williams, Felicia N; Maldonado, Susana A; Rivero, Haidy G; Rodriguez-Escobar, Noe; Jeschke, Marc G

    2015-12-01

    Several scar-scoring scales exist to clinically monitor burn scar development and maturation. Although scoring scars through direct clinical examination is ideal, scars must sometimes be scored from photographs. No scar scale currently exists for the latter purpose. We modified a previously described scar scale (Yeong et al., J Burn Care Rehabil 1997) and tested the reliability of this new scale in assessing burn scars from photographs. The new scale consisted of three parameters as follows: scar height, surface appearance, and color mismatch. Each parameter was assigned a score of 1 (best) to 4 (worst), generating a total score of 3-12. Five physicians with burns training scored 120 representative photographs using the original and modified scales. Reliability was analyzed using coefficient of agreement, Cronbach alpha, intraclass correlation coefficient, variance, and coefficient of variance. Analysis of variance was performed using the Kruskal-Wallis test. Color mismatch and scar height scores were validated by analyzing actual height and color differences. The intraclass correlation coefficient, the coefficient of agreement, and Cronbach alpha were higher for the modified scale than those of the original scale. The original scale produced more variance than that in the modified scale. Subanalysis demonstrated that, for all categories, the modified scale had greater correlation and reliability than the original scale. The correlation between color mismatch scores and actual color differences was 0.84 and between scar height scores and actual height was 0.81. The modified scar scale is a simple, reliable, and useful scale for evaluating photographs of burn patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Hypertrophic scarring: the greatest unmet challenge following burn injury

    PubMed Central

    Finnerty, Celeste C; Jeschke, Marc G; Branski, Ludwik K; Barret, Juan P.; Dziewulski, Peter; Herndon, David N

    2017-01-01

    Summary Improvements in acute burn care have enabled patients to survive massive burns which would have once been fatal. Now up to 70% of patients develop hypertrophic scars following burns. The functional and psychosocial sequelae remain a major rehabilitative challenge, decreasing quality of life and delaying reintegration into society. The current approach is to optimise the healing potential of the burn wound using targeted wound care and surgery in order to minimise the development of hypertrophic scarring. This approach often fails, and modulation of established scar is continued although the optimal indication, timing, and combination of therapies have yet to be established. The need for novel treatments is paramount, and future efforts to improve outcomes and quality of life should include optimisation of wound healing to attenuate or prevent hypertrophic scarring, well-designed trials to confirm treatment efficacy, and further elucidation of molecular mechanisms to allow development of new preventative and therapeutic strategies. PMID:27707499

  15. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.

    PubMed

    Cho, Yoon Soo; Jeon, Jong Hyun; Hong, Aram; Yang, Hyeong Tae; Yim, Haejun; Cho, Yong Suk; Kim, Do-Hern; Hur, Jun; Kim, Jong Hyun; Chun, Wook; Lee, Boung Chul; Seo, Cheong Hoon

    2014-12-01

    To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively. The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  16. Drought and Burn Scars in Southeastern Australia

    NASA Technical Reports Server (NTRS)

    2003-01-01

    More than 2 million acres were consumed by hundreds of fires between December 2002 and February 2003 in southeastern Australia's national parks, forests, foothills and city suburbs. These images were acquired on February 14, 2002 (left) and February 17, 2003 (right) by the Multi-angle Imaging SpectroRadiometer (MISR) instrument onboard NASA's Terra satellite. The year 2002 was one of Australia's hottest and driest on record, and the acreage burnt during the summer 2002-2003 fire season in Victoria, the Australian Capital Territory and southern New South Wales, is the largest since 1938-1939, when more than 3 million acres were scorched.

    The extent of the burnt area and the dry conditions as of February 2003 are indicated by these contrasting false-color views. Both image panels display data from the near-infrared, red and blue spectral bands of MISR's downward-viewing (nadir) camera, as red, green and blue, respectively. This display technique causes healthy vegetation to appear red and burnt areas to show as dark brown. The data displayed from the two dates were processed identically to preserve relative brightness variations. Vegetation changes related to the dry conditions (not related to the brown burn scars) are also indicated in the February 2003 panel, where many previously red areas exhibit instead the pale yellow-brown of the underlying soils and geology. Significant reduction in the surface area of several large and important water bodies are also apparent. The diminished extent of Lake Hume (along the left-hand edge) in the later date provides a good example.

    The Multi-angle Imaging SpectroRadiometer observes the daylit Earth continuously and every 9 days views the entire globe between 82 degrees north and 82 degrees south latitude. These data products were generated from a portion of the imagery acquired during Terra orbits 14999 and 16858. The panels cover an area of about 208 kilometers x 286 kilometers, and utilize data from blocks 118 to

  17. Functional and subjective assessment of burn contracture release in a mission setting.

    PubMed

    Sinha, Indranil; Zhu, Dagny; Ojomo, Kristin; Gfrerer, Lisa; Sawh-Martinez, Rajendra; Patel, Anup; Chan, Rodney K; Watkins, James F

    2016-03-01

    Burns and subsequent contractures are common in developing nations. Contracture release is performed to treat such patients with functional limitations. The aim of this study is to evaluate post-operative functional and psychosocial outcomes following contracture release in a mission setting. During a surgical mission in Mumbai, India, 39 patients burn contractures underwent surgical release. A total of 31 patients (64% female, mean age 27 years) chose to participate in the study. Patients were scored preoperatively and postoperatively using a SF-36 validated survey and AMA impairment guideline assessment. Thirty-one patients completed questionnaires pre-operative and 6-weeks post operatively. Twenty-four patients completed a survey 3-months post operatively (77.4%). Among those enrolled, 67% were women with the majority sustaining <20% total body surface area burns (70.7%) but had multiple contractures (80.6%). SF-36 physical component score increased from a mean score of 49.8 preoperatively to 55.6 by 3 months following contracture release (P<0.001). The SF-36 mental component score similarly increased from 38.8 to 51.1 by 3 months (P<0.001). AMA Whole Person Impairment (WPI) scores improved from 40.3% impairment pre-operative to 26.6% at 6-weeks post-operative (P<0.001). Patients SF-36 and WPI scores improved following burn contracture release, confirming both functional and psychologic improvement following surgery. During the acute post-operative period, this study suggests that contracture release in a mission setting is of benefit to patients. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  18. Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients.

    PubMed

    Wang, Xue-Qing; Mill, Julie; Kravchuk, Olena; Kimble, Roy M

    2010-12-01

    This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39±0.032 cm, with the thickest at 6 months (0.40±0.036 cm). There were 17 scald burn scars (0.34±0.045 cm), 4 contact burn scars (0.61±0.092 cm), and 10 flame burn scars (0.42±0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue <125, light blue 125-250, and green 250-440 PU. The thickness of these scars was significantly different between the predominant colours of burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  19. The Clinical Application of Preexpanded and Prefabricated Super-Thin Skin Perforator Flap for Reconstruction of Post-Burn Neck Contracture.

    PubMed

    Wang, Chunmei; Zhang, Junyi; Yang, Sifen; Hyakusoku, Hiko; Song, Ping; Pu, Lee L Q

    2016-02-01

    Based on our previous animal study, we applied the "bridging effect" to the neighboring axial flap through preexpansion and prefabrication of a skin perforator flap as a new method to reconstruct a large skin defect after release of severe neck burn scar contracture. Twelve patients suffering from severe post-burn cervical contractures underwent reconstruction of large skin defects after surgical release of severe scar contractures with preexpanded and prefabricated super-thin skin perforator flaps supplied primarily by a number of perforators via the "bridging effect" from the branches of the adjacent arteries as 2-stage procedures. During the first-stage operation, 2 tissue expanders were placed accordingly, and this was followed by a subsequent second-stage procedure where an expanded super-thin skin perforator flap was transposed to reconstruct a large neck skin defect. Follow-up was between 6 months and 3 years in this series. All super-thin skin perforator flaps survived in this series with primary healing except one with a distal flap necrosis that was treated with a subsequent skin graft. All patients have had a good contour with improved range of motion in the neck. The preexpansion and prefabrication of a super-thin skin perforator flap can possibly improve the anastomoses between neighboring subdermal vascular plexuses and extend the supplying area of these vessels to the flap. This method may provide a favorable super-thin skin flap that can be used for reconstruction of large neck defects after release of post-burn cervical scar contracture as demonstrated in this case series.

  20. Factors Affecting Burn Contracture Outcome in Developing Countries: A Review of 2506 Patients.

    PubMed

    Garcia, Lauren P; Huang, Alice; Corlew, Daniel Scott; Aeron, Kush; Aeron, Yogi; Rai, Shankar Man; Jovic, Goran; Agag, Richard L

    2016-09-01

    Burn contractures hinder joint mobility, resulting in functional impairment and reduced quality of life. This is of greater significance in developing countries where there are fewer resources for assistance with such impairments. Contracture release reduces deformity, but multiple factors affect the extent of postsurgical improvements and outcomes. Elucidating these factors may enable surgeons to better care for burn patients. This study assesses factors that impact burn contracture resolution in developing nations. A retrospective review of 2506 burn contractures was performed using information extracted from a large nongovernment organization (ReSurge International) database from Nepal, India, and Zambia. Data points included age, type of burn, time elapsed between injury and release, and extent of final release achieved based on preoperative and postoperative images of hand (n = 1960), elbow (n = 371), and knee (n = 176) contractures. Hand improvement was scored based on digit/wrist involvement (severity of dysfunction) and joint extension capability (functionality); elbow and knee improvement were calculated using preoperative and postoperative joint angles. Multivariate analysis was performed. Hands burned by hot liquid had greater functionality after surgery than open-fire burns (P < 0.01). Improvement in severity of dysfunction and functionality were inversely correlated to age (P < 0.01) and time until surgery (P < 0.01). Elbow improvement decreased as age increased (P < 0.01). Postoperative increase of knee extension decreased for each year elapsed between injury and surgery (P < 0.01). Burn type, age when burned, and timing of surgery were significant factors affecting hand outcomes, whereas age affected elbow outcomes, and time elapsed until surgery affected knee results. An algorithm was formulated to enable physicians in developing countries with limited resources to triage patients and optimize patient outcomes.

  1. Australia fires and burn scars as seen from STS-62

    NASA Image and Video Library

    1994-03-05

    STS062-106-042 (4-18 March 1994) --- This view of southern Australia about 100 miles northwest of Melbourne shows areas of protected reserves of natural forests in the midst of agricultural crop lands. The green patch seen here has been recently burned as indicated by the irregular large scar. The impact of winds on the scar is clearly visible. This nature preserve is reported to be the home to a large number of animals including the koala bears. Similar views were shot by the STS-60 crewmembers last month. These photographs will assist earth scientists in mapping the impact of forest fires and in moniotring the recovery of burned areas.

  2. Feasibility of an Exoskeleton-Based Interactive Video Game System for Upper Extremity Burn Contractures.

    PubMed

    Schneider, Jeffrey C; Ozsecen, Muzaffer Y; Muraoka, Nicholas K; Mancinelli, Chiara; Della Croce, Ugo; Ryan, Colleen M; Bonato, Paolo

    2016-05-01

    Burn contractures are common and difficult to treat. Measuring continuous joint motion would inform the assessment of contracture interventions; however, it is not standard clinical practice. This study examines use of an interactive gaming system to measure continuous joint motion data. To assess the usability of an exoskeleton-based interactive gaming system in the rehabilitation of upper extremity burn contractures. Feasibility study. Eight subjects with a history of burn injury and upper extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility. Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play. Visual analog scale for engagement, difficulty and comfort. Angular range of motion by subject, joint, and game. The study population had an age of 43 ± 16 (mean ± standard deviation) years and total body surface area burned range of 10%-90%. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game. This study demonstrates the feasibility of use of an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  3. Association between depression, patient scar assessment and burn-specific health in hospitalized burn patients.

    PubMed

    Roh, Young Sook; Chung, Hyun Soo; Kwon, Boeun; Kim, Giyon

    2012-06-01

    Depression is one of the most common psychological problems arising after a burn, but its relationship with patient scar assessment and burn-specific health are poorly understood. The aim of this study was to identify the incidence of in-hospital symptoms of depression, compare level of patient scar assessment, and burn-specific health by depression cutoff point, and identify the relationship between depression and these variables. In a cross-sectional descriptive study, 113 burn patients from two inpatient burn centers were divided into two groups based on the cutoff point of the Korean Center for Epidemiologic Studies Depression Scale (Korean CES-D): ≥25 or <25. Patient Scar Assessment Scale and Korean Burn-Specific Health Scale-Brief (BSHS-B-K) were used to identify associations with depression. Incidence of severe, definite depression as assessed by a score of 25 or above on the Korean CES-D was approximately 50% on an average at 60.9 days after injury. Burn patients with the Korean CES-D≥25 had significantly higher total mean patient scar assessment scores (43.34±11.49 vs. 36.84±9.56, t=3.265, p=.001), and lower burn-specific health subscale scores compared to patients with Korean CES-D<25. Depression was positively correlated with all subscales of the Patient Scar Assessment, ranging from r=.196 to .335 except scar color. Depression was significantly correlated with all subscales of the BSHS-B-K, range from r=-.320 to -.725. Results indicate that incidence of symptoms of depression is relatively high, and depressed burn patients report worse burn scar or sensation and lower levels of burn-specific health. Early, timely recognition and management of depression in these patients are warranted. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  4. Percutaneous collagen induction therapy: an alternative treatment for burn scars.

    PubMed

    Aust, Matthias C; Knobloch, Karsten; Reimers, Kerstin; Redeker, Jörn; Ipaktchi, Ramin; Altintas, Mehmet Ali; Gohritz, Andreas; Schwaiger, Nina; Vogt, Peter M

    2010-09-01

    This study aims to evaluate percutaneous collagen induction (PCI) in post-burn scarring. Patients with scarring after burn frequently request help in improving the aesthetic appearance of their residual cicatricial deformity. Their scars are generally treated by tissue transfer, W- and Z-plasties, flaps, cortisone injections or ablative procedures that injure or destroy the epidermis and its basement membrane and subsequently lead to fibrosis of the papillary dermis. The ideal treatment would be to preserve the epidermis and promote normal collagen and elastin formation in the dermis. A total of 16 consecutive patients (average age: 37+/-15.5 years, average body mass index (BMI): 25.7) in Germany with post-burn scarring. PCI using the Medical Roll-CIT (Vivida, Cape Town, South Africa). This device was designed to multiply-puncture the skin to the level of the dermal scar to institute remodelling. Patients were prepared with topical vitamin A and C cosmetic creams for a minimum of 4 weeks preoperatively to maximise collagen stimulation. The outcome was measured rating (visual analogue scale (VAS) and Vancouver Scar Scale (VSS)), histological specimen 12 months after intervention. On average, patients rated their improvement as a mean of 80% better (+/-15.5) than before treatment. Histologic examination revealed considerable increase in collagen and elastin deposition 12 months postoperatively. The epidermis demonstrated 45% thickening of stratum spinosum and normal rete ridges as well as the normalisation of the collagen/elastin matrix in the reticular dermis at 1 year postoperatively. This pilot study shows that PCI appears to be a safe method for treating post-burn scarring without destroying the epidermis. The procedure can be repeated safely and is also applicable in regions where laser treatments and deep peels are of limited use. However, it is necessary to initiate an efficacy trial to prove the data of this pilot study. 2009 Elsevier Ltd and ISBI. All rights

  5. The menace of post-burn contractures: a developing country's perspective.

    PubMed

    Saaiq, M; Zaib, S; Ahmad, S

    2012-09-30

    A study was carried out regarding 213 patients of either gender and all ages who presented with post-burn contractures. The commonest site of contracture was the neck. 92 patients (43.19%) had received their initial burn injury management in general surgery units in tertiary care hospitals compared to 43 patients (20.18%) in district headquarter hospitals. Only 26 patients (12.20%) were managed in plastic surgery/burn wards, and 52 patients (24.41%) received no regular treatment from any hospital. The majority of patients (n=197) had a history of conservative management, with only 16 patients (7.51%) having a split thickness skin graft for part of their initial burns. None of the patients had the appropriate anti-deformity splintage in the affected parts or any physiotherapy during the acute phase of their burns.

  6. Malignant Melanoma on a Thermal Burn Scar with an Interval of More Than 70 Years

    PubMed Central

    Uchida, Shusuke; Oiso, Naoki; Shiga, Kuriko; Narita, Tomohiko; Kawada, Akira

    2016-01-01

    Cases of malignant melanoma on thermal burn scars have occasionally been reported. We report a 78-year-old Japanese female with malignant melanoma on a thermal burn scar with an interval of more than 70 years. Our case reemphasizes the importance of regular examinations in persons with thermal burn scars. PMID:27721752

  7. East Peak Fire Burn Scar, Colorado [annotated

    NASA Image and Video Library

    2017-09-27

    On June 22, 2013, the Operational Land Imager (OLI) on Landsat 8 captured this false-color image of the East Peak fire burning in southern Colorado near Trinidad. Burned areas appear dark red, while actively burning areas look orange. Dark green areas are forests; light green areas are grasslands. Lightning ignited the blaze on June 19, 2013. By June 25, it had burned nearly 13,500 acres (5,500 hectares). NASA Earth Observatory image by Jesse Allen and Robert Simmon, using Landsat data from the U.S. Geological Survey. Caption by Adam Voiland. Instrument: Landsat 8 - OLI More images from this event: 1.usa.gov/14DesQC Credit: NASA Earth Observatory NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

  8. Assessment of burn-specific health-related quality of life and patient scar status following burn.

    PubMed

    Oh, Hyunjin; Boo, Sunjoo

    2017-11-01

    This study assessed patient-perceived levels of scar assessment and burn-specific quality of life (QOL) in Korean burn patients admitted to burn care centers and identified differences in scar assessment and QOL based on various patient characteristics. A cross-sectional descriptive study using anonymous paper-based survey methods was conducted with 100 burn patients from three burn centers specializing in burn care in South Korea. Mean subject age was 44.5 years old, and 69% of the subjects were men. The overall mean QOL was 2.91 out of 5. QOL was lowest for the work subdomain (2.25±1.45) followed by the treatment regimen subdomain (2.32±1.16). The subjects' mean total scar assessment score was 35.51 out of 60, and subjects were most unsatisfied with scar color. Subjects with low income, flame-source burns, severe burns, visible scars, and scars on face or hand reported significantly lower QOL. Subjects with severe burn degree and burn range perceived their burn scar condition to be worse than that of others. The results show that burn subjects experience the most difficulties with their work and the treatment regimen. Subjects with severe burn and visible scarring have a reduced QOL and a poor scar status. Scar management intervention may improve QOL of burn patients especially those with severe burn and visible scars. Further studies are warranted to evaluate the relationship between scar assessment and QOL. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  9. Botulinum Toxin Type A Inhibits α-Smooth Muscle Actin and Myosin II Expression in Fibroblasts Derived From Scar Contracture.

    PubMed

    Chen, Minliang; Yan, Tongtong; Ma, Kui; Lai, Linying; Liu, Chang; Liang, Liming; Fu, Xiaobing

    2016-09-01

    Scar contracture (SC) is one of the most common complications resulting from major burn injuries. Numerous treatments are currently available but they do not always yield excellent therapeutic results. Recent reports suggest that botulinum toxin type A (BTXA) is effective at reducing SC clinically, but the molecular mechanism for this action is unknown. α-Smooth muscle actin (α-SMA) and myosin II are the main components of stress fibers, which are the contractile structures of fibroblasts. The effects of BTXA on α-SMA and myosin II in SC are still unknown. This study aimed to explore the effect of BTXA on α-SMA and myosin II expression in fibroblasts derived from SC and to elucidate its actual mechanism further. Fibroblasts were isolated from tissue specimens of SC. Fibroblasts were cultured in Dulbecco modified Eagle medium with different concentrations of BTXA and their proliferation was analyzed through the tetrazolium-based colorimetric method at 1, 4, and 7 days. Proteins of α-SMA and myosin II were checked using Western blot in fibroblasts treated with different concentrations of BTXA at 1, 4, and 7 days. Fibroblasts without BTXA treatment had a higher proliferation than that in other groups, which indicated that the proliferation of fibroblasts was significantly inhibited by BTXA (P < 0.05). Proteins of α-SMA and myosin II between fibroblasts with BTXA and fibroblasts without BTXA are statistically significant (P < 0.05). These results suggest that BTXA effectively inhibited the growth of fibroblasts derived from SC and reduced the expression of α-SMA and myosin II, which provided theoretical support for the application of BTXA to control SC.

  10. Reconstruction of thoracic burn sequelae by scar release and flap resurfacing.

    PubMed

    Angrigiani, Claudio; Artero, Guillermo; Castro, Gaston; Khouri, Roger K

    2015-12-01

    In the USA, 450,000 thermal burns receive medical treatment annually. Burn scars are commonly excised and covered with skin grafts. Long-term, these treatments commonly leave patients with discomfort, reduced total lung capacity and forced vital capacity, and restriction of thoracic expansion and shoulder joint mobility. In this article, we present our experience with using scar release and immediate flap reconstruction to treat thoracic restriction due to burn sequelae. From 1998 to 2014, we enrolled 16 patients with anterior thoracic burn sequelae that had previously been treated conservatively or with skin grafts that eventually recidivated. Preoperatively, we measured thoracic circumference in expiration and inspiration, %FVC, %FEV1, and shoulder mobility. All patients underwent anterior thoracic scar release and immediate flap resurfacing. At 2 weeks to 3 months postoperatively (mean, 2.6 months), mean thoracic circumference upon inspiration increased from 83.6 cm±5.7 to 86.5 cm±5.8 (p<0.0000000001). Mean %FVC improved from 76.0%±2.64% to 88.2%±4.69% (p<0.0000001). Mean %FEV1 improved from 79.2%±3.85 to 87.8%±2.98 (p<0.000001). All 14 patients who had restricted shoulder mobility preoperatively no longer had restricted shoulder mobility postoperatively. The mean patient-reported satisfaction was 4.6/5 (range, 3-5). At a mean follow up of 2.5 years, none of the contractures recidivated. Complications included 2 cases of tissue necrosis of the distal end of the flap. In one case, the flap was restored; in the other case, the patient eventually had to receive a new flap. Additional complications included two local infections that were successfully treated with oral and local antibiotics and two hematomas that were drained and eventually healed without tissue loss. Scar releases and flaps provide a safe and effective method for the correction of restricted thoracic expansion, respiratory restriction, decreased range of shoulder motion, and discomfort from

  11. Three-dimensional Reconstruction of Scar Contracture-bearing Axilla and Digital Webs Using the Square Flap Method

    PubMed Central

    Huang, Chenyu

    2014-01-01

    Background: Joint scar contractures are characterized by tight bands of soft tissue that bridge the 2 ends of the joint like a web. Classical treatment methods such as Z-plasties are mainly based on 2-dimensional designs. Our square flap method is an alternative surgical method that restores the span of the web in a stereometric fashion, thereby reconstructing joint function. Methods: In total, 20 Japanese patients with joint scar contractures on the axillary (n = 10) or first digital web (n = 10) underwent square flap surgery. The maximum range of motion and commissure length were measured before and after surgery. A theoretical stereometric geometrical model of the square flap was established to compare it to the classical single (60 degree), 4-flap (45 degree), and 5-flap (60 degree) Z-plasties in terms of theoretical web reconstruction efficacy. Results: All cases achieved 100% contracture release. The maximum range of motion and web space improved after square flap surgery (P = 0.001). Stereometric geometrical modeling revealed that the standard square flap (α = 45 degree; β = 90 degree) yields a larger flap area, length/width ratio, and postsurgical commissure length than the Z-plasties. It can also be adapted by varying angles α and β, although certain angle thresholds must be met to obtain the stereometric advantages of this method. Conclusions: When used to treat joint scar contractures, the square flap method can fully span the web space in a stereometric manner, thus yielding a close-to-original shape and function. Compared with the classical Z-plasties, it also provides sufficient anatomical blood supply while imposing the least physiological tension on the adjacent skin. PMID:25289342

  12. Hypertrophic scar contracture is mediated by the TRPC3 mechanical force transducer via NFkB activation.

    PubMed

    Ishise, Hisako; Larson, Barrett; Hirata, Yutaka; Fujiwara, Toshihiro; Nishimoto, Soh; Kubo, Tateki; Matsuda, Ken; Kanazawa, Shigeyuki; Sotsuka, Yohei; Fujita, Kazutoshi; Kakibuchi, Masao; Kawai, Kenichiro

    2015-06-25

    Wound healing process is a complex and highly orchestrated process that ultimately results in the formation of scar tissue. Hypertrophic scar contracture is considered to be a pathologic and exaggerated wound healing response that is known to be triggered by repetitive mechanical forces. We now show that Transient Receptor Potential (TRP) C3 regulates the expression of fibronectin, a key regulatory molecule involved in the wound healing process, in response to mechanical strain via the NFkB pathway. TRPC3 is highly expressed in human hypertrophic scar tissue and mechanical stimuli are known to upregulate TRPC3 expression in human skin fibroblasts in vitro. TRPC3 overexpressing fibroblasts subjected to repetitive stretching forces showed robust expression levels of fibronectin. Furthermore, mechanical stretching of TRPC3 overexpressing fibroblasts induced the activation of nuclear factor-kappa B (NFκB), a regulator fibronectin expression, which was able to be attenuated by pharmacologic blockade of either TRPC3 or NFκB. Finally, transplantation of TRPC3 overexpressing fibroblasts into mice promoted wound contraction and increased fibronectin levels in vivo. These observations demonstrate that mechanical stretching drives fibronectin expression via the TRPC3-NFkB axis, leading to intractable wound contracture. This model explains how mechanical strain on cutaneous wounds might contribute to pathologic scarring.

  13. Postburn Neck Lateral Contracture Anatomy and Treatment: A New Approach.

    PubMed

    Grishkevich, Viktor M; Grishkevich, Max

    2015-01-01

    Lateral contracture of the neck is a rare and insufficiently researched burn consequent. Contracture restricts head motion, can cause a secondary face deformity, presents severe cosmetic defects, and, therefore, requires surgical reconstruction. Literature does not sufficiently address the issue; therefore, anatomy not researched and treatment techniques not developed. The anatomy of postburn lateral cervical flexion contracture was studied in 21 operated patients. Using obtained data, new approaches were investigated, which were directed toward maximal efficacy of the local tissues use. Follow-up results were observed from 6 months to 9 years. Lateral cervical contractures were divided into two types based on their anatomy: edge and medial. Edge contractures were caused by burns and scars located on the posterior neck surface and were characterized by the presence of the fold in central lateral zone. In the fold, only one (posterior) sheet is scars that cause the contracture. Medial contractures were caused by scars located on the lateral cervical surface and were characterized by the presence of the fold in which both sheets were scars. In both types, contracture was caused by scar sheet surface deficiency in length, which has a trapezoid form (contracture cause). In all cases, there was surface surplus in the fold's sheets allowed contracture release with local tissue. The technique that allows the maximum local tissue use and ensures full contracture elimination is the trapeze-flap plasty. Two anatomic types of lateral cervical scar contractures were identified: edge and medial. An anatomically justified efficacy reconstructive technique for both types is trapeze-flap plasty.

  14. Chromatic analysis of burn scar based on ANN by using photoelectrical technology

    NASA Astrophysics Data System (ADS)

    Wan, Baikun; Qi, Hongzhi; Ming, Dong; Zhang, Mingjian; Wang, Qifang

    2005-01-01

    In this paper a novel method for the chromatic analysis of burn scar is proposed. The aim of the algorithm is to evaluate the curative effect and set up the treatment plan pertinently, because the scar color is an impersonal parameter reflects the degree of scar hypertrophy. The method is based on artificial neural network (ANN) by using photoelectrical technique, and composed of three main parts: firstly capture the digital color images of the burn scar using CCD camera, then change the RGB color data of the burn scar into that of HSB color space and emend it using ANN, lastly judge the degree of burn scar hypertrophy by chromatic analysis using ANN again. The experimental results were good conformed to the degrees of scar hypertrophy given by clinical evaluations. It suggests that the chromatic analysis technique of the burn scar is valuable for further study and apply to the clinical engineering.

  15. Quality of life and mediating role of patient scar assessment in burn patients.

    PubMed

    Oh, Hyunjin; Boo, Sunjoo

    2017-09-01

    In this study, we examined the plausibility of the mediating effect of the levels of patient scar assessment on the relationship between burn severity measured with total body surface area and burn-specific health-related quality of life (HRQL) among patients with burns in South Korea. In this cross sectional descriptive study, we collected data from 100 burn patients in three burn centers specializing in burn care in South Korea. Patient scar assessment, burn specific HRQL, and burn-related characteristics were self-reported with anonymous, paper-based surveys. The findings showed a positive correlation between burn severity, patient scar assessment, and HRQL in burn patients. The evidence of this paper is that quality of life after burns more determined by scar characteristics than burn severity. In the light of the poor HRQL in burn patients, the results of this study support that improving scar status could improve patients' HRQL. Health care providers should keep in mind that patients' perspectives of their scars would be a great indicator of their HRQL, so the providers' focus should be on intensive scar management intervention in their care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  16. Anesthetic Practices for Laser Rehabilitation of Pediatric Hypertrophic Burn Scars.

    PubMed

    Wong, Brendan M; Keilman, Jeffrey; Zuccaro, Jennifer; Kelly, Charis; Maynes, Jason T; Fish, Joel S

    The use of ablative fractional carbon dioxide laser therapy and pulsed dye laser therapy has led to significant improvements in the rehabilitation of hypertrophic burn scars. However, laser procedures are associated with appreciable pain among pediatric patients. Clinical consensus suggests using general anesthesia for pediatric laser procedures; however, guidelines for perioperative care are lacking. The objective of this quality improvement study is to determine whether a difference exists in postoperative pain outcomes in pediatric patients who receive intraoperative opioid regimens compared with patients who receive opioid-sparing regimens for laser therapy of hypertrophic burn scars. A retrospective review of patients who received laser therapy at a pediatric burn center from April 2014 to May 2015 was performed. Overall, 88 of the 92 procedures reviewed were included. A statistically significant difference was not found between the likelihood of postoperative pain when intraoperative opioid regimens (n = 63) were given compared with opioid-sparing regimens (n = 25) X (1, n = 88) = 2.870, P = .0902. There was also no difference between short-acting (n = 48), long-acting (n = 9), or combination (n = 6) intraoperative opioids compared with opioid-sparing regimens (n = 25) in the likelihood of postoperative pain. Despite the small sample size, the low number of postoperative pain cases is encouraging. Ultimately, these data provide a foundation for developing anesthetic guidelines for pediatric laser procedures. Specifically, clinicians should consider the potential to deliver adequate perioperative care via an opioid-sparing regimen ± adjuvant.

  17. The effectiveness of moisturizers in the management of burn scars following burn injury: a systematic review.

    PubMed

    Klotz, Tanja; Kurmis, Rochelle; Munn, Zachary; Heath, Kathryn; Greenwood, John E

    2015-11-13

    The common mantra with which patients often leave a burns unit is "moisturize and massage". Various products have been reported for use in practice including aqueous cream BP, bees wax and herbal oil creams, silicone based creams, paraffin/petroleum/mineral oil based products and aloe vera gels. Often combined with other scar management techniques such as pressure therapy, massage and contact media, moisturizers convey active properties of their own.  To date no published review on the optimal moisturizer for burn scar management has been identified via searches of recognized databases. The objective of this review was to identify and synthesize the best available evidence on the effectiveness of moisturizer use in the management of active burn scars following burn injury.  More specifically, this review focused on the following questions:  Does moisturizer use have an effect on scar outcomes following burn injury, including scar formation, skin breakdown, patient acceptance and water loss?  What is the optimal base composition of moisturizers used in scar management for patients who have sustained a burn injury? Types of participants:  Patients of any age who have sustained a burn injury of any size, and have been admitted to a hospital or regional burn unit or burn centre for the management of their injury.  Types of intervention(s)/phenomena of interest:  Studies evaluating moisturizer applied to healed skin following burn injury were considered for inclusion. Moisturizer may have been compared to usual care as defined by the individual study, other interventions, or a different type of moisturizer. Studies comparing moisturizer and massage compared to moisturizer alone were excluded.  Types of studies:  This review primarily considered experimental study designs, including randomized and pseudo-randomized controlled trials.  Types of outcomes:  Primary outcomes for examination in this review included scar formation and skin breakdown, measured by

  18. The role of two-sided splinting for recalcitrant paediatric post-burn hand flexion contracture: a case report.

    PubMed

    Prasetyono, Toh; Caroline, I

    2017-07-01

    A 2-year-old boy presented to the plastic and reconstructive surgery outpatient clinic with bilateral post-burn hand flexion contracture. The contracture had been released twice elsewhere. The third surgical repair on one hand at a time was conducted by the author (TOHP). However, inadeq.uate compliance to the postoperative splinting and exercise led to the recurrence of the contracture in the following year. A customised two-sided splint was therefore created to ensure proper placement and compliance. Reinforcement to the parents to encourage the boy to practise active exercise on demand was also an integral part of the management. Good functional and cosmetic outcome were presented at 1-year follow-up. This case highlights the value of a two-sided splint for the management of post-burn hand flexion contracture in children whose compliance is inevitably cannot be guaranteed.

  19. Health professionals' and consumers' opinion: what is considered important when rating burn scars from photographs?

    PubMed

    Simons, Megan; Tyack, Zephanie

    2011-01-01

    With advances in wound care technology, there is a trend toward patients undertaking specialist burns treatment in an outpatient capacity. Photographic scar evaluation is a part of this trend in some health services because it permits scar assessment by different health professionals, both within and across outpatient services, to assess the impact of scar management strategies. The aim of this study was to explore the parameters considered integral to scar assessment when completing photographic scar evaluation. First, opinions were sought from 38 burn health professionals in 2 tertiary pediatric hospitals who participated in focus groups where in-person and in-photograph scar rating were completed using three burn scar rating scales (modified Vancouver scar scale, Manchester scar scale, and patient and observer scar assessment scale) presented with a standard format and instructions. Second, 36 occupational therapists and physiotherapists from Australia and New Zealand completed questionnaires. Third, 10 healthcare consumers from 1 tertiary pediatric hospital participated in face-to-face or telephone interviews. Parameters believed to be assessed using photographic evaluation of burns scarring were vascularity, surface area, color, contour, height, and overall opinion. However, surface area was considered questionable as an indicator of scar maturity. These parameters mostly differ from those considered important in a burn scar outcome measure when rating scars in-person: height/thickness, vascularity, color, pliability, joint function, and patient/client opinion. A categorical scale with visual descriptors, as well as specific strategies to improve photographic technique, may go some way to addressing the perceived difficulty in rating these parameters using burn scar photographs.

  20. Reconstruction of the face and neck scar contractures using staged transfer of expanded "Super-thin flaps".

    PubMed

    Gao, Jian-Hua; Ogawa, Rei; Hyakusoku, Hiko; Lu, Feng; Hu, Zhi-Qi; Jiang, Ping; Yang, Ling; Feng, Chuanbo

    2007-09-01

    The authors introduced the "Super-thin flap" concept, which is sometimes called the subdermal vascular network (SVN) flap, in 1994. Since 1994, we have reconstructed face and neck scar contractures using various types of "Super-thin flaps." In this report, we introduce expanded "Super-thin flaps" for reconstruction of the face and neck for the first time in a patient. Since 2000 we have used 21 expanded flaps to reconstruct 21 face or neck scar cases in nine males and 12 females. In the first operation, an expander was inserted on the fascia of the pectoralis major muscle, and then about 1,000 cc of saline was injected during a 2-month period. In the second operation, the flap was thinned primarily and applied to the recipient site. Three weeks after the second operation, the pedicle of the flap was cut down and sutured. Flap size ranged from 4 cm x 14 cm to 10 cm x 22 cm. Expanded volume ranged from 800 cc to 1,200 cc. All flaps survived completely and scar tissues were replaced with normal skin. Flaps did not shrink after the operations, and contractures did not recur. Advantages of the expanded flaps are presented: (1) Large flaps can be harvested because of the expander; (2) Extremely thin flaps can be safely employed; (3) Texture and color match are good; (4) Donor site can be closed primarily; and (5) Microsurgery is not required. However, the disadvantage of the method is the requirement for two or three operations.

  1. A Modeling Approach for Burn Scar Assessment Using Natural Features and Elastic Property

    SciTech Connect

    Tsap, L V; Zhang, Y; Goldgof, D B; Sarkar, S

    2004-04-02

    A modeling approach is presented for quantitative burn scar assessment. Emphases are given to: (1) constructing a finite element model from natural image features with an adaptive mesh, and (2) quantifying the Young's modulus of scars using the finite element model and the regularization method. A set of natural point features is extracted from the images of burn patients. A Delaunay triangle mesh is then generated that adapts to the point features. A 3D finite element model is built on top of the mesh with the aid of range images providing the depth information. The Young's modulus of scars is quantified with a simplified regularization functional, assuming that the knowledge of scar's geometry is available. The consistency between the Relative Elasticity Index and the physician's rating based on the Vancouver Scale (a relative scale used to rate burn scars) indicates that the proposed modeling approach has high potentials for image-based quantitative burn scar assessment.

  2. In vivo assessment of human burn scars through automated quantification of vascularity using optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Liew, Yih Miin; McLaughlin, Robert A.; Gong, Peijun; Wood, Fiona M.; Sampson, David D.

    2013-06-01

    In scars arising from burns, objective assessment of vascularity is important in the early identification of pathological scarring, and in the assessment of progression and treatment response. We demonstrate the first clinical assessment and automated quantification of vascularity in cutaneous burn scars of human patients in vivo that uses optical coherence tomography (OCT). Scar microvasculature was delineated in three-dimensional OCT images using speckle decorrelation. The diameter and area density of blood vessels were automatically quantified. A substantial increase was observed in the measured density of vasculature in hypertrophic scar tissues (38%) when compared against normal, unscarred skin (22%). A proliferation of larger vessels (diameter≥100 μm) was revealed in hypertrophic scarring, which was absent from normal scars and normal skin over the investigated physical depth range of 600 μm. This study establishes the feasibility of this methodology as a means of clinical monitoring of scar progression.

  3. Acne Scars

    MedlinePlus

    ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ...

  4. [Effects of scar excision combined with negative-pressure on repair of hypertrophic scar in burn children].

    PubMed

    Cai, J H; Deng, H P; Shen, Z A; Sun, T J; Li, D J; Li, D W; He, L X; Wang, L; Jin, X

    2017-07-20

    Objective: To explore the effects of scar excision combined with negative-pressure on repair of hypertrophic scar in burn children. Methods: From October 2010 to August 2016, 25 children with hypertrophic scar after deep burn were hospitalized, with scar course ranging from 3 months to 11 years and scar area ranging from 35 to 427 [83(51, 98)]cm(2). A total of 35 scars of 25 children were located in trunk (11 scars), upper limb (11 scars), and lower limb (13 scars). All children received scar excision operation and negative-pressure treatment (negative-pressure value ranged from -40 to -20 kPa), among which 6 cases received scar excision operation and negative-pressure treatment for two times for further removal of scars. After scar excision, electronic spring scale was used to measure the tension of the incision. The tension value of children ranged from 3.43 to 23.84 [7.16 (5.59, 9.12)] N, and then the incision was closed with appropriate suture according to the value of the tension. The incision with smaller tension was firstly opened on post operation day (POD) 8. After removing the suture, negative-pressure was conducted to POD 14. The incision with larger tension was firstly opened on POD 12. After removing the suture, biological semi-membrane was used to reduce tension to POD 16. All healed incisions were performed with anti-scar treatment for 1 year and relaxation and fixation for 3 months. General condition of the incision was observed after operation. The reduction percentage of scar area was calculated half-year after operation. The Patient and Observer Scar Assessment Scale was used to record the overall score of scar and scar score of trunk, upper limb, and lower limb before operation and half-year after operation. Data were processed with paired t test and Wilcoxon rank sum test. Results: After removing the suture, all incisions of children healed well without redness, effusion, and rupture. Half-year after operation, the appearance and deformity of

  5. Scar formation following excisional and burn injuries in a red Duroc pig model.

    PubMed

    Blackstone, Britani N; Kim, Jayne Y; McFarland, Kevin L; Sen, Chandan K; Supp, Dorothy M; Bailey, J Kevin; Powell, Heather M

    2017-07-20

    Scar research is challenging because rodents do not naturally form excessive scars, and burn depth, size, and location cannot be controlled in human longitudinal studies. The female, red Duroc pig model has been shown to form robust scars with biological and anatomical similarities to human hypertrophic scars. To more closely mimic the mode of injury, recreate the complex chemical milieu of the burn wound environment and enhance scar development, an animal model of excessive burn-induced scarring was developed and compared with the more commonly used model, which involves excisional wounds created via dermatome. Standardized, full-thickness thermal wounds were created on the dorsum of female, red Duroc pigs. Wounds for the dermatome model were created using two different total dermatome settings: ∼1.5 mm and ≥ 1.9 mm. Results from analysis over 150 days showed that burn wounds healed at much slower rate and contracted more significantly than dermatome wounds of both settings. The burn scars were hairless, had mixed pigmentation, and displayed fourfold and twofold greater excess erythema values, respectively, compared with ∼1.5 mm and ≥ 1.9 mm deep dermatome injuries. Burn scars were less elastic, less pliable, and weaker than scars resulting from excisional injuries. Decorin and versican gene expression levels were elevated in the burn group at day 150 compared with both dermatome groups. In addition, transforming growth factor-beta 1 was significantly up-regulated in the burn group vs. the ∼1.5 mm deep dermatome group at all time points, and expression remained significantly elevated vs. both dermatome groups at day 150. Compared with scars from dermatome wounds, the burn scar model described here demonstrates greater similarity to human hypertrophic scar. Thus, this burn scar model may provide an improved platform for studying the pathophysiology of burn-related hypertrophic scarring, investigating current anti-scar therapies, and development of

  6. Anaesthetic management of post-burn contractures, a recurrent challenge from oil pipeline vandalization in Nigeria: a case report.

    PubMed

    Jasper, Abiodun Oyinpreye

    2009-12-03

    A 13 year- old girl presented to the department with sternomental contractures as a result of facial burns from kerosene explosion. Difficult airway was envisaged. Over the period of time she developed sub-mental contracture with keloids; and was scheduled for release of contractures and flap closure.Anaesthesia was induced with halothane and 100% oxygen. A size 3 laryngeal mask airway (LMA) was inserted and anaesthesia maintained with oxygen/nitrous oxide/halothane/muscle relaxant technique. The successful placement of LMA at 2(nd )attempt was aided by a surgical incision on the submental contracture. Blood loss was 600 mls and a unit of packed red blood cells was transfused. She made full recovery and was discharged home after 1 month.

  7. Postburn shoulder medial-adduction contracture: anatomy and treatment with trapeze-flap plasty.

    PubMed

    Grishkevich, Viktor M

    2013-03-01

    Shoulder-adduction contractures after burn, most frequent among big joints, cause functional deficiency of the upper limb and, therefore, benefits from surgical correction. Many reconstructive techniques and flaps have been suggested for contracture treatment, but the problem in choosing an adequate reconstructive technique based on the anatomy of the contracture remains. Shoulder-adduction contracture has been given less emphasis in research than any other type and its surgical reconstructive technique remains of concern. Anatomic features of scar shoulder-adduction contractures were studied in 346 patients, personally operated upon. This allowed us to classify all contractures into three types: edge, medial and total. New surgical techniques specifically for medial contractures were developed. Eighty percent of patients had edge contractures in which the axillary fossa was spared. In 20% of patients, axilla, including the hairy dome, was involved. These cases were anatomically classified into two types: medial, making up 30% of the cases, when contracted scars involved only axilla, and total caused by scars, tightly surrounding the shoulder joint. The scars, causing medial contracture, form a crescent-shaped fold along the medial axillary line. The fold's sheets are scars in which there is skin surface surplus in width, which allows the contracture release with local tissues. Surface deficiency in length has a trapezoid form. Medial contracture can be successfully treated with opposite transposition of trapezoid adipose-scar flaps prepared from both sheets of the fold. Medial shoulder-adduction contracture is a newly described type with specific anatomic features. Contracture can be successfully treated with local tissues using trapeze-flap plasty. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  8. Study of Burn Scar Extraction Automatically Based on Level Set Method using Remote Sensing Data

    PubMed Central

    Liu, Yang; Dai, Qin; Liu, JianBo; Liu, ShiBin; Yang, Jin

    2014-01-01

    Burn scar extraction using remote sensing data is an efficient way to precisely evaluate burn area and measure vegetation recovery. Traditional burn scar extraction methodologies have no well effect on burn scar image with blurred and irregular edges. To address these issues, this paper proposes an automatic method to extract burn scar based on Level Set Method (LSM). This method utilizes the advantages of the different features in remote sensing images, as well as considers the practical needs of extracting the burn scar rapidly and automatically. This approach integrates Change Vector Analysis (CVA), Normalized Difference Vegetation Index (NDVI) and the Normalized Burn Ratio (NBR) to obtain difference image and modifies conventional Level Set Method Chan-Vese (C-V) model with a new initial curve which results from a binary image applying K-means method on fitting errors of two near-infrared band images. Landsat 5 TM and Landsat 8 OLI data sets are used to validate the proposed method. Comparison with conventional C-V model, OSTU algorithm, Fuzzy C-mean (FCM) algorithm are made to show that the proposed approach can extract the outline curve of fire burn scar effectively and exactly. The method has higher extraction accuracy and less algorithm complexity than that of the conventional C-V model. PMID:24503563

  9. Study of burn scar extraction automatically based on level set method using remote sensing data.

    PubMed

    Liu, Yang; Dai, Qin; Liu, Jianbo; Liu, ShiBin; Yang, Jin

    2014-01-01

    Burn scar extraction using remote sensing data is an efficient way to precisely evaluate burn area and measure vegetation recovery. Traditional burn scar extraction methodologies have no well effect on burn scar image with blurred and irregular edges. To address these issues, this paper proposes an automatic method to extract burn scar based on Level Set Method (LSM). This method utilizes the advantages of the different features in remote sensing images, as well as considers the practical needs of extracting the burn scar rapidly and automatically. This approach integrates Change Vector Analysis (CVA), Normalized Difference Vegetation Index (NDVI) and the Normalized Burn Ratio (NBR) to obtain difference image and modifies conventional Level Set Method Chan-Vese (C-V) model with a new initial curve which results from a binary image applying K-means method on fitting errors of two near-infrared band images. Landsat 5 TM and Landsat 8 OLI data sets are used to validate the proposed method. Comparison with conventional C-V model, OSTU algorithm, Fuzzy C-mean (FCM) algorithm are made to show that the proposed approach can extract the outline curve of fire burn scar effectively and exactly. The method has higher extraction accuracy and less algorithm complexity than that of the conventional C-V model.

  10. [Advances in the research of pressure therapy for pediatric burn patients with facial scar].

    PubMed

    Wei, Y T; Fu, J F; Li-Tsang, Z H P

    2017-05-20

    Facial scar and deformation caused by burn injury severely affect physical and psychological well-being of pediatric burn patients, which needs medical workers and pediatric burn patients' family members to pay much attention to and to perform early rehabilitation treatment. Pressure therapy is an important rehabilitative strategy for pediatric burn patients with facial scar, mainly including wearing headgears and transparent pressure facemasks, which have their own features. To achieve better treatment results, pressure therapy should be chosen according to specific condition of pediatric burn patients and combined with other assistant therapies. Successful rehabilitation for pediatric burn patients relies on cooperation of both family members of pediatric burn patients and society. Rehabilitation knowledge should be provided to parents of pediatric burn patients to acquire their full support and cooperation in order to achieve best therapeutic effects and ultimately to rebuild physical and psychological well-being of pediatric burn patients.

  11. Severe post-burn neck contracture release and skin graft harvest using tumescent local anaesthesia as the sole anesthetic technique.

    PubMed

    Prasad, Mukesh Kumar; Puneet, Pulak; Rani, Kanchan; Shree, Divya

    2012-02-01

    Severe post-burn contractures in the neck often cause anatomical distortion and restriction of neck movements, resulting in varying degrees of difficulty in airway management. Any mode of anesthesia that may obviate the need for imperative airway control may be desirable in such situations in which a difficult airway may be anticipated. Here we present one such situation where tumescent local anesthesia was employed to manage a case of severe post-burn neck contractures posted for contracture release and split-skin grafting. The other benefits of this method were minimal blood loss and excellent postoperative analgesia. In conclusion, it can be emphasized that the application of tumescent anesthesia is an important anesthetic tool in patients with predicted difficult airway management.

  12. Identification of factors predicting scar outcome after burn in adults: A prospective case-control study.

    PubMed

    Wallace, Hilary J; Fear, Mark W; Crowe, Margaret M; Martin, Lisa J; Wood, Fiona M

    2017-09-01

    This study examined influences on scarring after burn in a prospective study using a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS). A prospective case-control study was conducted among 616 adult subjects who sustained a burn in Western Australia. Patient factors influencing scar outcome including gender, Fitzpatrick skin type and selected co-morbidities were explored, as well as injury and clinical factors. A logistic regression model for raised scar after burn was developed which achieved an overall correct prediction rate of 81.1%; 74.8% for those with raised scar and 86.0% for those without raised scar. From this study, injury and clinical predictors for raised scar after adjustment for other variables are: increasing %TBSA, greater burn depth as indicated by level of surgical intervention, wound complications and prolonged hospital stay. Intrinsic patient predictors for raised scar in patients with comparable injuries are: young age (≤30 years), female gender and Fitzpatrick skin types 4-6. The strength of association statistics (odds ratios and 95% confidence intervals) reported will be of practical benefit for clinical decision-making and counselling of patients, and plausible biological explanations for the findings support the validity of the results. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  13. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    DTIC Science & Technology

    2016-10-01

    investigators participating in the Training Conclave. • Randomization Table Agenda developed and is currently in use (submitted with Y1 annual...see table ). • Data for all primary and secondary measurement sites are represented. Primary Sites Secondary Sites Total Sites Subjects/Allowed

  14. Treatment of Burn and Surgical Wounds With Recombinant Human Tropoelastin Produces New Elastin Fibers in Scars.

    PubMed

    Xie, Hua; Lucchesi, Lisa; Zheng, Bo; Ladich, Elena; Pineda, Teresa; Merten, Rose; Gregory, Cynthia; Rutten, Michael; Gregory, Kenton

    2017-02-15

    Tropoelastin (TE), the soluble precursor of insoluble elastin fibers, is produced in minimal amounts in adults. Burn injuries result in inflexible collagen-rich scars because of lack of elastin fiber formation. We studied the feasibility of using recombinant human tropoelastin to enable elastin fiber production in burn and surgical scars to improve skin flexibility. In a swine hypertrophic burn scar model, normal skin and 3 × 3-cm partial thickness thermal burns underwent dermatome resection at 1 week post burn and randomized to four subcutaneous injections of saline or TE (either 0.5, 5, or 10 mg/ml) spaced 3 days apart. Two burn sites received TE injections after wound closure (0.5 or 10 mg/ml). At 90 days, skin hardness, flexibility, and histology were evaluated. All injury sites developed hypertrophic scars. New elastin fibers were found in burn scars in all injuries injected after skin closure with low (5/5) and high (6/6) TE doses (P < .05). No elastin fibers were observed without TE treatment. No significant differences in skin hardness, flexibility, or inflammation were observed. This is the first report demonstrating that subcutaneous injections of TE into surgical and burn injuries can safely produce new elastin fibers in scars. Despite the development of new elastin fibers, skin flexibility was not improved, possibly because of insufficient elastin fiber maturation or the hypertrophic model used. The ability to restore elastin fiber formation in adult skin after burns, trauma, and surgery may improve skin regeneration and reduce disabling complications of scar formation.

  15. Campfire burns of the palms in crawling infants in Saudi Arabia: results following release and graft of contractures.

    PubMed

    Al-Qattan, Mohammad M

    2009-01-01

    In Saudi Arabia, camping in the desert is commonly practiced by families. A campfire is usually lit and unsupervised crawling infants are at risk of burns from these campfires. During a 12-year period, a total of 53 children with hand contractures related to campfire burns were treated. The mean age at the time of burn was 9 months (range: 5-12 months). All patients presented with isolated palmar contractures of one (n=24) or both (n=29) hands. Surgical release and skin grafting were performed for a total of 82 hands. Full-thickness skin grafts from the groin area were used in mild cases, and thick split-thickness skin grafts harvested from the thigh were used in severe contractures. Graft take ranged from 90 to 100% "take" in all patients. Follow-up ranged from 6 months to 10 years. Recurrence of contracture was calculated for 30 children (52 grafted hands) who had follow-up for more than 5 years. Twenty hands (group I) had thick split-thickness skin grafts, and 10 (50%) of these required a second release and grafting procedure. The remaining 32 hands (group II) had full-thickness grafts and only 3 (9.4%) required a second release and grafting procedure. The difference was statistically significant (P=.003), indicating that group I are more likely to require secondary surgery on long-term follow-up.

  16. Increased expression of three types of transient receptor potential channels (TRPA1, TRPV4 and TRPV3) in burn scars with post-burn pruritus.

    PubMed

    Yang, Yoon Seok; Cho, Soo Ick; Choi, Min Gyu; Choi, Young Hee; Kwak, In Suk; Park, Chun Wook; Kim, Hye One

    2015-01-01

    Post-burn pruritus is a common distressing consequence of burn wounds. Empirical treatment often fails to have a satisfactory outcome on post-burn pruritus, as the mechanism of post-burn pruritus has not been fully elucidated. The aim of this study was to evaluate the manifestation of transient receptor potential (TRP) channels in post-burn pruritus. Fifty-one burn patients with (n=33) or without (n=18) pruritus were investigated, including skin biopsies. Not unexpectedly, the scarred body area was larger in the former group. In immunohistochemistry, TPRV3 was significantly elevated in the epidermis of burn scars with pruritus. Furthermore, real time- PCR showed that mRNA of TRPA1 and TRPV4 was increased in itching burn scars. Staining for substance P and CGRP did not differ between the 2 grouped, but the former neuropeptide was increased in burn scars. These results may help determine a specific therapeutic approach for post-burn pruritus.

  17. Impact of facial burns: relationship between depressive symptoms, self-esteem and scar severity.

    PubMed

    Hoogewerf, Cornelis Johannes; van Baar, Margriet Elisabeth; Middelkoop, Esther; van Loey, Nancy Elisa

    2014-01-01

    This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale, the Rosenberg Self-esteem Scale and the Hospital Anxiety and Depression Scale. Structural Equation Modeling was used to assess the relations between depressive symptoms, self-esteem and scar severity. The model showed that patient-rated facial scar severity was not predictive for self-esteem and depressive symptoms six months post-burn. There was, however, a significant relationship between early depressive symptoms and both patient-rated facial scar severity and subsequent self-esteem. The variables in the model accounted for 37% of the variance in depressive symptoms six months post-burn and the model provided a moderately well-fitting representation of the data. The study suggests that self-esteem and depressive symptoms were not affected by self-reported facial scar severity but that earlier depressive symptoms were indicative for a more severe self-reported facial scar rating. Therefore, routine psychological screening during hospitalisation is recommended in order to identify patients at risk and to optimise their treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable?

    PubMed

    Lye, Ian; Edgar, Dale W; Wood, Fiona M; Carroll, Sara

    2006-01-01

    Objective measurement of burn scar response to treatment is important to facilitate individual patient care, research, and service development. This work examines the validity and reliability of the tonometer as a means of quantifying scar pliability. Ten burn survivors were recruited into the study. Triplicate measures were taken for each of four scar and one normal skin point. The pliability score from the Vancouver Scar Scale also was used as a comparison. The tonometer demonstrated a high degree of reliability (intraclass correlation coefficients 0.91-0.94). It also was shown to provide a valid measure of pliability by quantifying decreased tissue deformation for scar (2.04 +/- 0.45 mm) compared with normal tissue (3.02 +/- 0.92 mm; t = 4.28, P = .004) and a moderate correlation with Vancouver Scar Scale scores. The tissue tonometer provides a repeatable, objective index of burn scar pliability. Using the methods described, it is a simple, clinically useful technique for monitoring an individual's scar.

  19. Fat Grafting in Burn Scar Alleviates Neuropathic Pain via Anti-Inflammation Effect in Scar and Spinal Cord

    PubMed Central

    Huang, Shu-Hung; Wu, Sheng-Hua; Lee, Su-Shin; Chang, Kao-Ping; Chai, Chee-Yin; Yeh, Jwu-Lai; Lin, Sin-Daw; Kwan, Aij-Lie; David Wang, Hui-Min; Lai, Chung-Sheng

    2015-01-01

    Burn-induced neuropathic pain is complex, and fat grafting has reportedly improved neuropathic pain. However, the mechanism of fat grafting in improving neuropathic pain is unclear. Previous investigations have found that neuroinflammation causes neuropathic pain, and anti-inflammatory targeting may provide potential therapeutic opportunities in neuropathic pain. We hypothesized that fat grafting in burn scars improves the neuropathic pain through anti-inflammation. Burn-induced scar pain was confirmed using a mechanical response test 4 weeks after burn injuries, and autologous fat grafting in the scar area was performed simultaneously. After 4 weeks, the animals were sacrificed, and specimens were collected for the inflammation test, including COX-2, iNOS, and nNOS in the injured skin and spinal cord dorsal horns through immunohistochemistry and Western assays. Furthermore, pro-inflammatory cytokines (IL-1 β and TNF-α) in the spinal cord were collected. Double immunofluorescent staining images for measuring p-IκB, p-NFκB, p-JNK, and TUNEL as well as Western blots of AKT, Bax/Bcl-2 for the inflammatory process, and apoptosis were analyzed. Fat grafting significantly reduced COX2, nNOS, and iNOS in the skin and spinal cord dorsal horns, as well as IL-1β and TNF-α, compared with the burn group. Moreover, regarding the anti-inflammatory effect, the apoptosis cells in the spinal cord significantly decreased after the fat grafting in the burn injury group. Fat grafting was effective in treating burn-induced neuropathic pain through the alleviation of neuroinflammation and ameliorated spinal neuronal apoptosis. PMID:26368011

  20. A novel approach to ablative fractional treatment of mature thermal burn scars.

    PubMed

    Bowen, Robert E

    2010-04-01

    This report details the use of a fractionated ablative Er:YAG laser in treating two cases of thermal burn injuries using a novel approach which matches the energy required to the depth of the burn scar. This method is termed "selective objective fractional technique (SOFT)".

  1. Lower-extremity burn reconstruction in the child.

    PubMed

    Barbour, John R; Schweppe, Mark; O, Seung-Jun

    2008-07-01

    Lower-extremity burns in a pediatric patient require special consideration. The management of burn reconstruction in pediatric patients is often complex, requiring multiple reconstructive operations, and the primary intention of the surgeon is to prevent burn scar deformities. Timely management of the burn wound and postburn scars has decreased the incidence of burn scar deformities and contractures of the lower extremity in recent years. We present an overview of the principles of reconstruction techniques using skin grafting and biologic skin substitutes to restore the important barrier lost secondary to burns. In addition, we address methods of repairing scar contracture, a common occurrence in burn patients, at specific locations on the lower extremity. Finally, special scenarios such as burns associated with fractures, burn injury in insensate children, and Marjolin ulcer are discussed.

  2. The evidence for natural therapeutics as potential anti-scarring agents in burn-related scarring.

    PubMed

    Mehta, M; Branford, O A; Rolfe, K J

    2016-01-01

    Though survival rate following severe thermal injuries has improved, the incidence and treatment of scarring have not improved at the same speed. This review discusses the formation of scars and in particular the formation of hypertrophic scars. Further, though there is as yet no gold standard treatment for the prevention or treatment of scarring, a brief overview is included. A number of natural therapeutics have shown beneficial effects both in vivo and in vitro with the potential of becoming clinical therapeutics in the future. These natural therapeutics include both plant-based products such as resveratrol, quercetin and epigallocatechin gallate as examples and includes the non-plant-based therapeutic honey. The review also includes potential mechanism of action for the therapeutics, any recorded adverse events and current administration of the therapeutics used. This review discusses a number of potential 'treatments' that may reduce or even prevent scarring particularly hypertrophic scarring, which is associated with thermal injuries without compromising wound repair.

  3. Predicting fire scars in Ozark timber species following prescribed burning

    Treesearch

    Aaron P. Stevenson; Richard P. Guyette; Rose-Marie Muzika

    2009-01-01

    A potential consequence of using prescribed fire is heat-related injury to timber trees. Scars formed following fire injuries are often associated with extensive decay in hardwoods. The ability to predict scarring caused by prescribed fire is important when multiple management goals are incorporated on a single forest site.

  4. Flexion contractures of fingers: contracture elimination with trapeze-flap plasty.

    PubMed

    Grishkevich, V M

    2011-02-01

    Scar flexion contracture of fingers is one of the most serious consequences of hand burns and patient disability after burn. Many kinds of reconstructive techniques are currently used and new procedures are being investigated. The author presents a new method of finger contracture reconstruction developed in the process of burn reconstructive operations on hands of over a thousand patients. Finger flexion contractures are caused by a semilunar fold, both sheets of which are scars. The sheets have a surface deficiency in length, which causes a contracture, and excess of skin in width, which allows contracture elimination with local flaps. The length deficiency extends from the crest of the fold to the joint rotation axis and has a trapezoid form. To compensate for skin deficiency and to address the contracture, it is necessary to convert both fold sheets into trapezoid flaps by radial incisions. Because the fold is of semilunar (crescent) shape, the flaps accept a trapezoid form. One or several pairs of the flaps are mobilized with the split fat layer from the fold's crest to the joint rotation axis level. The oppositely transposed flaps fully or partially cover the wound in the proximal interphalangeal (PIP) zone first. The remaining smaller wounds are covered with full-thickness skin grafts. The flaps have a reliable blood circulation; partial flap loss is an exception. The flap's surface does not decrease, the skin grafts shrink insufficiently, and the distant results, as a rule, are good. Two hundred and seventy-five patients were operated upon. Scar contractures were satisfactorily addressed in all patients. Incomplete extension was found in 46 patients; this was caused by interphalangeal joint injuries (ligaments, capsule, cartilage), ankylosis or boutonniere deformity.

  5. [A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS].

    PubMed

    Gao, Yashan; Zan, Tao; Li, Haizhou; Li, Qingfeng

    2015-09-01

    To study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. A total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and pre-expanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. The patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). Pre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.

  6. Incidences of malignancy in chronic burn scar ulcers: experience from Bangladesh.

    PubMed

    Das, Kishore Kumar; Chakaraborty, Anjana; Rahman, Ashrafur; Khandkar, Sazzad

    2015-09-01

    Malignant transformation on any scar tissue is known as Marjolin's ulcer. Most cases of Marjolin's ulcer reported so far occur in post-burn scars but not all ulcers that occur in post-burn scar are malignant. One hundred and forty cases of chronic non-healing ulcers in post-burn scar were included in this prospective observational study. The study was conducted in the Department of Burn and Plastic Surgery Unit of Dhaka Medical College Hospital. Mean age of the patients was 40.63±18.44 with a range from 12 to 75 years. Two third of the patients were male. All patients underwent excision biopsy and coverage with either split thickness skin graft or flap. Histopathological analysis of the resected specimen revealed malignancy in 46 cases and pseudoepitheliomatous hyperplasia in four cases and verruca plantaris in one case. The rest of the cases were chronic non-healing benign ulcers. All 46 cases of Marjolin's ulcer were squamous cell carcinoma with a mean latency period of 26.73 years. The commonest site of chronic ulcer was in the lower extremities (n-80, 57%), and malignancy was also found to be more common there (n-18). The most common type of burn was flame burn (68.57%). The Marjolin's ulcers were significantly larger in size than benign ulcers, and were mostly exophytic or ulcerative in appearance whereas benign ulcers were mostly flat. A non-healing ulcer in a post-burn scar should be addressed promptly because of its potential to develop into a malignant ulcer. Emphasis should be given to early surgical treatment of deep partial to full thickness burns to prevent scar formation, particularly over joints, and thus reduce the risk of development of Marjolin's ulcer.

  7. Effect of intense pulsed light on immature burn scars: A clinical study

    PubMed Central

    Sarkar, Arindam; Dewangan, Yatindra Kumar; Bain, Jayanta; Rakshit, Pritha; Dhruw, Krishnanand; Basu, Sandip Kanti; Saha, Jayanta Kumar; Majumdar, Bijay Kumar

    2014-01-01

    Introduction: As intense pulsed light (IPL) is widely used to treat cutaneous vascular malformations and also used as non-ablative skin rejunuvation to remodel the skin collagen. A study has been undertaken to gauze the effect of IPL on immature burn scars with regard to vascularity, pliability and height. Materials and Methods: This study was conducted between June 2013 and May 2014, among patients with immature burn scars that healed conservatively within 2 months. Photographic evidence of appearance of scars and grading and rating was done with Vancouver Scar Scale parameters. Ratings were done for both case and control scar after the completion of four IPL treatment sessions and were compared. Results: Out of the 19 cases, vascularity, pliability and height improved significantly (P < 0.05) in 13, 14 and 11 scars respectively following IPL treatment. Conclusions: Intense pulsed light was well-tolerated by patients, caused good improvement in terms of vascularity, pliability, and height of immature burn scar. PMID:25593424

  8. Evidence based management for paediatric burn: new approaches and improved scar outcomes.

    PubMed

    Kishikova, Lyudmila; Smith, Matthew D; Cubison, Tania C S

    2014-12-01

    Little evidence has been produced on the best practice for managing paediatric burns. We set out to develop a formal approach based on the finding that hypertrophic scarring is related to healing-time, with durations under 21 days associated with improved scar outcome. Incorporating new advances in burn care, we compared outcomes under the new approach to a cohort treated previously. Our study was a retrospective cross-sectional case note study, with demographic, treatment and outcome information collected. The management and outcome of each case was assessed and compared against another paediatric burns cohort from 2006. 181 burns presenting across a six month period were analysed (2010 cohort) and compared to 337 children from a previous cohort from 2006. Comparison of patients between cohorts showed an overall shift towards shorter healing-times in the 2010 cohort. A lower overall rate of hypertrophic scarring was seen in the 2010 cohort, and for corresponding healing-times after injury, hypertrophic scarring rates were halved in comparison to the 2006 cohort. We demonstrate that the use of a structured approach for paediatric burns has improved outcomes with regards to healing-time and hypertrophic scarring rate. This approach allows maximisation of healing potential and implements aggressive prophylactic measures. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  9. Suppression of scar formation in a murine burn wound model by the application of non-thermal plasma

    NASA Astrophysics Data System (ADS)

    Hoon Lee, Dae; Lee, Jae-Ok; Jeon, Wonju; Choi, Ihn-Geun; Kim, Jun-Sub; Hoon Jeong, Je; Kang, Tae-Cheon; Hoon Seo, Cheong

    2011-11-01

    Suppression of hypertrophic scar generation in an animal model by treatment with plasma is reported. Contact burn following mechanical stretching was used to induce scar formation in mice. Exposure to the plasma tended to reduce the scar area more rapidly without affecting vitality. The treatment resulted in decreased vascularization in the scar tissue. Plasma-treated scars showed mild decrease in the thickness of hypertrophic tissues as shown by histological assessment. Finally, we showed that plasma treatment induced cell death and reactive oxygen species generation in hypertrophic scar fibroblast. All of the results support that plasma treatment can control scar generation.

  10. Patient experiences of burn scars in adults and children and development of a health-related quality of life conceptual model: A qualitative study.

    PubMed

    Simons, Megan; Price, Nathaniel; Kimble, Roy; Tyack, Zephanie

    2016-05-01

    The aim of this study was to understand the impact of burn scars on health-related quality of life (HRQOL) from the perspective of adults and children with burn scars, and caregivers to inform the development of a conceptual model of burn scar HRQOL. Twenty-one participants (adults and children) with burn scars and nine caregivers participated in semi-structured, face-to-face interviews between 2012 and 2013. During the interviews, participants were asked to describe features about their (or their child's) burn scars and its impact on everyday life. Two coders conducted thematic analysis, with consensus achieved through discussion and review with a third coder. The literature on HRQOL models was then reviewed to further inform the development of a conceptual model of burn scar HRQOL. Five themes emerged from the qualitative data: 'physical and sensory symptoms', 'impact of burn scar interventions', 'impact of burn scar symptoms', 'personal factors' and 'change over time'. Caregivers offered further insights into family functioning after burn, and the impacts of burn scars and burn scar interventions on family life. In the conceptual model, symptoms (sensory and physical) of burn scars are considered proximal to HRQOL, with distal indicators including functioning (physical, emotional, social, cognitive), individual factors and the environment. Overall quality of life was affected by HRQOL. Understanding the impact of burn scars on HRQOL and the development of a conceptual model will inform future burn scar research and clinical practice. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  11. Social challenges of visible scarring after severe burn: A qualitative analysis.

    PubMed

    Martin, Lisa; Byrnes, Michelle; McGarry, Sarah; Rea, Suzanne; Wood, Fiona

    2017-02-01

    Visible scarring after burn causes social challenges which impact on interpersonal connection. These have health impacts which may worsen outcomes for burn patients and reduce the potential for posttraumatic growth (PTG). The aim of the study was to investigate adult burn survivors' experiences of interpersonal relationships as potential barriers to posttraumatic recovery following hand or face burns. This qualitative study explored patient experiences of interpersonal situations. A purposive sample (n=16) who had visible burn scarring were interviewed more than two years after their burn. Emotional barriers included the fear of rejection, feelings of self-consciousness, embarrassment and humiliation. Situational barriers included inquisitive questions, comments and behaviours of others. Responses depended on the relationship with the person, how they were asked and the social situation. Active coping strategies included positive reframing, humour, changing the self, and pre-empting questions. Avoidant coping strategies included avoidance of eye contact, closed body language, hiding scars, and learning to shut down conversations. Emotional and situational barriers reduced social connection and avoidant coping strategies reduced the interaction of people with burns with others. Active coping strategies need to be taught to assist with social reintegration. This highlights the need for peer support, family support and education, and social skills training. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  12. Frequent p53 gene mutations in soft tissue sarcomas arising in burn scar.

    PubMed

    Nakanishi, H; Tomita, Y; Yoshikawa, H; Sato, N; Ochi, T; Aozasa, K

    1999-03-01

    Squamous cell carcinoma (SCC) is the commonest malignancy that arises in burn scars, which frequently contain p53 mutations. Soft tissue sarcoma (STS) also develops, though less frequently, in burn scars. p53 gene mutations were analyzed in paraffin-embedded specimens from 5 patients with STS (4 males and 1 female) that had arisen in a burn scar, by means of polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) followed by direct sequencing. Age at burn injury ranged from 2 to 10 (median 3) years, and STS developed with a latent period ranging from 29 to 79 (median 60) years. Histologically, all were malignant fibrous histiocytoma. The PCR-SSCP revealed aberrant bands in 4 (80%) of 5 cases. Direct sequencing revealed a total of 11 mutations in these 4 cases: 1 case had a single mutation, 1 had 2 mutations, and 2 had 4 mutations. Every tumor had at least 1 mutation that changed an amino acid, which may have provided the selection pressure for expansion. Thus, there is a high frequency of p53 gene mutations in STS appearing in burn scars. p53 mutations were also frequent in pyothorax-associated lymphoma (PAL), a lymphoma that develops in patients with long-standing pyothorax, so p53 mutations might be frequent in malignancies that develop in chronic inflammatory sites.

  13. Measuring the impact of burn scarring on health-related quality of life: Development and preliminary content validation of the Brisbane Burn Scar Impact Profile (BBSIP) for children and adults.

    PubMed

    Tyack, Zephanie; Ziviani, Jenny; Kimble, Roy; Plaza, Anita; Jones, Amber; Cuttle, Leila; Simons, Megan

    2015-11-01

    No burn-scar specific, health-related quality of life (HRQOL) measure exists. This study aimed to develop a patient-reported, evaluative HRQOL measure to assess the impact of burn scarring in children and adults. Semi-structured interviews, content validation surveys, and cognitive interviews were used to develop and test content validity of a new measure - the Brisbane Burn Scar Impact Profile (BBSIP). Participants comprised Australian adults (n=23) and children (n=19) with burn scarring; caregivers of children with burn scarring (n=28); and international scar management experts (n=14). Items distinct from other burn scar measures emerged. Four versions of the BBSIP were developed; one for children aged 8-18 years, one for adults, one for caregivers (as proxies for children aged less than 8-years), and one for caregivers of children aged 8-18 years. Preliminary content validity of the BBSIP was supported. Final items covered physical and sensory symptoms; emotional reactions; impact on social functioning and daily activities; impact of treatment; and environmental factors. The BBSIP was developed to assess burn-scar specific HRQOL and will be available at http://www.coolburns.com.au under a creative commons license. Further testing is underway. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  14. Effect of 'Compound R' on thermal burn and full-depth wound contracture in fuzzy rats.

    PubMed

    Noormohamed, S E; Ray, T

    1998-01-01

    We evaluated the efficacy of Compound R emulsion on wound contraction in fuzzy rats. While the rats were under anesthesia, two mirror-image burn wounds were inflicted on the depilated back skin of each. Wounds were assigned randomly to treatment or placebo (oil), and the wound-scar areas were measured when they healed. A second set of wounds was created by taking two 6 millimeter punch biopsies from each rat and treated with Compound R or placebo. Under anesthesia, areas of the wound were measured on days 0, 5, 8 and on healing. Mean+/-SE areas for the healed burn wounds were: 151+/-24 mm2 for the treated and 102+/-26 mm2 for the placebo side (paired Student's t test, t=4.21, p=0.0015). Areas for Compound R-treated punch biopsy-induced wounds were significantly larger than placebo treated at each time point (p < 0.01). Results from this study show that Compound R impeded wound contraction.

  15. Wildfires, smoke, and burn scars, near Yakutsk, Russia

    NASA Technical Reports Server (NTRS)

    2002-01-01

    The Lena River in central Siberia is hidden beneath a veil of smoke from multiple wildfires burning around the city of Yakutsk, Russia. Fires have been burning in the region off and on since late May 2002, and may be agricultural in cause. This image was acquired by the Moderate Resolution Imaging Spectroradiometer (MODIS) on the Terra satellite on July 23, 2002. In the false=-color image, vegetation is bright green, smoke is blueish-white, and burned areas are reddish-brown. In both images, fire detections are marked with red outlines. Credit: Jacques Descloitres, MODIS Land Rapid Response Team, NASA/GSFC

  16. The effects of conservative treatments on burn scars: A systematic review.

    PubMed

    Anthonissen, Mieke; Daly, Daniel; Janssens, Thaïs; Van den Kerckhove, Eric

    2016-05-01

    A variety of conservative treatments for burn scars are available, but there is no clear consensus on the evidence. The purpose of this study was to summarize the available literature on the effects of conservative treatments of burn scars in adults. RCTs and CCTs were sought in three databases, reference lists of retrieved articles and relevant reviews. The Scottish Intercollegiate Guidelines Network scoring system was used to assess the quality of the selected studies. Information on the study characteristics, results and interventions was extracted. Twenty-two articles were included into the review and categorized in six topics: 5 on massage therapy, 4 on pressure therapy, 6 on silicone gel application, 3 on combined therapy of pressure and silicone, 3 on hydration and 1 on ultrasound. Pressure and silicone therapy are evidence-based conservative treatments of hypertrophic scar formation after a burn producing clinically relevant improvement of scar thickness, redness and pliability. Massage therapy could have a positive result on scar pliability, pain and pruritus, but with less supporting evidence. The use of moisturizers and lotions could have an effect on itching, but the findings are contradictory. Of all other non-invasive treatments such as splinting, casting, physical activity, exercise and mobilizations no RCTs or CCTs were found. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  17. ICG angiography predicts burn scarring within 48 h of injury in a porcine vertical progression burn model.

    PubMed

    Fourman, Mitchell S; McKenna, Peter; Phillips, Brett T; Crawford, Laurie; Romanelli, Filippo; Lin, Fubao; McClain, Steve A; Khan, Sami U; Dagum, Alexander B; Singer, Adam J; Clark, Richard A F

    2015-08-01

    The current standard of care in determining the need to excise and graft a burn remains with the burn surgeon, whose clinical judgment is often variable. Prior work suggests that minimally invasive perfusion technologies are useful in burn prognostication. Here we test the predictive capabilities of Laser Doppler Imaging (LDI) and indocyanine green dye (ICG) angiography in the prediction of burn scarring 28 days after injury using a previously validated porcine burn model that shows vertical progression injury. Twelve female Yorkshire swine were burned using a 2.5 × 2.5 cm metal bar at variable temperature and application times to create distinct burn depths. Six animals (48 injuries total) each were analyzed with LDI or ICG angiography at 1, 24, 48, and 72 h following injury. A linear regression was then performed correlating perfusion measurements against wound contraction at 28 days after injury. ICG angiography showed a peak linear correlate (r(2)) of .63 (95% CI .34 to .92) at 48 h after burn. This was significantly different from the LDI linear regression (p < .05), which was measured at r(2) of .20 (95% CI .02 to .39). ICG angiography linear regression was superior to LDI at all timepoints. Findings suggest that ICG angiography may have significant potential in the prediction of long-term burn outcomes.

  18. [Cancers in the scars of thermal burns (apropos of 67 cases)].

    PubMed

    Kasse, A A; Betel, E; Dem, A; Diop, M; Fall, M C; Diop, P S; Dembele, B; Drabo, B; Timbely, G; Neloum, J; Toure, P

    1999-01-01

    Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes

  19. Crocodile oil enhances cutaneous burn wound healing and reduces scar formation in rats.

    PubMed

    Li, Hua-Liang; Chen, Li-Ping; Hu, Yong-Hua; Qin, Yan; Liang, Ge; Xiong, You-Xiong; Chen, Qing-Xi

    2012-03-01

    This study was performed to evaluate the burn wound-healing efficacy of crocodile oil from Crocodylus siamensis by employing deep second-degree burns in a Wistar rat model. Twenty-four rats were assigned equally into four groups using a random-number table, and two burns were created on the dorsum of each animal except for the sham group. The three treatment groups received with saline solution (12 burns, served as negative control), silver sulfadiazine (12 burns, served as positive control), or crocodile oil (12 burns). Silver sulfadiazine cream was used as standard care, and the treatments were repeated twice daily for 28 days. After day 28 the animals were euthanized and the wounds were removed for quantitative real-time polymerase chain reaction, histologic, and immunohistochemical study. Crocodile oil accelerated the wound-healing process as indicated by a significant decrease in wound closure time in comparison to the burn control and silver sulfadiazine treatment groups. Histologic results showed well-organized and distributed skin structure and collagen deposition in the animals treated with crocodile oil. Transforming growth factor-β1 (TGF-β1), a key cytokine promoting scarring, was also observed to play a role in the burn wound healing. Immunohistochemical staining results showed the negative expression of TGF-β1 and Smad3 in the 28-days-postburn skin of crocodile oil group versus positive in the epidermis of burn controls. Compared to the burn control group, expressions of TGF-β1 and Smad3 mRNA decreased significantly (p < 0.01) in the 28-days-postburn skin of the crocodile oil group. Our results showed that crocodile oil could enhance cutaneous burn wound healing and reduce scar formation in rats, which might be related to TGF-β1/Smad3 signaling. © 2012 by the Society for Academic Emergency Medicine.

  20. [Effectiveness of scar split thickness skin graft combined with acellular allogeneic dermis in treatment of large deep II degree burn scar].

    PubMed

    Cui, Zelong; Yang, Xiaohui; Shou, Jiabao; Wang, Guangyi

    2014-12-01

    To investigate the feasibility and effectiveness of using scar split thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep II degree burn scar. Between January 2013 and December 2013, 20 cases of large deep II degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar split thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar split thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound healing; and all patients underwent regular rehabilitation exercises. No significant difference was found in wound healing, infection, and healing time between 2 groups (P > 0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23 ± 1.41 in trial group and was 10.17 ± 2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). A combination of scar split thickness skin

  1. Scar outcome of children with partial thickness burns: A 3 and 6 month follow up.

    PubMed

    Gee Kee, E L; Kimble, R M; Cuttle, L; Stockton, K A

    2016-02-01

    There is a paucity of research investigating the scar outcome of children with partial thickness burns. The aim of this study was to assess the scar outcome of children with partial thickness burns who received a silver dressing acutely. Children aged 0-15 years with an acute partial thickness burn, ≤10% TBSA were included. Children were originally recruited for an RCT investigating three dressings for partial thickness burns. Children were assessed at 3 and 6 months after re-epithelialization. 3D photographs were taken of the burn site, POSAS was completed and skin thickness was measured using ultrasound imaging. Forty-three children returned for 3 and 6 month follow-ups or returned a photo. Days to re-epithelialization was a significant predictor of skin/scar quality at 3 and 6 months (p<0.01). Patient-rated color and observer-rated vascularity and pigmentation POSAS scores were comparable at 3 months (color vs. vascularity 0.88, p<0.001; color vs. pigmentation 0.64, p<0.001), but patients scored higher than the observer at 6 months (color vs. vascularity 0.57, p<0.05; color vs. pigmentation 0.15, p=0.60). Burn depth was significantly correlated with skin thickness (r=0.51, p<0.01). Hypopigmentation of the burn site was present in 25.8% of children who re-epithelialized in ≤ 2 weeks. This study has provided information on outcomes for children with partial thickness burns and highlighted a need for further education of this population. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  2. East Peak Fire Burn Scar, Colorado [high res

    NASA Image and Video Library

    2017-09-27

    On June 22, 2013, the Operational Land Imager (OLI) on Landsat 8 captured this false-color image of the East Peak fire burning in southern Colorado near Trinidad. Burned areas appear dark red, while actively burning areas look orange. Dark green areas are forests; light green areas are grasslands. Lightning ignited the blaze on June 19, 2013. By June 25, it had burned nearly 13,500 acres (5,500 hectares). NASA Earth Observatory image by Jesse Allen and Robert Simmon, using Landsat data from the U.S. Geological Survey. Caption by Adam Voiland. Instrument: Landsat 8 - OLI More images from this event: 1.usa.gov/14DesQC Credit: NASA Earth Observatory NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

  3. A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars

    PubMed Central

    Żądkowski, Tomasz; Nachulewicz, Paweł; Mazgaj, Maciej; Woźniak, Magdalena; Cielecki, Czesław; Wieczorek, Andrzej Paweł; Beń-Skowronek, Iwona

    2016-01-01

    Abstract Treatment of hypertrophic scars arising as a result of thermal burns in children is still a big problem. The results of the treatment are not satisfactory for patients and parents, and new methods of treatment are still investigated. We present the use of one of the most modern carbon dioxide (CO2) lasers (Lumenis Encore laser equipped with a Synergistic Coagulation and Ablation for Advanced Resurfacing module) in the treatment of hypertrophic scars in children after burns. From March to April of 2013, a group of 47 patients aged 6 to 16 years underwent 57 laser surgery treatments. The average time from accident was 7.5 years. The results of treatment were investigated in 114 areas. The assessed areas were divided into 2 groups: 9-cm2 area 1, where the thickness of the scar measured by physician was the lowest and 9-cm2 area 2, where the thickness of the scar was the biggest. The results were considered on the Vancouver Scar Scale (VSS) independently by the surgeon and by parents 1, 4, and 8 months after the procedure. In addition, ultrasound evaluation of the scar thickness before and after laser procedure was made. VSS total score improved in all areas assessed by both the physician and parents. The biggest change in total VSS score in area 1 in the evaluation of the investigator was obtained at follow-up after the 1st month of treatment (average 7.23 points before and 5.18 points after the 1st month after surgery—a difference of 2.05 points). Scar ratings by parents and the physician did not differ statistically (P < 0.05). In the ultrasound assessment, the improvement was statistically significant, more frequently for both minimum and maximum thickness of the scars (B-mode measures) (P < 0.05). The use of a CO2 laser in the treatment of hypertrophic scars in children is an effective and safe method. The use of a CO2 laser improves the appearance and morphology of scarring assessed using the VSS by both the parents and the physician. The

  4. Reconstructive Surgery of Extensive Face and Neck Burn Scars Using Tissue Expanders

    PubMed Central

    Ashab Yamin, Mohammad Reza; Mozafari, Naser; Mozafari, Mohadase; Razi, Zahra

    2015-01-01

    BACKGROUND Neck reconstruction is considered as one of the most important surgeries in cosmetic and reconstructive surgery. The present study aimed to assess the results of reconstructive surgery of extensive face and neck burning scars using tissue expanders. METHODS This descriptive prospective study was conducted on 36 patients with extensive burning scars on the neck and face. Operation for tissue expander insertion was performed and tissue distension started two or three weeks later, depending on the patients’ incisions. After sufficient time for tissue expansion, while removing the expander and excision of the lesion, the expanded flap was used to cover the lesion. Overall, 43 cosmetic surgeries were done. RESULTS Rectangular expanders were employed in most patients (73.81%) and were located in the neck in most of them (60.78%). Complications were detected in five patients (13.89%), with exposure of the prosthesis being the most common one. Scar tissues at the reconstruction site and the flap donor site were acceptable in 94.44% and 98.18% of the cases, respectively. Overall, most of the patients (77.78%) were satisfied with the operation results.  CONCLUSION Using tissue expanders in tissue reconstruction of extensive neck and facial burning scars results in highly desirable outcomes. PMID:25606476

  5. The burned hand. Early treatment and surgery of scars and contractions.

    PubMed

    Asko-Seljavaara, S; Kilpi, M L; Hytönen, M; Sundell, B

    1980-01-01

    Hand burns are common injuries in which early accurate diagnosis of the severity of the injury and active surgical treatment can save it or diminish the permanent disability caused by the thermal trauma. During the four year period of 1976--1979 we treated 45 patients with acute hand burns; secondary surgery was performed in 29 scarred and contracted hands. Deep dermal or subdermal (III degree) burns were either immediately excised to the vital tissue (within 6 hr postburn) or early afterwards (within 1--7 days post injury). The reconstruction of the excised areas was made by free skin grafting in 43 hands. If deep structures were exposed, subsequent reconstructions were used: local, groin, or free flaps. The aims in treatment of scarred hands were to restore function and to repair unstable scars. The following secondary procedures, often combined in a one-stage operation, were performed: scar excision and regrafting, web space correction, groin flap reconstruction, digital joint arthrodesis or capsulectomy, tendon transfer, and spherical osteotomy.

  6. Immediate tangential excision accelerates wound closure but does not reduce scarring of mid-dermal porcine burns

    PubMed Central

    Macri, L.K..; Singer, A.J.; McClain, S.A.; Crawford, L.; Prasad, A.; Kohn, J.; Clark, R.A.F.

    2016-01-01

    Summary Current evidence supports the use of excision to remove eschar from deep dermal and full-thickness burns. However, the role of excision of mid-dermal burns remains unclear. This study aimed to develop a porcine model that could produce reproducible middermal thermal burns that undergo tangential excision; and investigate the effects of immediate tangential excision (30 minutes postburn) on healing and scarring. An aluminum bar preheated in hot water (70°C) was applied for 20 or 30 s to produce a total of sixteen mid-dermal burns per pig on each of six pigs. Thirty minutes after burn creation, half of the burns were tangentially excised. Four partial- thickness wounds per pig were created as controls. Depth of burn injury (1 and 24 h), reepithelialization (7 and 10 d) and scar depth (28 d) were assessed microscopically. Total scar surface area was grossly evaluated on day 28. Exposure of porcine skin to a preheated aluminum bar at 70 °C for 20 or 30 sec resulted in reproducible mid-dermal burns, where immediate excision enhanced complete wound closure as judged by complete re-epithelialization, but did not reduce initial depth of injury, scar contraction and scar depth. Immediate surgical intervention is sufficient to enhance wound closure, but not to mitigate mid-dermal burn scar formation. This work provides a suitable animal model to evaluate novel therapies that may be used to inhibit burn progression, accelerate wound closure and decrease scarring, especially those therapies unable to penetrate burn eschar. PMID:27857653

  7. Immediate tangential excision accelerates wound closure but does not reduce scarring of mid-dermal porcine burns.

    PubMed

    Macri, L K; Singer, A J; McClain, S A; Crawford, L; Prasad, A; Kohn, J; Clark, R A F

    2016-03-31

    Current evidence supports the use of excision to remove eschar from deep dermal and full-thickness burns. However, the role of excision of mid-dermal burns remains unclear. This study aimed to develop a porcine model that could produce reproducible middermal thermal burns that undergo tangential excision; and investigate the effects of immediate tangential excision (30 minutes postburn) on healing and scarring. An aluminum bar preheated in hot water (70°C) was applied for 20 or 30 s to produce a total of sixteen mid-dermal burns per pig on each of six pigs. Thirty minutes after burn creation, half of the burns were tangentially excised. Four partial- thickness wounds per pig were created as controls. Depth of burn injury (1 and 24 h), reepithelialization (7 and 10 d) and scar depth (28 d) were assessed microscopically. Total scar surface area was grossly evaluated on day 28. Exposure of porcine skin to a preheated aluminum bar at 70 °C for 20 or 30 sec resulted in reproducible mid-dermal burns, where immediate excision enhanced complete wound closure as judged by complete re-epithelialization, but did not reduce initial depth of injury, scar contraction and scar depth. Immediate surgical intervention is sufficient to enhance wound closure, but not to mitigate mid-dermal burn scar formation. This work provides a suitable animal model to evaluate novel therapies that may be used to inhibit burn progression, accelerate wound closure and decrease scarring, especially those therapies unable to penetrate burn eschar.

  8. Identification of Cutaneous Functional Units Related to Burn Scar Contracture Development

    DTIC Science & Technology

    2009-08-01

    documented forearm skin movement associ- ated with wrist extension. The purpose of this study was to expand the identification of skin movement associated...excluded if they had a history of skin disease or orthopedic conditions affecting joint ROM. Demo- graphic and anthropometric measurements were re- corded as...2.5 cm) spaced markings were placed on the ventral arm, dorsal forearm , and hand as well as the posterior thigh and leg. The test areas and asso

  9. Psychopathology and psychological problems in patients with burn scars: epidemiology and management.

    PubMed

    Van Loey, Nancy E E; Van Son, Maarten J M

    2003-01-01

    Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy

  10. Treatment of cervical contractures utilising a closed platysmotomy like approach: Case report and review of the literature.

    PubMed

    Haik, Josef; Prat, Daphna; Kornhaber, Rachel; Tessone, Ariel

    2016-09-01

    Contractures to the cervical region as a result of burns has the capacity to cause restrictions in range of movement, function of the lower face, cervical spine distortion and poor aesthetic outcomes that remain a surgical challenge. Consequently, physical and aesthetic deformities as a result of cervical contractures are reported to cause depression having implications for patients' quality of life and psychosocial wellbeing. At the time this research was conducted, there were no case reports describing a closed platysmotomy approach in burn patients. In this article, we review the literature surrounding closed platysmotomies and present what we believe to be the first reported case in the treatment of cervical contractures utilising a closed platysmotomy approach in a burns patient. A closed platysmotomy approach for the treatment of cervical contractures is a less invasive technique. Further investigation is warranted to determine the feasibility of this reconstructive approach in the area of burn scar management.

  11. Logistics of building a laser practice for the treatment of hypertrophic burn scars.

    PubMed

    Hultman, Charles Scott; Edkins, Renee E; Cairns, Bruce A; Meyer, Anthony A

    2013-05-01

    Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars. We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light. Cases were performed in an operating room, with anesthesia, after preauthorization. We examined professional charges and collections, case time, variable and indirect expenses, and breakeven volumes. Our practice grew as follows: 2008, 1 case; 2009, 44 cases; 2010, 169 cases; and 2011, 415 cases. Overall collection rate was 32.1%. Expenses incurred by the provider, per 8-hour session, included laser rental/lease ($2375), personnel salaries ($1900), and physician overhead ($808), for a total cost of $5083. Mean charge was $1642 per case; mean collection was $527 per case. Median case time (procedure plus turnover) was 40 minutes. In this model, breakeven volume is 9.7 cases per day; breakeven time is 49.7 minutes. Provider profit margin for 10 cases per day, or 83% capacity utilization, is $187 per day (income - expenses = $5270 - $5083). Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.

  12. Fire scar growth and closure rates in white oak (Quercus alba) and the implications for prescribed burning

    Treesearch

    Michael C. Stambaugh; Kevin T. Smith; Daniel C. Dey

    2017-01-01

    In burned forestlands, fire scar wounds commonly occur on tree stems as a result of cambial heating. In hardwood forests in particular, wounding can lead to stem decay with the extent of decay being related to scar size and exposure time. Therefore, wound closure rates are important to understand in the context of fire management such that allowing sufficient time for...

  13. Objective evaluation of the effect of autologous platelet concentrate on post-operative scarring in deep burns.

    PubMed

    Klosová, Hana; Stětinský, Jiří; Bryjová, Iveta; Hledík, Stanislav; Klein, Leo

    2013-09-01

    The healing of grafted areas after surgical treatment of deep burns frequently generates mutilating scars, and rises the risk of subsequent scar hypertrophy. Scar assessment based on clinical evaluation is inherently subjective, which stimulates search for objective means of evaluation. The aim of this study was to objectively evaluate the effect of using autologous platelet concentrate (APC) in combination with split thickness skin grafting (STSG) on scarring processes following surgery of deep burns as compared with application of STSG alone. Selected viscoelastic properties of 38 scars on 23 patients in total were examined using the Cutometer MPA 580 under controlled conditions for long-term outcomes 1, 3, 6 and 12 months after surgery following deep burns. The findings of this study suggest that the STSG+APC combination reduces the time of scar viscoelastic properties recovery as compared with application of STSG alone. This was statistically significant for viscoelastic parameters R2 and Q1. APC has been advocated to enhance scarring after surgery of deep dermal and full thickness burns. We objectively demonstrated that the viscoelastic properties of scars treated with STSG+APC combination return more rapidly to the plateau state than areas treated with STSG only. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  14. The experience of scar management for adults with burns: An interpretative phenomenological analysis.

    PubMed

    Martin, C; Bonas, S; Shepherd, L; Hedges, E

    2016-09-01

    Burns can have both physical and psychological effects on individuals. Pressure garments and silicone gels are used to improve the aesthetic appearance and functions of the skin, but these treatments have been associated with various physical, emotional, sexual and social difficulties. Interpretative phenomenological analysis (IPA) was used to explore participants' experiences of scar management. IPA examines individual experiences before comparing results across cases, and is suited to capture the different ways in which individuals experience a phenomena as well as cautiously looking at patterns across cases. Eight burn patients who had experienced scar management, including pressure garments, were interviewed. Two superordinate themes were identified: Assimilation of Pressure Garment Identity, and Psychosocial Functions of the Pressure Garments. The findings offered insight into the positive and negative experiences of scar management, describing the diverse personal and social functions of the pressure garments and how they became integrated into participants' identities. By understanding the individual nature of these experiences, healthcare professionals can enhance support around these issues and potentially aid adherence to treatment. Further research with different demographic groups as well as for other burn treatments would be useful to develop and contextualise these findings. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  15. Novel Use of Orthosis in a Case of Burn Contracture Microstomia.

    PubMed

    Soumya, S V; Daniel, S S; Ashish, K G; Santosh, K

    2016-06-01

    To prevent cicatrical scar formation of the oral commissure post commissuroplasty. Bilateral commisuroplasty followed by tooth borne static orthosis and then after dynamic orthosis for a period of one year. The use of both static and dynamic orthosis in appropriate sequence resulted in good scar outcome.

  16. Effect of extracorporeal shock wave therapy on scar pain in burn patients

    PubMed Central

    Cho, Yoon Soo; Joo, So Young; Cui, Huisong; Cho, Sung-Rae; Yim, Haejun; Seo, Cheong Hoon

    2016-01-01

    Abstract Background: Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. Methods: A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm2 (0.05–0.15 mJ/mm2) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. Results: The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm2), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). Conclusion: ESWT significantly reduced scar pain in burn patients after wound recovery. PMID:27512886

  17. Healing the Burn: Advances in Burn Treatment Technology Aim to Save Lives, Lessen Pain and Scarring.

    PubMed

    Allen, Summer E

    2016-01-01

    When brothers Jamie and Glen Selby, aged 5 and 7, arrived at the Shriners Burns Institute in Denver, Colorado, in July 1983, more than 97% of their skin had been destroyed by a fire they had accidentally started while playing in an abandoned house. The boys were so badly burned that their outlook was grim-a 6-year-old friend who was also in the fire died from his injuries?but Jamie and Glen were lucky. Not only did they survive, but they were also some of the first patients to benefit from a new burn treatment nicknamed test-tube skin.

  18. A new static progressive splint for treatment of knee and elbow flexion contractures.

    PubMed

    Suksathien, Rachawan; Suksathien, Yingyong

    2010-07-01

    Knee and elbow flexion contractures are a frequent cause of ambulation and function problems that often require extensive rehabilitation. Traditional methods are of limited benefit in severe and fixed contracture. A new static progressive splint was developed from daily-use knee and elbow orthosis and a newly invented gradual telescopic rod, which is designed to provide low load, and gradual and prolonged stretching. The splint was used in ten cases (11 knees) of knee flexion contracture and three cases of elbow flexion contracture. There were multiple etiologies of contracture such as burn scar contractures, intra-articular fractures, septic arthritis, juvenile rheumatoid arthritis, and immobilization. The average timing of the contracture before splinting was 14.6 months (range, 2 to 36) in the knee group and 16.7 months (range, 6 to 30) in the elbow group. The average initial extension was -53.6 degrees (range, -30 to -85) in the knee group and -70 degrees (range -65 to -80) in the elbow group. The average post treatment extension was -15 degrees (range, 0 to -30) in the knee group and -38.3 degrees (range, -30 to -45) in the elbow group. The average duration of treatment was 9.2 weeks (range, 4 to 16) in the knee group and 14 weeks (range, 11 to 20) in the elbow group. The most dramatic result was found in the patient who had burn scar flexion contractures of both knees for 20 months. The knee extensions increased from -60 and-85 degrees to full extension in four and 14 weeks after treatment, respectively. There were no recurrences or complications from the use of this splint. The patients were able to easily adjust the gradual telescopic rod themselves to provide the appropriate force for stretching. The static progressive splint is a new, effective, and low cost method for treatment of knee and elbow flexion contracture from multiple etiologies. The excellent result was found in extra-articular contracture.

  19. The correlation between time to skin grafting and hypertrophic scarring following an acute contact burn in a porcine model.

    PubMed

    Chan, Queenie E; Harvey, John G; Graf, Nicole S; Godfrey, Craig; Holland, Andrew J A

    2012-01-01

    One sequelae of burn injury remains the development of hypertrophic scarring. This appears more likely when the healing has been prolonged. Early excision of deep dermal burns and subsequent split skin grafting (SSG) may provide a more favorable result. The optimal timing of grafting for deeper dermal burns remains controversial. This study sought to establish evidence for the optimal grafting time using a porcine model. Five Large White female pigs were exposed to four contact burn injuries for duration of 20 seconds at 92°C. Each site was randomized to a treatment arm: dressing only as the control, SSG day 3, SSG day 14, and SSG day 21. Burn wound biopsies were obtained at days 0, 3, 14, 21, and 99 after the burn injury, together with microbiological swabs. Digital photographs were taken to assess scarring using the Vancouver scar scale. All biopsies were subject to histological and immunohistochemical analysis. Vancouver scar scale scores and histopathological analysis indicated that areas grafted on day 3 had the least fibrosis and scarring (P = 0.031). There was a strong correlation between the histological evaluation of the degree of fibrosis and α-smooth muscle actin levels (r = .60, P = .014). A greater degree of fibrosis was observed in the presence of infection (P = .028). Sites grafted on day 3 consistently exhibited the best clinical and histological scar outcome. The increased fibrosis observed in delayed grafting may have been be related to progression of burn depth and infection. These results suggest that early grafting of deep dermal burns may be preferential.

  20. Interrater and intrarater reliability of the Semmes Weinstein aesthesiometer to assess touch pressure threshold in burn scars.

    PubMed

    Meirte, J; Moortgat, P; Truijen, S; Maertens, K; Lafaire, C; De Cuyper, L; Hubens, G; Van Daele, U

    2015-09-01

    Burn scars are frequently accompanied with sensory deficits often remaining present months or even years after injury. Clinimetric properties of assessment tools remain understudied within burn literature. Tactile sense of touch can be examined with the touch pressure threshold (TPT) method using the Semmes Weinstein monofilament test (SWMT). There is in recent research no consensus on the exact measurement procedure when using the SWMT. The aim of this paper was to determine the interrater and intrarater reliability of TPT within burn scars and healthy controls using the 'ascending descending' measurement procedure. We used the newly developed guidelines for reporting reliability and agreement studies (GRRAS) as a basis to report this reliability study. In total 36 individuals were tested; a healthy control group and a scar group. The interrater reliability was excellent in the scar group (ICC=0.908/SEM=0.21) and fair to good in the control group (ICC=0.731/SEM=0.12). In the scar group intrarater ICC value was excellent (ICC=0.822/SEM=0.33). Within the control group also an excellent intrarater reliability (ICC=0.807/SEM=0.27) was found. In conclusion this study shows that the SWMT with the 'ascending descending' measurement procedure is a feasible and reliable objective measure to evaluate TPT in (older) upper extremities burn scars as well as in healthy skin. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  1. Burns

    MedlinePlus

    ... cause swelling, blistering, scarring and, in serious cases, shock, and even death. They also can lead to infections because they damage your skin's protective barrier. Treatment for burns depends on the cause of the ...

  2. [Advances in the research of prevention and treatment of postburn contractures of hand].

    PubMed

    Wang, K A; Wu, G S; Sun, Y; Xia, Z F

    2017-01-20

    Scar contracture deformity, which can lead to dysfunction of hand and low quality of life, is one of the common complication after hand burns. The prevention measures of scar contracture after hand burns include large skin grafting, prevention of infection, insistence on wearing pressure gloves, use of silicone sheets, wearing orthosis, accepting proper physical therapy, and early functional exercise. The primary treatments of postburn contractures of the hand are surgery, drugs, laser treatment, and rehabilitation therapy. Excision of scars, release of muscle, joints or bones, and soft tissue transplantation are the core of surgery. Laser treatment has a bright future but still needs to be further studied. Additionally, some novel treatments such as molecular targeted therapy, cell therapy, fat injection, and botulinum toxin injection will play important roles in prevention and treatment of postburn contractures in the future. The purpose of this article is to review the literature concerning postburn contractures of the hand, and summarize the present situation of prevention and treatment of such disease comprehensively.

  3. What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers.

    PubMed

    Thompson, Callie M; Sood, Ravi F; Honari, Shari; Carrougher, Gretchen J; Gibran, Nicole S

    2015-11-01

    Reliable characterization of a hypertrophic scar (HTS) is integral to epidemiologic studies designed to identify clinical and genetic risk factors for HTS. The Vancouver Scar Scale (VSS) has been widely used for this purpose; however, no publication has defined what score on this scale corresponds to a clinical diagnosis of HTS. In a survey of 1000 burn care providers, we asked respondents what VSS score indicates a HTS and asked them to score scar photos using the VSS. We used receiver-operating-characteristic (ROC) curves to evaluate VSS sub-scores and their combinations in diagnosis of HTS. Of 130 responses (13.5%), most were physicians (43.9%) who had worked in burn care for over 10 years (63.1%) and did not use the VSS in clinical practice (58.5%). There was no consensus as to what VSS score indicates a diagnosis of HTS. VSS height score (0-3) performed best for diagnosis of HTS; using a cut-off of ≥1, height score was 99.5% sensitive and 85.9% specific for HTS. Burn clinicians do not routinely use the VSS and perceptions vary widely regarding what constitutes a HTS. When a dichotomous variable is needed, the VSS height score with a cut-off of ≥1 may be optimal. Our findings underscore the need for an objective tool to reproducibly characterize HTS across burn centers. Published by Elsevier Ltd.

  4. What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers

    PubMed Central

    Thompson, Callie M.; Sood, Ravi F.; Honari, Shari; Carrougher, Gretchen J.; Gibran, Nicole S.

    2015-01-01

    Introduction Reliable characterization of a hypertrophic scar (HTS) is integral to epidemiologic studies designed to identify clinical and genetic risk factors for HTS. The Vancouver Scar Scale (VSS) has been widely used for this purpose; however, no publication has defined what score on this scale corresponds to a clinical diagnosis of HTS. Methods In a survey of 1000 burn care providers, we asked respondents what VSS score indicates a HTS and asked them to score scar photos using the VSS. We used receiver-operating-characteristic (ROC) curves to evaluate VSS subscores and their combinations in diagnosis of HTS. Results Of 130 responses (13.5%), most were physicians (43.9%) who had worked in burn care for over 10 years (63.1%) and did not use the VSS in clinical practice (58.5%). There was no consensus as to what VSS score indicates a diagnosis of HTS. VSS height score (0–3) performed best for diagnosis of HTS; using a cut-off of ≥1, height score was 99.5% sensitive and 85.9% specific for HTS. Conclusions Burn clinicians do not routinely use the VSS and perceptions vary widely regarding what constitutes a HTS. When a dichotomous variable is needed, the VSS height score with a cut-off of ≥1 may be optimal. Our findings underscore the need for an objective tool to reproducibly characterize HTS across burn centers. PMID:26141527

  5. Predicting severity of pathological scarring due to burn injuries: a clinical decision making tool using Bayesian networks.

    PubMed

    Berchialla, Paola; Gangemi, Ezio Nicola; Foltran, Francesca; Haxhiaj, Arber; Buja, Alessandra; Lazzarato, Fulvio; Stella, Maurizio; Gregori, Dario

    2014-06-01

    It is important for clinicians to understand which are the clinical signs, the patient characteristics and the procedures that are related with the occurrence of hypertrophic burn scars in order to carry out a possible prognostic assessment. Providing clinicians with an easy-to- use tool for predicting the risk of pathological scars. A total of 703 patients with 2440 anatomical burn sites who were admitted to the Department of Plastic and Reconstructive Surgery, Burn Center of the Traumatological Hospital in Torino between January 1994 and May 2006 were included in the analysis. A Bayesian network (BN) model was implemented. The probability of developing a hypertrophic scar was evaluated on a number of scenarios. The error rate of the BN model was assessed internally and it was equal to 24·83%. While classical statistical method as logistic models can infer only which variables are related to the final outcome, the BN approach displays a set of relationships between the final outcome (scar type) and the explanatory covariates (patient's age and gender, burn surface area, full-thickness burn surface area, burn anatomical area and wound-healing time; burn treatment options such as advanced dressings, type of surgical approach, number of surgical procedures, type of skin graft, excision and coverage timing). A web-based interface to handle the BN model was developed on the website www.pubchild.org (burns header). Clinicians who registered at the website could submit their data in order to get from the BN model the predicted probability of observing a pathological scar type. © 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  6. Treatment of Post-Burn Scar Deformations Using Tissue Expansion and Endoscopy

    PubMed Central

    Sharobaro, V.I.; Moroz, V.Y.; Starkov, Y.G.; Yudenich, A.A.

    2008-01-01

    Summary Background. The essential drawbacks of conventional tissue expansion, a technique widely used in reconstructive surgery, are its significant duration and the high complications rate. The experience of our clinic covers 329 patients treated with this method from 1987 to 2006. The mean time of expansion was previously 72 ± 2 days (± SD) and the rate of local complications was 38.6%. We applied effective new approaches to this method in order to reduce its drawbacks, i.e. the endoscopic implantation of expanders, intensive expansion, and a modified technique of elevation of an expanded flap. Methods. Twenty-seven patients treated in the A.V. Vishnevsky Institute of Surgery between 2001 and 2006 for post-burn scar deformities underwent endoscopic implantations of 46 silicone expanders in various anatomical areas. High-grade tissue expansion was initiated immediately after implantation. The elevation of the reconstructed flap was performed, including defective tissues in the flap, after which the expander was removed and the expanded tissues were transposed. Results. With the help of the techniques developed, it was possible to reduce the mean expansion time from 72 days to 34 (less than half) and to reduce the complications rate from 38.6% to 6.5%. Conclusions. Endoscopic expander implantation, the accelerated technique of tissue expansion, and modified elevation of the expanded flap enabled us to considerably improve results in the treatment of post-burn scar deformities, using the tissue expansion method. PMID:21991107

  7. Contracture deformity

    MedlinePlus

    Deformity - contracture ... Contracture can be caused by any of the following: Brain and nervous system disorders, such as cerebral ... Follow your health care provider's instructions for treating contracture at home. Treatments may include: Doing exercises and ...

  8. Spatial and temporal corroboration of a fire-scar-based fire history in a frequently burned ponderosa pine forest.

    PubMed

    Farris, Calvin A; Baisan, Christopher H; Falk, Donald A; Yool, Stephen R; Swetnam, Thomas W

    2010-09-01

    Fire scars are used widely to reconstruct historical fire regime parameters in forests around the world. Because fire scars provide incomplete records of past fire occurrence at discrete points in space, inferences must be made to reconstruct fire frequency and extent across landscapes using spatial networks of fire-scar samples. Assessing the relative accuracy of fire-scar fire history reconstructions has been hampered due to a lack of empirical comparisons with independent fire history data sources. We carried out such a comparison in a 2780-ha ponderosa pine forest on Mica Mountain in southern Arizona (USA) for the time period 1937-2000. Using documentary records of fire perimeter maps and ignition locations, we compared reconstructions of key spatial and temporal fire regime parameters developed from documentary fire maps and independently collected fire-scar data (n = 60 plots). We found that fire-scar data provided spatially representative and complete inventories of all major fire years (> 100 ha) in the study area but failed to detect most small fires. There was a strong linear relationship between the percentage of samples recording fire scars in a given year (i.e., fire-scar synchrony) and total area burned for that year (y = 0.0003x + 0.0087, r2 = 0.96). There was also strong spatial coherence between cumulative fire frequency maps interpolated from fire-scar data and ground-mapped fire perimeters. Widely reported fire frequency summary statistics varied little between fire history data sets: fire-scar natural fire rotations (NFR) differed by < 3 yr from documentary records (29.6 yr); mean fire return intervals (MFI) for large-fire years (i.e., > or = 25% of study area burned) were identical between data sets (25.5 yr); fire-scar MFIs for all fire years differed by 1.2 yr from documentary records. The known seasonal timing of past fires based on documentary records was furthermore reconstructed accurately by observing intra-annual ring position of fire

  9. Reduction of burn scar formation by halofuginone-eluting silicone gel sheets: a controlled study on nude mice.

    PubMed

    Zeplin, Philip H

    2012-03-01

    Burn scar formations can cause disfiguration and loss of dermal function. The purpose of this study was to examine whether application of modified silicone gel sheets with an antifibrotic drug halofuginone-eluting hybrid surface produce an effect on scar development. There were a total of 2 animal groups. The athymic nude mice (nu/nu) of both groups underwent transplantation of full-thickness human skin grafts onto their backs and setting of partial thickness burn injury. The status of local scar development was observed over a period of 3 months after the application of silicone gel sheets and also after application of surface-modified halofuginone-eluting silicone gel sheets. Subsequently, via real-time polymerase chain reaction, the cDNA levels from key mediators of scar formation (transforming growth factor beta, COL1A1, connective tissue growth factor, fibroblast growth factor 2, matrix metalloproteinase 2, matrix metalloproteinase 9) were established and statistically evaluated. In comparison with uncoated silicone gel sheets, the application of halofuginone-eluting silicone gel sheets lead to a significant difference in gene expression activity in scar tissue. Halofuginone-eluting hybrid surface silicone gel sheets significantly increase the antiscarring effect of adhesive silicone gel sheets by deceleration and downregulation of scar development by normalization of the expression activity.

  10. Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin

    PubMed Central

    Dematte, Maria Fernanda; Gemperli, Rolf; Salles, Alessandra Grassi; Dolhnikoff, Marisa; Lanças, Tatiana; Saldiva, Paulo Hilário Nascimento; Ferreira, Marcus Castro

    2011-01-01

    OBJECTIVE: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05% tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. Setting: Tertiary, Institutional. METHOD: Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. RESULTS: Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. CONCLUSION: Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients. PMID:22086527

  11. Interpretation of the DermaLab Combo® pigmentation and vascularity measurements in burn scar assessment: an exploratory analysis.

    PubMed

    Gankande, T U; Duke, J M; Wood, F M; Wallace, H J

    2015-09-01

    The DermaLab Combo® measures pigmentation and vascularity of a burn scar more reliably than the modified Vancouver Scar Scale (mVSS). This study aims to examine how the DermaLab Combo® continuous measurements of pigmentation and vascularity of burns scars relate to the mVSS, a standard clinical scar assessment method; and secondly, to obtain evidence to support the concurrent validity of DermaLab Combo® measurements for pigmentation and vascularity. Scar assessments were performed on an index burn scar of 100 subjects using two methods: the mVSS (two raters) and the DermaLab Combo® device (one rater). Using the DermaLab Combo®, measurements of pigmentation and vascularity for the index scar and an adjacent normal skin site were obtained. Indices were generated to represent the scar pigmentation (melanin index, MI%) and scar vascularity (erythema index, EI%) relative to the patient's matched normal skin. Exploratory univariate and bivariate analyses were conducted and the concordance of classification by mVSS score using DermaLab® cut-off values was assessed. For pigmentation, the results suggest a 80% classification concordance for the DermaLab Combo® MI% values into mVSS pigmentation categories (hypopigmentation, normal pigmentation and hyperpigmentation) using two predictors (MI% and EI%) and visually fitted discriminant axis cut-offs. Due to the high degree of overlap of EI% values between the vascularity categories, meaningful classification of EI% values using the mVSS was not possible. Quantifying percentage changes in melanin and erythema relative to matched normal skin improved understanding of the DermaLab Combo® pigmentation and vascularity measurements. The DermaLab Combo® pigmentation MI% values were able to be classified into pigmentation categories of the mVSS, and pigmentation classification concordance was further improved with consideration of the scar's DermaLab Combo® vascularity EI% values. The DermaLab Combo® is an objective tool

  12. Management of pediatric perineal and genital burns: twenty-year review.

    PubMed

    Alghanem, A A; McCauley, R L; Robson, M C; Rutan, R L; Herndon, D N

    1990-01-01

    Between 1966 and 1986, fifty-seven pediatric patients with partial and/or full-thickness perineal and genital burns with a minimum of 1-year follow-up were identified. Fifty percent of the patients with genital burns and 20% of the patients with perineal and/or buttock burns required skin grafting in the acute stage. No patient required suprapubic cystostomies, diverting colostomies, or local flap coverage of exposed testicles. Burn scar contractures were the most frequent complications. Thirty-two patients (56%) required contracture release of the perineum and coverage with either skin grafts or local skin flaps. In three patients (6%) contracture required release of the penis and scrotum. One patient lost a testicle. Three patients developed rectal prolapse and were treated without surgery. Four patients developed rectal stenosis with fecal incontinence because of burn scar contracture and were treated by anal dilatation, local transposition flaps, and/or excision of the scar and primary closure. Acute management of pediatric patients with such injuries can be conservative. Delayed complications of contractures of the perineum and genitals can be easily corrected with scar excisions, skin grafts, or the use of local skin flaps.

  13. The effects of electroacupuncture on analgesia and peripheral sensory thresholds in patients with burn scar pain.

    PubMed

    Cuignet, Olivier; Pirlot, A; Ortiz, S; Rose, T

    2015-09-01

    The aim of this study is to observe if the effects of electro-acupuncture (EA) on analgesia and peripheral sensory thresholds are transposable from the model of heat pain in volunteers to the clinical setting of burn scar pain. After severe burns, pathological burn scars (PPBS) may occur with excruciating pain that respond poorly to treatment and prevent patients from wearing their pressure garments, thereby leading to unesthetic and function-limiting scars. EA might be of greater benefit in terms of analgesia and functional recovery, should it interrupt this vicious circle by counteracting the peripheral hyperalgesia characterizing PPBS. Therefore we enrolled 32 patients (22 males/10 females) aged of 46±11 years with clinical signs of PPBS and of neuropathic pain despite treatment. The study protocol consisted in 3 weekly 30-min sessions of standardized EA with extra individual needles in accordance to Traditional Chinese Medicine, in addition of previous treatments. We assessed VAS for pain and quantitative sensory testing (QST) twice: one week before and one after protocol. QST measured electrical thresholds for non-nociceptive A-beta fibers, nociceptive A-delta and C fibers in 2 dermatomes, respectively from the PPBS and from the contralateral pain-free areas. Based on heat pain studies, EA consisted in sessions at the extremity points of the main meridian flowing through PPBS (0.300s, 5Hz, sub noxious intensity, 15min) and at the bilateral paravertebral points corresponding to the same metameric level, 15min. VAS reduction of 3 points or below 3 on a 10 points scale was considered clinically relevant. Paired t-test compared thresholds (mean [SD]) and Wilcoxon test compared VAS (median [IQR]) pre and after treatment, significant p<0.05. The reduction of VAS for pain reached statistical but not clinical relevance (6.8 [3] vs. 4.5 [3.6]). This was due to a large subgroup of 14 non-responders whose VAS did not change after treatment (6.6 [2.7] vs. 7.2 [3

  14. Nanolayered siRNA delivery platforms for local silencing of CTGF reduce cutaneous scar contraction in third-degree burns

    PubMed Central

    Castleberry, Steven A.; Golberg, Alexander; Sharkh, Malak Abu; Khan, Saiqa; Almquist, Benjamin D.; Austen, William G.; Yarmush, Martin L.; Hammond, Paula T.

    2017-01-01

    Wound healing is an incredibly complex biological process that often results in thickened collagen-enriched healed tissue called scar. Cutaneous scars lack many functional structures of the skin such as hair follicles, sweat glands, and papillae. The absence of these structures contributes to a number of the long-term morbidities of wound healing, including loss of function for tissues, increased risk of re-injury, and aesthetic complications. Scar formation is a pervasive factor in our daily lives; however, in the case of serious traumatic injury, scars can create long-lasting complications due to contraction and poor tissue remodeling. Within this report we target the expression of connective tissue growth factor (CTGF), a key mediator of TGFβ pro-fibrotic response in cutaneous wound healing, with controlled local delivery of RNA interference. Through this work we describe both a thorough in vitro analysis of nanolayer coated sutures for the controlled delivery of siRNA and its application to improve scar outcomes in a third-degree burn induced scar model in rats. We demonstrate that the knockdown of CTGF significantly altered the local expression of αSMA, TIMP1, and Col1a1, which are known to play roles in scar formation. The knockdown of CTGF within the healing burn wounds resulted in improved tissue remodeling, reduced scar contraction, and the regeneration of papillary structures within the healing tissue. This work adds support to a number of previous reports that indicate CTGF as a potential therapeutic target for fibrosis. Additionally, we believe that the controlled local delivery of siRNA from ultrathin polymer coatings described within this work is a promising approach in RNA interference that could be applied in developing improved cancer therapies, regenerative medicine, and fundamental scientific research. PMID:27108403

  15. Nanolayered siRNA delivery platforms for local silencing of CTGF reduce cutaneous scar contraction in third-degree burns.

    PubMed

    Castleberry, Steven A; Golberg, Alexander; Sharkh, Malak Abu; Khan, Saiqa; Almquist, Benjamin D; Austen, William G; Yarmush, Martin L; Hammond, Paula T

    2016-07-01

    Wound healing is an incredibly complex biological process that often results in thickened collagen-enriched healed tissue called scar. Cutaneous scars lack many functional structures of the skin such as hair follicles, sweat glands, and papillae. The absence of these structures contributes to a number of the long-term morbidities of wound healing, including loss of function for tissues, increased risk of re-injury, and aesthetic complications. Scar formation is a pervasive factor in our daily lives; however, in the case of serious traumatic injury, scars can create long-lasting complications due to contraction and poor tissue remodeling. Within this report we target the expression of connective tissue growth factor (CTGF), a key mediator of TGFβ pro-fibrotic response in cutaneous wound healing, with controlled local delivery of RNA interference. Through this work we describe both a thorough in vitro analysis of nanolayer coated sutures for the controlled delivery of siRNA and its application to improve scar outcomes in a third-degree burn induced scar model in rats. We demonstrate that the knockdown of CTGF significantly altered the local expression of αSMA, TIMP1, and Col1a1, which are known to play roles in scar formation. The knockdown of CTGF within the healing burn wounds resulted in improved tissue remodeling, reduced scar contraction, and the regeneration of papillary structures within the healing tissue. This work adds support to a number of previous reports that indicate CTGF as a potential therapeutic target for fibrosis. Additionally, we believe that the controlled local delivery of siRNA from ultrathin polymer coatings described within this work is a promising approach in RNA interference that could be applied in developing improved cancer therapies, regenerative medicine, and fundamental scientific research.

  16. Improving comfort and throughput for patients undergoing fractionated laser ablation of symptomatic burn scars.

    PubMed

    Edkins, Renee E; Hultman, C Scott; Collins, Paul; Cairns, Bruce; Hanson, Marilyn; Carman, Margaret

    2015-03-01

    Utilization of fractionated ablation with a carbon dioxide (CO2) laser has shown to be efficacious in the management of symptomatic burn scars. Although effective, this procedure is painful and burn patients traditionally evidence low pain tolerance. For this reason intravenous anesthesia is used during these procedures. However, operative anesthetics and intravenous opioids are associated with patient discomfort postoperatively and prolonged recovery times. The American Society of Anesthesiologists' (ASA) Task Force on Acute Pain Management for the perioperative setting recommends the use of multimodal anesthesia, including the use of regional blockade with a local anesthetic. A quality improvement project was implemented to incorporate this practice and evaluate outcomes. The main goal of this project was to improve patient comfort as evidenced by improved pain scores with a decreased requirement for intravenous opioids post-procedure. The secondary goal of this project was to improve patient throughput in the setting of an outpatient surgical facility as evidenced by decreased time in the facility. A historic cohort of 36 cases was compared to 36 cases managed under the ASA guidelines for multimodal anesthesia utilizing a topical local anesthetic. Statistical analysis included a t-test for continuous variables while chi square was utilized to analysis dichotomous variables. Intravenous narcotic utilization and mean pain scores in the recovery phase of care were significantly reduced as a result of adoption of the ASA recommendations. Throughput time increased by 36 minutes; notably in the preoperative phase, while patient movement through the procedural phase was significantly decreased as was procedure to discharge times. Implementing the use of a topical anesthetic as a component of multimodal anesthesia for patients undergoing fractionated laser ablation of symptomatic burn scars can significantly decrease patient pain and the need for intravenous opioids

  17. A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: An observational study.

    PubMed

    Żądkowski, Tomasz; Nachulewicz, Paweł; Mazgaj, Maciej; Woźniak, Magdalena; Cielecki, Czesław; Wieczorek, Andrzej Paweł; Beń-Skowronek, Iwona

    2016-10-01

    Treatment of hypertrophic scars arising as a result of thermal burns in children is still a big problem. The results of the treatment are not satisfactory for patients and parents, and new methods of treatment are still investigated.We present the use of one of the most modern carbon dioxide (CO2) lasers (Lumenis Encore laser equipped with a Synergistic Coagulation and Ablation for Advanced Resurfacing module) in the treatment of hypertrophic scars in children after burns.From March to April of 2013, a group of 47 patients aged 6 to 16 years underwent 57 laser surgery treatments. The average time from accident was 7.5 years. The results of treatment were investigated in 114 areas. The assessed areas were divided into 2 groups: 9-cm area 1, where the thickness of the scar measured by physician was the lowest and 9-cm area 2, where the thickness of the scar was the biggest. The results were considered on the Vancouver Scar Scale (VSS) independently by the surgeon and by parents 1, 4, and 8 months after the procedure. In addition, ultrasound evaluation of the scar thickness before and after laser procedure was made.VSS total score improved in all areas assessed by both the physician and parents. The biggest change in total VSS score in area 1 in the evaluation of the investigator was obtained at follow-up after the 1st month of treatment (average 7.23 points before and 5.18 points after the 1st month after surgery-a difference of 2.05 points). Scar ratings by parents and the physician did not differ statistically (P < 0.05). In the ultrasound assessment, the improvement was statistically significant, more frequently for both minimum and maximum thickness of the scars (B-mode measures) (P < 0.05).The use of a CO2 laser in the treatment of hypertrophic scars in children is an effective and safe method. The use of a CO2 laser improves the appearance and morphology of scarring assessed using the VSS by both the parents and the physician. The treatment also reduced

  18. Living with burn scars caused by self-immolation among women in Iraqi Kurdistan: A qualitative study.

    PubMed

    Mirlashari, Jila; Nasrabadi, Alireza Nikbakht; Amin, Pakestan Mohammad

    2017-03-01

    Patients with burns have to live with a variety of long-term physical and psychosocial consequences. Burns lead to prolonged hospital stay, disfiguring scars, disability, and even death. Since self-immolation is common in women of Iraqi Kurdistan, the present study sought to explore the experiences of women living with scars caused by self-immolation. This paper was part of a qualitative research study. A purposive sample of 18 female self-immolation survivors from Iraqi Kurdistan was selected, and 21 individual interviews were conducted and analyzed using conventional content analysis. Four categories emerged during the data analysis: (1) feelings of disbelief, regret, and anger caused by post-burn scars; (2) desperately seeking solutions; (3) grief due to disappointment and surrender to despair; and (4) rejection and isolation. In conclusion, individuals with scars and disfigurements sometimes adopted inappropriate measures to deal with the psychological problems caused by others' behaviors and wrong perceptions. Educational and support programs are hence indicated to promote awareness levels of self-immolation survivors, their families, and the whole society.

  19. Derivation of Burn Scar Depths with Airborne Light Detection and Ranging (LIDAR) in Indonesian Peatlands

    NASA Astrophysics Data System (ADS)

    Ballhorn, U.; Siegert, F.

    2009-04-01

    more CO2 per year than the fourth-largest industrial nation, Germany, saved to achieve its Kyoto target. Since 1990, emissions from peat burning and peat decomposition have exceeded that of above ground biomass deforestation. These numbers show how important it is to have more accurate estimations for peat burn depth in the future. Until now few field measurements were made, which would require to know the fire affected area in advance or ignite peatland on purpose. Furthermore fire scars are quickly covered by regenerating vegetation. Another problem is the lack of a method without actually having to go into the field (e.g. through remote sensing techniques), due to the fact that many of the fire locations are remote and very difficult to access. We investigated if airborne light detection and ranging (LIDAR), an active laser pulse technology by which the height of objects can be precisely measured, can be used to determine the amount of peat burned during a fire event. From a LIDAR data set acquired in Central Kalimantan, Borneo, in 2007, one year after severe fires resulting from the 2006 El Niño drought, we calculated that the average depth of a burn scar was 0.30 ± 0.15 m .This was achieved through the construction of digital terrain models (DTMs) by interpolating the LIDAR ground return signals in burnt and adjacent unburned peatland. These calculated depths were compared to in situ measurements, which came to similar results. We believe that the method presented here to estimate burnt peat depth has the potential to considerably improve the accuracy of regional and global carbon emission models but would also be helpful for monitoring projects under the Kyoto Protocol like the Clean Development Mechanism (CDM) or the proposed Reducing Emissions from Deforestation and Degradation (REDD) mechanism.

  20. Fat Grafting and Adipose-Derived Regenerative Cells in Burn Wound Healing and Scarring: A Systematic Review of the Literature.

    PubMed

    Condé-Green, Alexandra; Marano, Andrew A; Lee, Edward S; Reisler, Tom; Price, Leigh Ann; Milner, Stephen M; Granick, Mark S

    2016-01-01

    There is an abundance of literature supporting the efficacy of fat grafting in aesthetic and reconstructive cases. There has been a recent emphasis on the regenerative capacity of adipose-derived stem cells and their utility in the improvement of wound healing and scarring provided by their cytokine and growth factor profiles. Despite the wealth of evidence supporting their efficacy, little attention has been paid to their utility in burn treatment. The authors' purpose was to provide an analysis of the literature regarding the use of fat grafting and regenerative cells in the treatment of burn wounds to guide surgeons and scientists on their clinical use. A systematic review of the literature was performed by a thorough search of 12 terms using the PubMed, Medline, and Cochrane databases. Two hundred forty-one articles were subject to evaluation by predetermined inclusion and exclusion criteria. Six murine and 12 human studies were selected, including case-control studies, case series, and case reports. They describe histologic and clinical effects of fat grafting and regenerative cell therapy, including improvements in burn scar size and texture, enhanced angiogenesis, decreased inflammation, alleviation of pain, and return of function. There is a dearth of randomized controlled trials and quantitative analysis supporting the efficacy of fat grafting and adipose regenerative cells in burns. However, the subjective improvements in scars are encouraging. The authors hope that this review will be a foundation for future studies and will highlight the breadth of knowledge yet to be explored by this therapy. Therapeutic, IV.

  1. Serum concentration of amino-terminal propeptide of type III procollagen (PIIINP) as a prognostic marker for skin fibrosis after scar correction in burned patients.

    PubMed

    Ulrich, Dietmar; Noah, Ernst-Magnus; Burchardt, Elmar Reinhardt; Atkins, Derek; Pallua, Norbert

    2002-12-01

    The amino-terminal propeptide of procollagen type III (PIIINP) has been proposed as a marker for fibrogenesis in patients with different fibroproliferative disorders, e.g. liver and lung fibrosis. In this study, serum concentrations of PIIINP were measured by ELISA as a marker for excessive cicatrization in burned patients before and after scar correction. All patients were followed 6 months to determine a new fibrotic reaction during the wound healing process using the Burn Scar Index and to correlate pre- and post-operative concentrations of PIIINP in their sera with the risk to develop a new severe tissue fibrosis leading to pathological scar formation. Furthermore, PIIINP was determined in the excised scar tissue by immunohistochemistry. The study included 38 patients. Nineteen patients (8 female, 11 male, average age 48.3+/-18.9 years) had hypertrophic scars after major burn injury (TBSA, 21+/-12%; Burn Scar Index, 10.4+/-3.7 points) and underwent scar correction. Nineteen patients (12 female, 7 male, average age 42.3+/-25.5 years) who underwent elective plastic-surgical operations served as the control group. Blood samples were drawn immediately before operation, at the 1st, 3rd, 7th, and 14th post-operative days, as well as 1st, 3rd, and 6th months after operation.Pre-operatively, PIIINP was significantly elevated (P<0.05) in burned patients who underwent scar correction. There was a significant increase (P<0.05) of PIIINP in burned patients from 9.8+/-3.7ng/ml pre-operatively to 13.9+/-4.2ng/ml at the 7th post-operation day. Up to 3 months after operation, the 6 months after scar correction concentration remained at a significantly elevated level compared to pre-operative values. The burned patients had a Burn Scar Index of 7.8+/-3.6 points. Pre-operative PIIINP serum concentrations correlated with the Burn Scar Index (r(2)=0.7 and 0.68; P<0.05). Scar tissue stained intensively positive for PIIINP. There was a significant correlation between pre

  2. [Rail plastic surgery technique in the treatment of popliteal contractures].

    PubMed

    Achbouk, A; Khales, A; Bourra, K; Tourabi, K; Ababou, K; Ihrai, H

    2011-03-31

    The case is presented of a patient aged 45 years suffering from thermal burns due to flame following the deflagration of a gas cylinder. The initial lesions involved the four limbs, in particular the knee, and the trunk. The initial taking in charge consisted in an early excision-graft of the limbs. The evolution of the burn was marked by the development of hypertrophic scars at the level of the non-transplanted zones and at the edge of the graft as also by the onset of contractures. Because of the functional problem caused by the contracture as a result of the considerably reduced extension, the patient was admitted for surgical treatment. Thanks to the rail technique described, the patient recovered normal knee function. Post-surgical treatment was straightforward with a hospitalization period of one month. The aesthetic results were satisfactory. The rail technique is part of the therapeutic arsenal for treating knee contractures. Its simplicity, easy technique, and satisfactory results, plus its easy follow-up, make it a highly appreciated technique in the treatment of this type of contracture.

  3. Derivation of burn scar depths and estimation of carbon emissions with LIDAR in Indonesian peatlands

    PubMed Central

    Ballhorn, Uwe; Siegert, Florian; Mason, Mike; Limin, Suwido

    2009-01-01

    During the 1997/98 El Niño-induced drought peatland fires in Indonesia may have released 13–40% of the mean annual global carbon emissions from fossil fuels. One major unknown in current peatland emission estimations is how much peat is combusted by fire. Using a light detection and ranging data set acquired in Central Kalimantan, Borneo, in 2007, one year after the severe peatland fires of 2006, we determined an average burn scar depth of 0.33 ± 0.18 m. Based on this result and the burned area determined from satellite imagery, we estimate that within the 2.79 million hectare study area 49.15 ± 26.81 megatons of carbon were released during the 2006 El Niño episode. This represents 10–33% of all carbon emissions from transport for the European Community in the year 2006. These emissions, originating from a comparatively small area (approximately 13% of the Indonesian peatland area), underline the importance of peat fires in the context of green house gas emissions and global warming. In the past decade severe peat fires occurred during El Niño-induced droughts in 1997, 2002, 2004, 2006, and 2009. Currently, this important source of carbon emissions is not included in IPCC carbon accounting or in regional and global carbon emission models. Precise spatial measurements of peat combusted and potential avoided emissions in tropical peat swamp forests will also be required for future emission trading schemes in the framework of Reduced Emissions from Deforestation and Degradation in developing countries. PMID:19940252

  4. Derivation of burn scar depths and estimation of carbon emissions with LIDAR in Indonesian peatlands.

    PubMed

    Ballhorn, Uwe; Siegert, Florian; Mason, Mike; Limin, Suwido

    2009-12-15

    During the 1997/98 El Niño-induced drought peatland fires in Indonesia may have released 13-40% of the mean annual global carbon emissions from fossil fuels. One major unknown in current peatland emission estimations is how much peat is combusted by fire. Using a light detection and ranging data set acquired in Central Kalimantan, Borneo, in 2007, one year after the severe peatland fires of 2006, we determined an average burn scar depth of 0.33 +/- 0.18 m. Based on this result and the burned area determined from satellite imagery, we estimate that within the 2.79 million hectare study area 49.15 +/- 26.81 megatons of carbon were released during the 2006 El Niño episode. This represents 10-33% of all carbon emissions from transport for the European Community in the year 2006. These emissions, originating from a comparatively small area (approximately 13% of the Indonesian peatland area), underline the importance of peat fires in the context of green house gas emissions and global warming. In the past decade severe peat fires occurred during El Niño-induced droughts in 1997, 2002, 2004, 2006, and 2009. Currently, this important source of carbon emissions is not included in IPCC carbon accounting or in regional and global carbon emission models. Precise spatial measurements of peat combusted and potential avoided emissions in tropical peat swamp forests will also be required for future emission trading schemes in the framework of Reduced Emissions from Deforestation and Degradation in developing countries.

  5. The Modification of Five-Flap Z-Plasty for Web Contracture.

    PubMed

    Chen, Baoguo; Song, Huifeng

    2015-12-01

    Web contractures are fairly commonly encountered in those who have suffered from burn injury or other trauma. Numerous local flaps have been adopted previously. The five-flap Z-plasty is one that has been used frequently. To release the scar as much as possible, based on the traditional design, we developed a modified technique of the five-flap Z-plasty to reconstruct the axillary and elbow web contractures. Hence, the length of the axis of the cicatrix could be much lengthened. Twenty patients (12 females and 8 males, 7 to 48 years-old) with 27 web contractures were arranged for the operation using the new flap. The contractures were formed on by burn injury in 17 patients, surgery in 2 patients, and traumatic cicatrix in 1 case. All patients were operated on using a modified five-flap Z-plasty to reach the aim of maximum contracture relaxation. All flaps survived well. No flap tip necrosis occurred. Good function was gained in all patients postoperatively by the one year average follow-up. There was no recurrence. The contracture band was freed satisfactorily. The technique is very easy to execute and can be used both in web and linear contractures. With the virtue of extending the length of the scar axis to a higher degree compared to the traditional method, we suggest this modified five-flap Z-plasty application. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  6. Post-burn hypertrophic scars are characterized by high levels of IL-1β mRNA and protein and TNF-α type I receptors.

    PubMed

    Salgado, Rosa M; Alcántara, Luz; Mendoza-Rodríguez, C Adriana; Cerbón, Marco; Hidalgo-González, Christian; Mercadillo, Patricia; Moreno, Luis M; Alvarez-Jiménez, Ricardo; Krötzsch, Edgar

    2012-08-01

    Post-burn hypertrophic scars are characterized by increased collagen synthesis and hyperplasia, and may be associated with erythema, pain, dysesthesia, pruritus, and skin border elevation. Although the etiopathogenesis of hypertrophic scarring remains unclear, proinflammatory and profibrogenic cytokines are known to play an important role in general skin dysfunction. This study assessed mRNA expression, proteins, and type I receptors of tumor necrosis factor-alpha (TNF-α) and interleukin 1-beta (IL-1β) in normal skin, normotrophic and post-burn hypertrophic scars. Skin biopsies were obtained from 10 hypertrophic and 9 normotrophic scars, and 4 normal skin sites. Only post-burn scars covering more than 10% of the body were included. Ex vivo histopathological analysis evaluated scar maturity, in situ hybridization assessed mRNA expression, and cytokine protein and cytokine/cell colocalization were performed using single- and double-label immunohistochemistry, respectively. IL-1β is overexpressed in hypertrophic scars at the post-transcriptional level, associated primarily with keratinocytes and CD1a(+) cells. Type I receptors for TNF-α are overexpressed in blood vessels of hypertrophic scars. The coordinated overexpression of IL-1β and TNF-α type I receptor may maintain the fibrogenic phenotypes of hypertrophic scars, even those in "remission". Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  7. Efficacy and Safety of Fractional CO2 Laser Resurfacing in Non-hypertrophic Traumatic and Burn Scars

    PubMed Central

    Majid, Imran; Imran, Saher

    2015-01-01

    Background: Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different aetiologies. Aim: To assess the efficacy and safety of fractional CO2 laser resurfacing treatment in the management of non-hypertrophic traumatic and burn scars. Materials and Methods: Twenty-five patients affected by non-hypertrophic traumatic and burn scars were treated with four sessions of fractional CO2 laser resurfacing treatment at 6-weekly intervals. Patients were photographed at each visit and finally, 3 months after the end of treatment schedule. Response to treatment was assessed clinically as well as by comparing the initial photograph of the patient with the one taken at the last follow-up visit 3-months after the final treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as ‘excellent’ if the mean score achieved was >2. A score of 1-2 was labeled as good response while a score below 1 was labeled as ‘poor’ response. The subjective satisfaction of each patient with the treatment offered was also assessed at the last follow-up visit. Results: The commonest site of scarring treated was the face followed by hands. Response to treatment was rated as excellent in 60% (15/25) patients while 24% (6/25) and 16% (4/25) patients were labeled as good and poor responders, respectively. Skin texture showed better response than other variables with average score of 2.44. Linear post-traumatic scars were seen to respond less than other morphological types. Majority of the patients (19 out of 25) were highly satisfied with the treatment offered. No long-term adverse effects were noted in any patient. Conclusions: Fractional photothermolysis with a fractional CO2 laser gives excellent results in patients with post-burn scars with minimal adverse

  8. Missense Variant in MAPK Inactivator PTPN5 Is Associated with Decreased Severity of Post-Burn Hypertrophic Scarring.

    PubMed

    Sood, Ravi F; Arbabi, Saman; Honari, Shari; Gibran, Nicole S

    2016-01-01

    Hypertrophic scarring (HTS) is hypothesized to have a genetic mechanism, yet its genetic determinants are largely unknown. The mitogen-activated protein kinase (MAPK) pathways are important mediators of inflammatory signaling, and experimental evidence implicates MAPKs in HTS formation. We hypothesized that single-nucleotide polymorphisms (SNPs) in MAPK-pathway genes would be associated with severity of post-burn HTS. We analyzed data from a prospective-cohort genome-wide association study of post-burn HTS. We included subjects with deep-partial-thickness burns admitted to our center who provided blood for genotyping and had at least one Vancouver Scar Scale (VSS) assessment. After adjusting for HTS risk factors and population stratification, we tested MAPK-pathway gene SNPs for association with the four VSS variables in a joint regression model. In addition to individual-SNP analysis, we performed gene-based association testing. Our study population consisted of 538 adults (median age 40 years) who were predominantly White (76%) males (71%) admitted to our center from 2007-2014 with small-to-moderate-sized burns (median burn size 6% total body surface area). Of 2,146 SNPs tested, a rare missense variant in the PTPN5 gene (rs56234898; minor allele frequency 1.5%) was significantly associated with decreased severity of post-burn HTS (P = 1.3×10-6). In gene-based analysis, PTPN5 (P = 1.2×10-5) showed a significant association and BDNF (P = 9.5×10-4) a borderline-significant association with HTS severity. We report PTPN5 as a novel genetic locus associated with HTS severity. PTPN5 is a MAPK inhibitor expressed in neurons, suggesting a potential role for neurotrophic factors and neuroinflammatory signaling in HTS pathophysiology.

  9. Physical rehabilitation of pediatric burns.

    PubMed

    Atiyeh, B; Janom, H H

    2014-03-31

    Significant improvements have been made in the acute treatment of pediatric burn injuries over the past 3 decades which have significantly decreased mortality. Each year, more burned children are necessitating serious medical attention during their convalescence. For children with serious consequences resulting from burns that can persist from childhood through adolescence into adulthood, the value of long-term rehabilitation cannot be over stated. Burn injury management should not focus only on the immediate treatment. Long-term functional outcome and the required rehabilitation that burn victims must go through should be given equal if not more attention. The present is a review of the available modalities utilized for the physical rehabilitation of convalescent pediatric burns in order to overcome the catabolic state, improve muscle power and fitness, reduce disfiguring scars and prevent contractures.

  10. Physical rehabilitation of pediatric burns

    PubMed Central

    Atiyeh, B.; Janom, H.H.

    2014-01-01

    Summary Significant improvements have been made in the acute treatment of pediatric burn injuries over the past 3 decades which have significantly decreased mortality. Each year, more burned children are necessitating serious medical attention during their convalescence. For children with serious consequences resulting from burns that can persist from childhood through adolescence into adulthood, the value of long-term rehabilitation cannot be over stated. Burn injury management should not focus only on the immediate treatment. Long-term functional outcome and the required rehabilitation that burn victims must go through should be given equal if not more attention. The present is a review of the available modalities utilized for the physical rehabilitation of convalescent pediatric burns in order to overcome the catabolic state, improve muscle power and fitness, reduce disfiguring scars and prevent contractures. PMID:25249846

  11. Hyperpigmented burn scar improved with a fractionated 1550 nm non-ablative laser.

    PubMed

    Bach, Daniel Q; Garcia, Miki S; Eisen, Daniel B

    2012-07-15

    Scars sustained following injury in patients with darker skin types can present a treatment challenge. These scars often hyperpigment and may remain refractory to first line treatments such as topical retinoids and hydroquinone. Additionally, more aggressive treatment interventions such as ablative resurfacing, chemical peels, and Q-switched laser therapy may actually worsen the pigmentation. We describe a 22-year female with a hyperpigmented scar and Fitzpatrick type IV skin that improved markedly following treatment with a fractionated erbium doped fiber laser. The improvement was maintained at least 1 year following the last procedure.

  12. Rehabilitating slash pile burn scars in upper montane forests of the Colorado Front Range

    Treesearch

    Paula J. Fornwalt; Charles C. Rhoades

    2011-01-01

    Slash pile burning is widely conducted by land managers to dispose of unwanted woody fuels, yet this practice typically has undesirable ecological impacts. Simple rehabilitation treatments may be effective at ameliorating some of the negative impacts of pile burning on plants and soils. Here, we investigated: (1) the impacts of slash pile burning on soil nitrogen and...

  13. Efficacy of intense pulsed light for the treatment of burn scar dyschromias: a pilot study to assess patient satisfaction, safety, and willingness to pay.

    PubMed

    Hultman, Charles Scott; Friedstat, Jonathan S; Edkins, Renee E

    2015-06-01

    No treatment algorithms exist to reliably treat burn scar dyschromias. Intense pulsed light (IPL) has been used successfully to treat hyperpigmentation disorders, but has not been studied extensively in the treatment of burn scars. The purpose of this investigation was to assess clinical efficacy and patient satisfaction with IPL for the treatment of burn scar dyschromia. Patients with burn scar dyschromias were treated using the Lume 1 platform (Lumenis) to target pigmented lesions, using fluences between 10 and 22 joules/cm and filters ranging from 560 to 650 nm. At the conclusion of the study, providers assessed changes in burn scar dyschromia, whereas patients were queried regarding satisfaction and perceived efficacy, using a 1 to 5 Likert scale. The patients, who were not charged for the IPL treatment, were queried regarding willingness to pay. Twenty patients (mean age, 35.4 years; mean total body surface area, 27.6%; mean composite Fitzpatrick score, 3.9) underwent IPL treatment of burn scar dyschromias, an average of 3.2 years after injury. Mean fluence was 15.4 J/cm (range, 10-22 J/cm), and the most common filter used was 590 nm (range, 560-650 nm). Mean area treated was 90.7 cm, with a range of 4 to 448 cm. Complications included pain (4), hyperpigmentation (1), and blistering (2). Sixteen patients noted mild to moderate improvement, reporting a 4.5 for efficacy and a 4.4 for satisfaction. Regarding willingness to pay, patients would spend a mean of U.S. $7429 to completely remove their scars, but only a median of U.S. $350 to get the actual results that they received. Mean length of follow-up was 3.8 months, with a standard deviation of 2.2 months. Patients perceived IPL as an efficacious modality in the treatment of burn scar dyschromia, with a high level of satisfaction, despite the potential for morbidity. However, we are reluctant to recommend IPL for routine treatment of burn scar dyschromias, given only minimal improvement observed, potential for

  14. Care for the Critically Injured Burn Patient Modulation of Burn Scars Through Laser Assisted Delivery of Stem Cells

    DTIC Science & Technology

    2016-10-01

    treatment at higher settings (including Erbium:YAG). The PEGylated gel matrices could be providing several benefits (over direct application of stem...for cell delivery, whether in matrices or not. While photographs of burn wounds treated with Allogeneic BM-MSC in PEGylated gels showed some...mesenchymal stem cells over laser treated 3rd degree burn wounds. FY3 Goal – Determine if PEGylated matrices with or without chitosan can improve on the

  15. Care for the Critically Injured Burn Patient Modulation of Burn Scars Through Laser Deliver of Stem Cells

    DTIC Science & Technology

    2013-10-01

    expected to be consistent with a better cosmetic appearance and feel. This could be a limitation based on the penetration depth capable by these laser...able obtained by protein (only) isolation methods used in our laboratory. We therefore elected to process snap frozen tissue samples for protein...direct evidence that either CO2 or Erbium:YAG laser would be superior for cell delivery to scarred tissue. We therefore elected to use both lasers

  16. Palmar crease release and secondary full-thickness skin grafts for contractures in primary full-thickness skin grafts during growth spurts in pediatric palmar hand burns.

    PubMed

    Oh, Suk-Joon; Kim, Seon Gyu; Cho, Jin Kyung; Sung, Chang Min

    2014-01-01

    Pediatric palmar hand burns are a difficult problem because of the serious hand deformity, with functional impairment resulting from rapid growth. In cases of severe pediatric palmar hand burns, a secondary full-thickness skin graft after a primary full-thickness skin graft offers a reliable way of obtaining the required functional and aesthetic outcomes.This study retrospectively evaluated 28 children who required palmar crease releases and secondary full-thickness skin grafts during the past 12 years. The case records were reviewed for sex and age distributions, injury mechanism, and time interval between the primary and secondary full-thickness skin grafts. Surgical procedures included secondary full-thickness skin grafts and incisional releases of grafted skin on the involved creases. There were 19 men and 9 women. The mean age at the time of the burn injury was 10.1 months (range, 5-19 months). The mean age at the time of the secondary full-thickness skin graft was 8.3 years (range, 3-17 years). The most common mechanism of burn injury was steam (n = 24). The median time interval from the primary to the secondary full-thickness skin graft was 67 months (range, 8-156 months). The number of released creases was 81. The number of palmar web contractures in 23 patients was 52. A secondary full-thickness skin graft was more frequently necessary in patients with a primary full-thickness skin graft in the proximal digital crease and palmar web areas. All patients achieved adequate digital length and palmar web contour after surgery. Our patients should be observed until the rapid pubertal growth period.

  17. Before and After Photos: Treatment of Hypertrophic Scars

    MedlinePlus

    ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ... Surgery Conditions Acne Scars Aging Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids ...

  18. Recovery of small pile burn scars in conifer forests of the Colorado Front Range

    Treesearch

    Charles C. Rhoades; Paula J. Fornwalt; Mark W. Paschke; Amber Shanklin; Jayne L. Jonas

    2015-01-01

    The ecological consequences of slash pile burning are a concern for land managers charged with maintaining forest soil productivity and native plant diversity. Fuel reduction and forest health management projects have created nearly 150,000 slash piles scheduled for burning on US Forest Service land in northern Colorado. The vast majority of these are small piles (

  19. Combination of medical needling and non-cultured autologous skin cell transplantation (renovacell) for repigmentation of hypopigmented burn scars in children and young people.

    PubMed

    Busch, K H; Bender, R; Walezko, N; Aziz, H; Altintas, M A; Aust, M C

    2016-06-30

    Burn scars remain a serious physical and psychological problem for the affected. Clinical studies as well as basic scientific research have shown that Medical Needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, Medical Needling has no influence on repigmentation of large hypopigmented scars. The goal is to evaluate whether both established methods - Needling (improvement of scar quality) and ReNovaCell (repigmentation) - can be combined. So far, eight patients with mean age of 20 years (6-28 years) with deep second and third degree burn scars have been treated. The average treated tissue surface was 76cm² (15-250cm²) and was focused on areas like face, neck, chest and arm. Medical Needling is performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (ReNovaCell) is applied, according to the known protocol. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, and with patient and observer ratings. Patient satisfaction/preference was also obtained. We present the final study results. Taken together, pigmentation ratings and objective measures indicate improvement in six of the study participants. Melanin increase seen 12 months after ReNovaCell treatment in the study group as a whole is notable. Medical Needling in combination with ReNovaCell shows promise for repigmentation of burn scars.

  20. Combination of medical needling and non-cultured autologous skin cell transplantation (renovacell) for repigmentation of hypopigmented burn scars in children and young people

    PubMed Central

    Busch, K.H.; Bender, R.; Walezko, N.; Aziz, H.; Altintas, M.A.; Aust, M.C.

    2016-01-01

    Summary Burn scars remain a serious physical and psychological problem for the affected. Clinical studies as well as basic scientific research have shown that Medical Needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, Medical Needling has no influence on repigmentation of large hypopigmented scars. The goal is to evaluate whether both established methods – Needling (improvement of scar quality) and ReNovaCell (repigmentation) – can be combined. So far, eight patients with mean age of 20 years (6-28 years) with deep second and third degree burn scars have been treated. The average treated tissue surface was 76cm² (15-250cm²) and was focused on areas like face, neck, chest and arm. Medical Needling is performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (ReNovaCell) is applied, according to the known protocol. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, and with patient and observer ratings. Patient satisfaction/preference was also obtained. We present the final study results. Taken together, pigmentation ratings and objective measures indicate improvement in six of the study participants. Melanin increase seen 12 months after ReNovaCell treatment in the study group as a whole is notable. Medical Needling in combination with ReNovaCell shows promise for repigmentation of burn scars. PMID:28149233

  1. Rehabilitation of the burn patient

    PubMed Central

    Procter, Fiona

    2010-01-01

    Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration PMID:21321643

  2. Science You Can Use Bulletin: Slash from the past: Rehabilitating pile burn scars

    Treesearch

    Sue Miller; Chuck Rhoades; Liz Schnackenberg; Paula Fornwalt; Eric Schroder

    2015-01-01

    In the National Forests of northern Colorado, there is a backlog of over 140,000 slash piles slated to be burned, most of them coming from post-mountain pine beetle salvage logging and hazard reduction treatments. Burning slash piles can create openings in the forest that remain treeless for over 50 years, and can also have the short-term impacts of increasing nutrient...

  3. Anti-scar Treatment for Deep Partial-thickness Burn Wounds

    DTIC Science & Technology

    2016-10-01

    topically to deep partial-thickness burn wounds in two animal models. The long-term objective is to learn to effectively use pirfenidone with regard...to dosage, formulation and timing of treatment of burn wounds, such that animal studies will likely translate to the clinic. The objective of this...formulations at different dosing levels are reproducible. For animal studies, three batches of 40 g of the ointment formulation at each dose plus the

  4. Treatment of split-thickness skin graft-related forearm scar contractures with a carbon dioxide laser protocol: 3 case reports.

    PubMed

    Kroonen, Leo; Shumaker, Peter R; Kwan, Julia M; Uebelhoer, Nathan; Hofmeister, Eric

    2013-11-01

    Split-thickness skin grafts in the forearm can lead to motion restriction and disability through the dense scarring of the skin and formation of graft-tendon adhesions. Three patients were referred for laser treatment of motion-limiting scar-associated split-thickness skin grafts to the forearm. All patients had reached a plateau in range of motion despite aggressive hand therapy and underwent serial laser scar treatments at 6- to 8-week intervals. Treatments were performed in a clinic setting and were initiated 2 to 5 months after reconstructive surgery. Rapid subjective functional and objective improvements in range of motion were noted after laser therapy. Results were cumulative and durable at final follow-up ranging from 10 to 15 months after the initial treatment. No complications were noted. Fractionated carbon dioxide laser therapy is a promising adjunct to hand therapy when the main restraint to motion is superficial skin scarring and skin-tendon adhesions.

  5. In vivo label-free lymphangiography of cutaneous lymphatic vessels in human burn scars using optical coherence tomography

    PubMed Central

    Gong, Peijun; Es’haghian, Shaghayegh; Harms, Karl-Anton; Murray, Alexandra; Rea, Suzanne; Wood, Fiona M.; Sampson, David D.; McLaughlin, Robert A.

    2016-01-01

    We present an automated, label-free method for lymphangiography of cutaneous lymphatic vessels in humans in vivo using optical coherence tomography (OCT). This method corrects for the variation in OCT signal due to the confocal function and sensitivity fall-off of a spectral-domain OCT system and utilizes a single-scattering model to compensate for A-scan signal attenuation to enable reliable thresholding of lymphatic vessels. A segment-joining algorithm is then incorporated into the method to mitigate partial-volume effects with small vessels. The lymphatic vessel images are augmented with images of the blood vessel network, acquired from the speckle decorrelation with additional weighting to differentiate blood vessels from the observed high decorrelation in lymphatic vessels. We demonstrate the method with longitudinal scans of human burn scar patients undergoing ablative fractional laser treatment, showing the visualization of the cutaneous lymphatic and blood vessel networks. PMID:28018713

  6. In vivo label-free lymphangiography of cutaneous lymphatic vessels in human burn scars using optical coherence tomography.

    PubMed

    Gong, Peijun; Es'haghian, Shaghayegh; Harms, Karl-Anton; Murray, Alexandra; Rea, Suzanne; Wood, Fiona M; Sampson, David D; McLaughlin, Robert A

    2016-12-01

    We present an automated, label-free method for lymphangiography of cutaneous lymphatic vessels in humans in vivo using optical coherence tomography (OCT). This method corrects for the variation in OCT signal due to the confocal function and sensitivity fall-off of a spectral-domain OCT system and utilizes a single-scattering model to compensate for A-scan signal attenuation to enable reliable thresholding of lymphatic vessels. A segment-joining algorithm is then incorporated into the method to mitigate partial-volume effects with small vessels. The lymphatic vessel images are augmented with images of the blood vessel network, acquired from the speckle decorrelation with additional weighting to differentiate blood vessels from the observed high decorrelation in lymphatic vessels. We demonstrate the method with longitudinal scans of human burn scar patients undergoing ablative fractional laser treatment, showing the visualization of the cutaneous lymphatic and blood vessel networks.

  7. The Effects of Topical Agent (Kelo-Cote or Contractubex) Massage on the Thickness of Post-Burn Scar Tissue Formed in Rats

    PubMed Central

    Ko, Won Jin; Suh, Bum Sin; Kim, Hyeon A; Heo, Woo Hoe; Choi, Gum Ha; Lee, Seo Ul

    2013-01-01

    Background We conducted an experimental study to compare the effect of massage using topical agents (Kelo-cote or Contractubex) on scar formation by massaging the healed burn wound on the dorsal area of Sprague-Dawley (SD) rats. Methods Four areas of second degree contact burn were made on the dorsal area of each of 15 SD rats, using a soldering iron 15 mm in diameter. After gross epithelialization in the defect, 15 SD rats were randomly divided into four groups: the Kelo-cote group, Contractubex group, Vaseline group, and control group. Rats in three of the groups (all but the Control group) were massaged twice per day for 5 minutes each day, while those in the Control group were left unattended. For histologic analysis, we performed a biopsy and evaluated the thickness of scar tissue. Results In the Kelo-cote and Contractubex groups, scar tissue thicknesses showed a significant decrease, compared with the Vaseline and control groups. However, no significant differences were observed between the Kelo-cote and Contractubex groups. In the Vaseline group, scar tissue thicknesses showed a significant decrease, compared with the control groups. Conclusions The findings of this study suggest that massage using a topical agent is helpful in the prevention of scar formation and that massage only with lubricant (no use of a topical agent) also has a considerable effect, although not as much as the use of a topical agent. Thus, we recommend massage with a topical agent on the post-burn scar as an effective method for decreasing the scar thickness. PMID:24286041

  8. Combination of medical needling and non-cultured autologous skin cell transplantation (ReNovaCell) for repigmentation of hypopigmented burn scars.

    PubMed

    Busch, K H; Bender, R; Walezko, N; Aziz, H; Altintas, M A; Aust, M C

    2016-11-01

    Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm(2) (15-250cm(2)) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. A histological study on the effect of pressure therapy on the activities of myofibroblasts and keratinocytes in hypertrophic scar tissues after burn.

    PubMed

    Li-Tsang, Cecilia W P; Feng, Beibei; Huang, Lin; Liu, Xusheng; Shu, Bin; Chan, Yvonne T Y; Cheung, Kwok-Kuen

    2015-08-01

    Although pressure therapy (PT) has been widely used as the first-line treatment for hypertrophic scars (HS), the histopathological changes involved have seldom been studied. This study aimed to examine the longitudinal effect of PT on the histopathological changes in HS. Ten scar samples were selected from six patients with HS after burn and they were given a standardized PT intervention for 3 months while 16 scar samples were obtained on those without PT. The scar biopsies were collected pre-treatment, 1 and 3 months post-intervention for both clinical and histopathological examinations. Clinical assessments demonstrated significant improvement in the thickness and redness of the scars after PT. Histological examination revealed that cell density in the dermal layer was markedly reduced in the 3-months post-pressurized scar tissues, while the arrangement of the collagen fiber was changed from nodular to wave-like pattern. The α-smooth muscle actin immunoreactivity was significantly decreased after 1-month pressure treatment. There was a significant reduction of myofibroblasts population and a concomitant increase in the apoptotic index in the dermal layer in the 3-months' post-pressurized scars. A significant negative correlation was found between the myofibroblasts population and the apoptotic index. The keratinocyte proliferation was found inhibited after PT. Results demonstrated that PT appeared to promote HS maturation by inhibiting the keratinocyte proliferation and suppressing myofibroblasts population, the latter possibly via apoptosis. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  10. MiR-1908 promotes scar formation post-burn wound healing by suppressing Ski-mediated inflammation and fibroblast proliferation.

    PubMed

    Xie, Chunhui; Shi, Kai; Zhang, Xi; Zhao, Jingchun; Yu, Jiaao

    2016-11-01

    The cell biological basis for scar formation is mainly via excessive fibroblast proliferation accompanied by hypernomic Col I accumulation and inflammation. The role of miR-1908 in scar formation has not been investigated. In this study, we found that miR-1908 expression was inversely associated with the scar suppressor Ski in normal, burn-wounded, healing and scar dermal tissues in humans. Bioinformatics and luciferase reporter gene assays confirmed that miR-1908 targeted the 3'UTR region of Ski mRNA and suppressed Ski expression. Next, human scar epidermal fibroblasts were isolated and the miR-1908 oligonucleotide mimic and inhibitor were respectively transfected into the cells. Western blot analysis proved that Ski expression was sharply reduced by the miR-1908 mimic. MTT and Cell Counting Kit-8 analyses showed that miR-1908 mimic transfection promoted cell proliferation. Simultaneously, data on real-time qPCR analysis indicated that expression of the fibrotic master gene TGF-β1, Ski-suppressing gene Meox2, Col I and proinflammatory markers IL-1α and TNF-α, were all significantly upregulated. In contrast, the miR-1908 inhibitor had a completely opposite effect on cell proliferation and gene expression. The mimic and inhibitor were locally injected into rats with abdominal burn-wounded scars during a 180-day, post-healing experiment. The miR-1908 mimic injection significantly reduced Ski expression, as well as the area, volume and fibrosis of scars in vivo. And, in contrast, the miR-1908 inhibitor injection had an opposite effect to that of the miR-1908 mimic injection. In conclusion, miR-1908 had a positive role in scar formation by suppressing Ski-mediated inflammation and fibroblast proliferation in vitro and in vivo.

  11. Epidemiology of skin cancer arisen from the burn scars in Nigerian Ibos.

    PubMed

    Onuigbo, Wilson I B

    2006-08-01

    During the period 20 February 1970-19 February 2000, burns resulting in squamous cell carcinoma of the skin were documented by using a histopathology data pool of surgical specimens kept by the author as regards his Ibos ethnic group in Nigeria, West Africa. There were 21 cases. The males outnumbered the females in the ratio of 3:1. The youngest patient was aged 8 years and the oldest 75 years (mean age 39 years). Most of the antecedent injuries occurred during childhood. The two etiologic agents of albinism and burns were combined in one patient while another rarity was the presentation of the cancer within keloids. In conclusion, in dark skinned races, research should be directed on the comparative role of burns in predisposing to squamous cell carcinoma in individuals whose skin is compromised by either albinism or keloids.

  12. Race and Melanocortin 1 Receptor Polymorphism R163Q Are Associated with Post-Burn Hypertrophic Scarring: A Prospective Cohort Study.

    PubMed

    Sood, Ravi F; Hocking, Anne M; Muffley, Lara A; Ga, Maricar; Honari, Shari; Reiner, Alexander P; Rowhani-Rahbar, Ali; Gibran, Nicole S

    2015-10-01

    The genetic determinants of post-burn hypertrophic scarring (HTS) are unknown, and melanocortin 1 receptor (MC1R) loss-of-function leads to fibrogenesis in experimental models. To examine the associations between self-identified race and MC1R single-nucleotide polymorphisms (SNPs) with severity of post-burn HTS, we conducted a prospective cohort study of burned adults admitted to our institution over 7 years. Subjects were evaluated using the Vancouver Scar Scale (VSS), asked to rate their itching, and genotyped for 8 MC1R SNPs. Testing for association with severe HTS (VSS>7) and itch severity (0-10) was based on multivariate regression with adjustment for known risk factors. Of 425 subjects analyzed, 77% identified as White. The prevalence of severe HTS (VSS>7) was 49%, and the mean itch score was 3.9. In multivariate analysis, Asian (prevalence ratio (PR) 1.54; 95% CI: 1.13-2.10), Black/African American (PR 1.86; 95% CI: 1.42-2.45), and Native American (PR 1.87; 95% CI: 1.48-2.35) race were independently associated with severe HTS. MC1R SNP R163Q was also significantly (P<0.001) associated with severe HTS. Asian race (linear regression coefficient 1.32; 95% CI: 0.23-2.40) but not MC1R SNP genotype was associated with increased itch score. We conclude that MC1R genotype may influence post-burn scarring.

  13. Silk fibroin/gelatin electrospun nanofibrous dressing functionalized with astragaloside IV induces healing and anti-scar effects on burn wound.

    PubMed

    Shan, Ying-Hui; Peng, Li-Hua; Liu, Xin; Chen, Xi; Xiong, Jie; Gao, Jian-Qing

    2015-02-20

    Functional wound dressing has provided new challenges for researchers who focus on burn to improve skin graft quality, reduce scarring, and develop a pluristratified dermal or epidermal construct of a burn wound. This study aimed to investigate the effect of a silk fibroin/gelatin (SF/GT) electrospun nanofibrous dressing loaded with astragaloside IV (AS) on deep partial-thickness burn wound. AS-loaded SF/GT-blended nanofibrous dressing was prepared by electrospinning nanotechnology. The optimal ratio (25:75) of silk fibroin to gelatin was further optimized by evaluating ATR-FTIR characteristics, mechanical properties, porosity, swelling rate, degradation, and release profile of the AS-loaded SF/GT nanofibrous dressing. In contrast to the blank control, the AS-loaded SF/GT nanofibrous dressing promoted cell adhesion and proliferation with good biocompatibility in vitro (p<0.01). This dressing also accelerated wound healing and inhibited scar formation in vivo by stimulating wound closure (p<0.05), increasing angiogenesis, regulating newly formed types of collagen, and improving collagen organization. These results showed that SF/GT nanofibrous dressing is a promising topical drug delivery system. Furthermore, AS-functionalized SF/GT nanofibrous dressing is an excellent topical therapeutic that could be applied to promote healing and elicit anti-scar effects on partial-thickness burn wound. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. [Repairing severe cicatricial contracture deformity in web-space by kite-like incision combined with full-thickness skin grafting].

    PubMed

    Liang, Liming; Chai, Jiake; Jia, Xiaoming; Wang, Yirong; Meng, Suyu; Liu, Tao

    2012-12-01

    To investigate the effectiveness of repairing severe cicatricial contracture deformity in the web-space by kite-like incision combined with full-thickness skin grafting. Between June 2008 and September 2011, 31 patients (87 web-spaces) with severe cicatricial contracture deformities in the web-spaces were treated. There were 24 males and 7 females, aged 5-43 years (median, 22 years). The causes of injuries were flame burn (26 cases), scald (3 cases), electric arc burn (1 case), and chemical burn (1 case). The degree of burn was deep second degree (14 cases) and third degree (17 cases). The interval time from injury to operation was 10 months to 17 years (median, 2.2 years). The kite-like incision was marked on the scar in the web-space. The rhombic scar between the adjacent metacarpophalangeal joints was excised, and cicatricial contracture was released completely. The secondary wound in the web-space was repaired with full-thickness autogeneic skin grafting. The secondary wound at donor site was directly sutured. All full-thickness skin grafts survived well. The incisions at donor sites healed primarily. Of 31 patients, 29 (82 web-spaces) were followed up 6-18 months (mean, 13 months). The sizes and depths of reconstructed web-spaces were similar to those of normal ones. No secondary cicatricial contracture was observed, and the function of fingers recovered well. The short-term effectiveness is satisfactory by kite-like incision combined with full-thickness skin grafting for repairing severe cicatricial contracture deformities in the web-space, while the long-term effectiveness needs further observation.

  15. Estimation of Surface and Top-of-Atmosphere Shortwave Irradiance in Biomass-Burning Regions during SCAR-B.

    NASA Astrophysics Data System (ADS)

    Christopher, Sundar A.; Li, Xiang; Welch, Ronald M.; Reid, Jeffrey S.; Hobbs, Peter V.; Eck, Thomas F.; Holben, Brent

    2000-10-01

    Using in situ measurements of aerosol optical properties and ground-based measurements of aerosol optical thickness (s) during the Smoke, Clouds and Radiation-Brazil (SCAR-B) experiment, a four-stream broadband radiative transfer model is used to estimate the downward shortwave irradiance (DSWI) and top-of-atmosphere (TOA) shortwave aerosol radiative forcing (SWARF) in cloud-free regions dominated by smoke from biomass burning in Brazil. The calculated DSWI values are compared with broadband pyranometer measurements made at the surface. The results show that, for two days when near-coincident measurements of single-scattering albedo 0 and s are available, the root-mean-square errors between the measured and calculated DSWI for daytime data are within 30 W m2. For five days during SCAR-B, however, when assumptions about 0 have to be made and also when s was significantly higher, the differences can be as large as 100 W m2. At TOA, the SWARF per unit optical thickness ranges from 20 to 60 W m2 over four major ecosystems in South America. The results show that s and 0 are the two most important parameters that affect DSWI calculations. For SWARF values, surface albedos also play an important role. It is shown that 0 must be known within 0.05 and s at 0.55 m must be known to within 0.1 to estimate DSWI to within 20 W m2. The methodology described in this paper could serve as a potential strategy for determining DSWI values in the presence of aerosols. The wavelength dependence of s and 0 over the entire shortwave spectrum is needed to improve radiative transfer calculations. If global retrievals of DSWI and SWARF from satellite measurements are to be performed in the presence of biomass-burning aerosols on a routine basis, a concerted effort should be made to develop methodologies for estimating 0 and

  16. A fully automatic processing chain to produce Burn Scar Mapping products, using the full Landsat archive over Greece

    NASA Astrophysics Data System (ADS)

    Kontoes, Charalampos; Papoutsis, Ioannis; Herekakis, Themistoklis; Michail, Dimitrios; Ieronymidi, Emmanuela

    2013-04-01

    Remote sensing tools for the accurate, robust and timely assessment of the damages inflicted by forest wildfires provide information that is of paramount importance to public environmental agencies and related stakeholders before, during and after the crisis. The Institute for Astronomy, Astrophysics, Space Applications and Remote Sensing of the National Observatory of Athens (IAASARS/NOA) has developed a fully automatic single and/or multi date processing chain that takes as input archived Landsat 4, 5 or 7 raw images and produces precise diachronic burnt area polygons and damage assessments over the Greek territory. The methodology consists of three fully automatic stages: 1) the pre-processing stage where the metadata of the raw images are extracted, followed by the application of the LEDAPS software platform for calibration and mask production and the Automated Precise Orthorectification Package, developed by NASA, for image geo-registration and orthorectification, 2) the core-BSM (Burn Scar Mapping) processing stage which incorporates a published classification algorithm based on a series of physical indexes, the application of two filters for noise removal using graph-based techniques and the grouping of pixels classified as burnt to form the appropriate pixels clusters before proceeding to conversion from raster to vector, and 3) the post-processing stage where the products are thematically refined and enriched using auxiliary GIS layers (underlying land cover/use, administrative boundaries, etc.) and human logic/evidence to suppress false alarms and omission errors. The established processing chain has been successfully applied to the entire archive of Landsat imagery over Greece spanning from 1984 to 2012, which has been collected and managed in IAASARS/NOA. The number of full Landsat frames that were subject of process in the framework of the study was 415. These burn scar mapping products are generated for the first time to such a temporal and spatial

  17. A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds

    PubMed Central

    Munteanu, A; Florescu, IP; Nitescu, C

    2016-01-01

    Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes. PMID:27974941

  18. A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds.

    PubMed

    A, Munteanu; Ip, Florescu; C, Nitescu

    2016-01-01

    Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes.

  19. Spatial and temporal corroboration of a fire-scar-based fire history in a frequently burned ponderosa pine forest

    Treesearch

    Calvin A. Farris; Christopher H. Baisan; Donald A. Falk; Stephen R. Yool; Thomas W. Swetnam

    2010-01-01

    Fire scars are used widely to reconstruct historical fire regime parameters in forests around the world. Because fire scars provide incomplete records of past fire occurrence at discrete points in space, inferences must be made to reconstruct fire frequency and extent across landscapes using spatial networks of fire-scar samples. Assessing the relative accuracy of fire...

  20. Estimation of aerosol transport from biomass burning areas during the SCAR-B experiment

    NASA Astrophysics Data System (ADS)

    Trosnikov, Igor V.; Nobre, Carlos A.

    1998-12-01

    A transport model for the estimation of tracers spreading from biomass burning areas has been developed on the basis of the semi-Lagrangian technique. The model consists of a three-dimensional Lagrangian form transport equation for tracers and uses the quasi-monotone local cubic-spline interpolation for calculation of unknown values at irregular points. A mass-conserving property of the model is based on the flux-corrected transport method using the algorithm of Priestley. The transport of the smoke particles from Amazonia was simulated for the period from August 20 to 29, 1995. During this period the air mass located below 2 km moved to the south and carried the smoke particles until 30°S.

  1. Rehabilitation of burn patients: an underestimated socio-economic burden.

    PubMed

    Mirastschijski, Ursula; Sander, Jan-Thorben; Weyand, Birgit; Rennekampff, Hans-Oliver

    2013-03-01

    Patients with burns utilise intensive medical care and rehabilitation. Deep dermal burns lead to scar contractures. Virtually no published data exists on costs for treatment of acute burns in comparison to burn sequelae. Our purpose was to collect financial data on burn therapy to estimate the socio-economic burden of thermal injuries. German-DRG for in-patient treatment of burns was collected from our burn center. DRG-related T95.- coding served as a search tool for burn associated sequelae. To include rehabilitation costs, data from the largest health care insurance and a workmen compensation fund were acquired. Acute burn treatment comprised 92% of costs for intensive care with approximately 4.600 EUR per percent total burned surface area (TBSA). Expenses for non-intensive care patients were significantly lower than for burn sequelae. Rehabilitation expenses were 4.4-fold higher than costs for acute burns including 59% for manual therapy and 37% for auxiliary material. TBSA multiplied by factor 4600 could serve for cost calculation of severely burned patients. Approximately 0.3 billion EUR in total or 270.000 EUR per patient/year were spent on burn sequelae. Early admission to specialized burn centers is advocated with state-of-the-art treatment to minimize burn sequelae and health care expenses. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  2. Effect of extracorporeal shock wave therapy on scar pain in burn patients: A prospective, randomized, single-blind, placebo-controlled study.

    PubMed

    Cho, Yoon Soo; Joo, So Young; Cui, Huisong; Cho, Sung-Rae; Yim, Haejun; Seo, Cheong Hoon

    2016-08-01

    Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm (0.05-0.15 mJ/mm) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). ESWT significantly reduced scar pain in burn patients after wound recovery.

  3. [EFFECTIVENESS OF DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR FLAP FOR REPAIR OF PERINEAL AND PERIANAL CICATRICIAL CONTRACTURE].

    PubMed

    Du, Liping; You, Xiaobo; Tang, Kuangyun; Fu, Rong

    2015-08-01

    To discuss the effectiveness of deep inferior epigastric artery perforator flap to repair perineal and perianal cicatricial contracture. Between March 2007 and December 2013, 23 patients with perineal and perianal cicatricial contracture were treated with deep inferior epigastric artery perforator flap. There were 15 males and 8 females, aged from 21 to 62 years (mean, 42 years). Burn depth was III degree. The burning scars involved in the fascia, even deeper, which was rated as peripheral type (mild stenosis of the anal region and perianal cicatricial contracture) in 13 cases and as central type (severe stenosis of the anal region and anal canal with shift or defect of external genitalia) in 10 cases. All patients had limited hip abduction and squatting. Repair operation was performed at 3 months to 2 years (mean, 6 months) after wound healing. The size of soft tissue defects ranged from 10 cmx6 cm to 28 cm x 13 cm after scar excision and release. The size of flaps ranged from 12 cmx7 cm to 30 cmx15 cm. The donor site was sutured directly in 16 cases and repaired by autograft of skin in 7 cases. The flap had distal necrosis, distal cyanosis, and spotted necrosis in 1 case, 2 cases, and 1 case respectively, which were cured after symptomatic treatment; the other flaps survived and wound healed primarily. Twenty-one patients were followed up 6 months to 2 years (mean, 1 year). Nineteen patients had good appearance of the perinea and position of external genitalia, normal function of defecation function; stenosis of the anal region was relived, and the flaps had good texture and elasticity. Linear scar contracture was observed at the edge of flap in 2 cases, and the appearance of the perineum was restored after Z plasty. The hip abduction reached 30-40°. No abdominal hernia was found at donor site. Deep inferior epigastric artery perforator flap has stable blood supply and flexible design, which is similar to the perianal and perineal tissues. The good effectiveness

  4. Laser scar revision: A review.

    PubMed

    Khatri, Khalil A; Mahoney, Danielle L; McCartney, Melissa J

    2011-04-01

    Surgery, burns, wounds, and inflammatory processes can lead to the development of a variety of different scars. Scars are categorized as hypertrophic, keloid, atrophic and acne scars. Different treatments are utilized for each scar type. The evolution of scar treatment has led to the advancement of lasers for the improvement of all scar types. Non-ablative lasers such as the pulsed dye laser have been shown to be effective in the treatment of hypertrophic and erythematous scars. Ablative lasers, the carbon dioxide (CO(2)) and erbium:YAG (Er:YAG), were some of the first lasers that were proven to be effective in the treatment of atrophic acne scars. Further developments in laser technology have led to non-ablative and ablative fractional devices that improve scar appearance and are better tolerated than ablative CO(2) and Er:YAG. This article will review scars and the laser options for scar revision.

  5. Reconstruction of severe hand contractures: An illustrative series

    PubMed Central

    Tucker, S. C.

    2011-01-01

    Aim: An overview of a series of severe burn contractures in 44 hands reconstructed over a 20 month period with an easy to follow algorithm. Settings and Design: The series was carried out by a single surgeon at Green Pastures Rehabilitation Centre in Pokhara, Nepal. All patients attending with severe burn contractures to the hand were included in the series. Materials and Methods: This is a retrospective review of burn contractures in a total of 44 hands. All the contractures involved limitation of movement by 60 degrees in two or more joints or by 80 degrees in one joint. The decision making process is presented as a flow chart indicating when and which flaps were used. Results: Illustrations demonstrate what was achieved, with all hands obtaining an improvement in function. Conclusions: Although many of these contractures can be dealt with by skin grafting the series clearly illustrates the indications for flap coverage. PMID:21713162

  6. Mechanobiology of scarring.

    PubMed

    Ogawa, Rei

    2011-09-01

    The mechanophysiological conditions of injured skin greatly influence the degree of scar formation, scar contracture, and abnormal scar progression/generation (e.g., keloids and hypertrophic scars). It is important that scar mechanobiology be understood from the perspective of the extracellular matrix and extracellular fluid, in order to analyze mechanotransduction pathways and develop new strategies for scar prevention and treatment. Mechanical forces such as stretching tension, shear force, scratch, compression, hydrostatic pressure, and osmotic pressure can be perceived by two types of skin receptors. These include cellular mechanoreceptors/mechanosensors, such as cytoskeleton (e.g., actin filaments), cell adhesion molecules (e.g., integrin), and mechanosensitive (MS) ion channels (e.g., Ca(2+) channel), and sensory nerve fibers (e.g., MS nociceptors) that produce the somatic sensation of mechanical force. Mechanical stimuli are received by MS nociceptors and signals are transmitted to the dorsal root ganglia that contain neuronal cell bodies in the afferent spinal nerves. Neuropeptides are thereby released from the peripheral terminals of the primary afferent sensory neurons in the skin, modulating scarring via skin and immune cell functions (e.g., cell proliferation, cytokine production, antigen presentation, sensory neurotransmission, mast cell degradation, vasodilation, and increased vascular permeability under physiological or pathophysiological conditions). Mechanoreceptor or MS nociceptor inhibition and mechanical force reduction should propel the development of novel methods for scar prevention and treatment. © 2011 by the Wound Healing Society.

  7. [Unusual breast scars].

    PubMed

    Petit, F; Divaris, M; Guilbert, F

    1999-12-01

    The authors report the case of an unusual form of skin tattoo, discovered on the breasts of a young woman, corresponding to several scars forming a symbolic image, performed deliberately with a burning object. This form of mutilation is called "branding". Imported from England, it is developing in France as a result of fashion, but its followers could one day regret the permanent scars left by this deep burn.

  8. [Effects of different artificial dermal scaffolds on vascularization and scar formation of wounds in pigs with full-thickness burn].

    PubMed

    Teng, Jian-ying; Guo, Rui; Xie, Jing; Sun, Dong-jie; Shen, Ming-qiang; Xu, Shao-jun

    2012-02-01

    To investigate the effects of three kinds of artificial dermal scaffolds on vascularization and scar formation of wounds in pigs with full-thickness burn. Eighteen Bama miniature pigs were divided into chitosan scaffold (CS) group, sulfonated carboxymethyl chitosan scaffold (SCCS) group, and acellular dermal matrix (ADM) scaffold group according to the random number table, with 6 pigs in each group. Every pig in all groups was inflicted with 4 or 8 full-thickness scald wounds on the back (totally 96 wounds). Forty-eight hours after injury, eschars of all wounds were excised. Twenty-four wounds in CS group were transplanted with double-layer artificial dermis of collagen-chitosan and silicone rubber, those in SCCS group with double-layer artificial dermis of collagen-sulfonated carboxymethyl chitosan and silicone rubber, and those in ADM scaffold group with ADM. The rest 24 wounds in the three groups were dressed with vaseline gauze as control group. After 2 weeks of treatment, all wounds of every group were covered with skin. In post treatment (scaffold transplantation or gauze covering) week (PTW) 1, 2, 3, and 4, gross condition of wound was observed, and specimens from central parts of wounds were harvested for observation and assessment of vessels or cells with positive expression of CD31, α smooth muscle actin (α-SMA), TGF-β(1) and TGF-β(3) with SP staining. Data were processed with one-way analysis of variance and LSD test. (1) Degree of vascularization in SCCS group was better than that in the other three groups. (2) The number of vessels with positive expression of CD31 in CS, SCCS, ADM scaffold, and control groups increased gradually from PTW 1 to PTW 3, and decreased in PTW 4. There were statistical differences among 4 groups from PTW 1 to PTW 4 (with F value respectively 24.005, 38.822, 25.274, 3.856, P < 0.05 or P < 0.01). The numbers of vessels that expressed CD31 in SCCS group from PTW 1 to PTW 3 were more than those in the other three groups (with

  9. Assessing the Potential Impact of the 2015-2016 El Niño on the California Rim Fire Burn Scar Through Debris Flow Hazard Mapping

    NASA Astrophysics Data System (ADS)

    Larcom, S.; Grigsby, S.; Ustin, S.

    2015-12-01

    Wildfires are a perennial issue for California, and the current record-breaking drought is exacerbating the potential problems for the state. Fires leave behind burn scars characterized by diminished vegetative cover and abundant bare soil, and these areas are especially susceptible to storm events that pose an elevated risk of debris flows and sediment-rich sheet wash. This study focused on the 2013 Rim Fire that devastated significant portions of Stanislaus National Forest and Yosemite National Park, and utilized readily available NASA JPL SRTM elevation data and AVIRIS spectral imaging data to construct a debris flow hazard map that assesses mass wasting risk for the Rim Fire burn scar. This study consisted entirely of remotely sensed data, which was processed in software programs such as ENVI, GRASS GIS, ArcMap, and Google Earth. Parameters that were taken into consideration when constructing this map include hill slope (greater than 30 percent rise), burn severity (assessed by calculating NDVI), and erodibility of the soil (by comparing spectral reflectance of AVIRIS images with the reference spectra of illite). By calculating percent of total burn area, 6% was classified as low risk, 55% as medium risk, and 39% as high risk. In addition, this study assessed the importance of the 2015-2016 El Niño, which is projected to be one of the strongest on record, by studying historic rainfall records and storm events of past El Niño's. Hydrological and infrastructural problems that could be caused by short-term convective or long-term synoptic storms and subsequent debris flows were explored as well.

  10. In-vivo cutaneous burn characterization and scar assay with multi-functional optical coherence tomography (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Kim, Bumju; Yoon, Yeorum; Le, Viet-Hoan; Yoon, Calvin J.; Kim, Ki Hean

    2016-03-01

    Research about the cutaneous burn was separated by assessment of burn depth and development of wound healing therapy. Various in vivo optical techniques were used to determined burn depth and observe the wound healing process. In this paper, we report the usage of multimodal optical coherence tomography system, which containing angiographic and polarization sensitive OCT (PS-OCT) with conventional OCT system, at burn studies. Burn was induced at 4 different degrees by control the attachment time of 75 Celsius degree heated brass rod at dorsal skin of the rat. For the burn depth assessment, we imaged the different burn degrees area. Changes of polarization sensitive signal were providing burn depth information. To see the wound healing process, each wound area imaged at long period. Conventional OCT shows the structural information about the tissue, like layer and hair follicle. Angiographic OCT provides vascular distribution and diameter of blood vessel information and PS-OCT shows birefringence tissue information. Based on the multimodal OCT data, burn depth assessment were well matched with burn induced time and wound healing process was consistent with previous wound healing report. Therefore, the multimodal OCT holds potential for burn study.

  11. Pressure therapy in the treatment of post-burn hypertrophic scar--a critical look into its usefulness and fallacies by pressure monitoring.

    PubMed

    Cheng, J C; Evans, J H; Leung, K S; Clark, J A; Choy, T T; Leung, P C

    1984-02-01

    Pressure therapy is generally accepted as the best noninvasive means of preventing and controlling hypertrophic scarring after burn injury. Most studies in the past have failed to correlate clinical response with magnitude of the garment-scar interface pressure. This study looked critically at our usual techniques of pressure therapy using pressure 'sensors' manufactured locally and based on electro-pneumatic principles. Many pitfalls, such as large variations of pressure at different geometric sites on the body, elastic deterioration in garments, problems of garment manufacture, and the unfavourable properties of the Lycra garments, were observed. Recommendations on pressure treatment were made based on our experiences, to improve the present technique of pressure therapy. These included the standardization of measurement techniques and garment tailoring, the regular checking of pressure at the garment-scar interface using pressure transducers, the appropriate garment adjustments, a strict regimen for garment wearing, and the intelligent use of pressure-padding and reinforcement. Areas of further research are also discussed.

  12. OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS' EXPERIENCE.

    PubMed

    Rrecaj, Shkurta; Hysenaj, Hajrie; Martinaj, Merita; Murtezani, Ardiana; Ibrahimi-Kacuri, Dafina; Haxhiu, Bekim; Buja, Zene

    2015-12-01

    Burn injuries in hands are much more complex and the appearance of contractures is a common complication. Hand burn injuries often result in limited functionality, flexion and extension of fingers and present a major hindrance in rehabilitation. The aim of physical therapy and splinting after hand burn injury is to maintain mobility, prevent the development of the contracture and to promote the functionality of hand and good cosmetic results. The purpose of this study is to presents our experience of 38 children with hand burn injuries, admitted and treated at the Department of Plastic Surgery, UCCK-Pristina, Kosovo, during the years 2012-2015. Physical therapy is focused on active/passive range of motion in affected joints, management of cicatrix, strengthening exercise, coordination and use of splints for correction contractures. Patients were evaluated in three, six months and the definitive evaluation is done after 9 months of physical therapy and splinting. We have improvement in range of motion (ROM), functionality, coordination, muscle force, decrease of keloids scars. This study shows the importance of physical therapy and splinting, achieving good results in preventing contracture, improving range of motion, muscle force and good cosmetic results.

  13. Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand

    PubMed Central

    Kasdan, Morton L.; Wilhelmi, Bradon J.

    2016-01-01

    Background: The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function. We report a case in which surgical reconstruction of a volar hand burn was performed with full-thickness skin grafting. The patient had a 40-year follow-up to assess the function and cosmesis of the repaired hand. Methods: We report a case in which a 15-month-old boy presented after receiving third-degree burns to the left volar hand, including the flexural aspects of the index, long, and ring fingers by placing it on a hot kitchen stove burner. The patient subsequently underwent scar contracture release and full-thickness skin grafting. Results: Eleven years after reconstruction, further contractures developed associated with the patient's growth, which were reconstructed with repeat full-thickness skin graft from the inguinal region. No recurrence was witnessed afterward and 40 years after initial injury, the patient maintains full activities of daily living and use of his hand in his occupation. Conclusions: There is debate regarding the superiority of split-thickness versus full-thickness grafts during reconstruction. Our case strengthens the argument for durability of a full-thickness skin graft following thermal burn injury. PMID:27555888

  14. Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand.

    PubMed

    Weeks, Dexter; Kasdan, Morton L; Wilhelmi, Bradon J

    2016-01-01

    The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function. We report a case in which surgical reconstruction of a volar hand burn was performed with full-thickness skin grafting. The patient had a 40-year follow-up to assess the function and cosmesis of the repaired hand. We report a case in which a 15-month-old boy presented after receiving third-degree burns to the left volar hand, including the flexural aspects of the index, long, and ring fingers by placing it on a hot kitchen stove burner. The patient subsequently underwent scar contracture release and full-thickness skin grafting. Eleven years after reconstruction, further contractures developed associated with the patient's growth, which were reconstructed with repeat full-thickness skin graft from the inguinal region. No recurrence was witnessed afterward and 40 years after initial injury, the patient maintains full activities of daily living and use of his hand in his occupation. There is debate regarding the superiority of split-thickness versus full-thickness grafts during reconstruction. Our case strengthens the argument for durability of a full-thickness skin graft following thermal burn injury.

  15. Microbial community structure and activity in a Colorado Rocky Mountain forest soil scarred by slash pile burning

    Treesearch

    Aida E. Jimenez Esquilin; Mary E. Stromberger; William J. Massman; John M. Frank; Wayne D. Shepperd

    2007-01-01

    Tree thinning and harvesting produces large amounts of slash material which are typically disposed of by burning, often resulting in severe soil heating. We measured soil chemical properties and microbial community structure and function over time to determine effects of slash pile burning in a ponderosa pine forest soil. Real time data were collected for soil...

  16. Clinical outcomes from a foam wedge splinting program for axillary contracture prevention in the intensive care unit.

    PubMed

    Godleski, Matthew; Holden, Mary Sullivan; Luby, Darcie; Weitzenkamp, David; Boimbo, Sandra; Lindberg, Gordon

    2014-01-01

    Preventing scar contracture after burn injury is a critical goal during recovery. Although the need for intervention is well-understood, data on specific techniques are limited. The study's objective is to provide data for the use of a foam abduction wedge in terms of safety, effectiveness, and patient and caregiver satisfaction through a prospective, single-arm trial. All patients presenting with a burn injury that required grafting in the axillary region and placed them at risk for shoulder joint contracture were offered inclusion. Patient outcomes were recorded for the duration of their burn intensive care unit admission. Ten subjects completed the protocol with a mean duration of wedge use of 41.5 ± 32.5 days. At discharge, the mean shoulder abduction was 132° ± 38° on the left and 118° ± 22° on the right. The mean shoulder flexion was 132° ± 31° on the left and 123° ± 29° on the right. As much as 90% of the subjects had greater than 90° of shoulder abduction and flexion at discharge. There were no observations of worsening burn injury wounds, graft failure, or new pressure-related wounds. One patient was found to have an upper-extremity peripheral nerve injury that was not clearly associated with the splint. Patient and nursing surveys indicated areas of satisfaction as well as areas for potential improvement. This study illustrates the anticipated clinical outcomes and care issues associated with the use of a specific contracture prevention method used in the burn intensive care unit setting as well as identifying areas for future research.

  17. Study on Surgical Management of Post Burn Hand Deformities

    PubMed Central

    Ahmed, Firdos; Jash, Prabir Kumar; Gupta, Madhumita; Suba, Santanu

    2015-01-01

    Context Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. Aim The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. Settings and Design It’s a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. Materials and Methods Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. Results Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. Conclusion Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases. PMID:26435994

  18. [Reconstruction of postburn popliteal fossa contractures using popliteal fossa middle artery pedicled flaps in children].

    PubMed

    Wei, Zairong; Sun, Guangfeng; Tang, Xiujun; Deng, Chengliang; Jin, Wenhu; Wang, Dali; Wang, Bo

    2012-08-01

    To investigate the characteristics of blood supply of popliteal fossa middle artery pedicled flaps and the feasibility of reconstruction of postburn popliteal fossa contractures using the flaps in children. Between January 2008 and October 2010, 6 cases of postburn popliteal fossa contractures were recontructed using popliteal fossa middle artery pedicled flaps. Of them, 2 were boys and 4 were girls, aged from 2 years and 2 months to 10 years. All burns were caused by hot water. The wound ranged from 5 cm x 4 cm to 10 cm x 8 cm after scar relaxation. The size of the flap ranged from 6 cm x 4 cm to 11 cm x 9 cm. Donor sites were covered with split-thickness skin graft in 5 cases, and sutured directly in 1 case. All the flaps and the skingraft survived; no vascular crisis or flap necrosis occurred. All incisions at donors and wounds healed by first intention. All patients were followed up 12-24 months. The color, texture, and appearance of the flaps were good. Hyperplastic scar was found at incision of popliteal fossa in 1 case at 6 months after operation; the range of motion (ROM) of the knee joint was 0-175 degrees, and no obvious change was observed at 15 months after operation. The others had no functional disturbance of the knee joints or claudication; the ROM of the knee joint was 0-180 degrees. The popliteal fossa middle artery pedicled flap has reliable blood supply, simple operative procedure, and good results in reconstruction of popliteal fossa contracture.

  19. The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis

    PubMed Central

    Ai, Jin-Wei; Liu, Jiang-tao; Pei, Sheng-Duo; Liu, Yu; Li, De-Sheng; Lin, Hong-ming; Pei, Bin

    2017-01-01

    Although pressure therapy (PT) represents the standard care for prevention and treatment of hypertrophic scar (HS) from burns, its practice is largely based on empirical evidence and its effectiveness remains controversial. To clarify the effect of PT (15–25 mmHg) for HS, we performed the systematic review and meta-analysis. Several electronic databases were screened to identify related randomized controlled trials (RCTs). 12 RCTs involving 710 patients with 761 HS resulting from burn injuries were included. Compared with non/low-PT, cases treated with PT (15–25 mmHg) showed significant differences in Vancouver Scar Scale score (MD = −0.58, 95% CI = −0.78–−0.37), thickness (SMD = −0.25, 95% CI = −0.40–−0.11), brightness (MD = 2.00, 95% CI = 0.59–3.42), redness (MD = −0.79, 95% CI = −1.52–−0.07), pigmentation (MD = −0.16, 95% CI = −0.32–−0.00) and hardness (SMD = −0.65, 95% CI = −1.07–−0.23). However, there was no difference in vascularity (MD = 0.03, 95% CI = −0.43–0.48). Our analysis indicated that patients with HS who were managed with PT (15–25 mmHg) showed significant improvements. Due to limitations, more large and well-designed studies are needed to confirm our findings and the side-effects of the PT may also need to be evaluated. PMID:28054644

  20. Burns

    MedlinePlus

    ... clothing, except clothing imbedded in the burn. Run cool - not cold - water over the burn or hold ... chemicals should be flushed off affected areas with cool running water for 20 minutes or longer or ...

  1. Burns

    MedlinePlus

    ... occur by direct or indirect contact with heat, electric current, radiation, or chemical agents. Burns can lead to ... is. The burn is caused by chemicals or electricity. The person shows signs of shock . The person ...

  2. Severe burn injuries: acute and long-term treatment.

    PubMed

    Spanholtz, Timo A; Theodorou, Panagiotis; Amini, Peymaneh; Spilker, Gerald

    2009-09-01

    The physician that initially sees a patient with an extensive and deep dermal burn injury must be able to provide initial acute treatment and to make a well-founded decision whether to have the patient transported to a burn care center (BCC). Physicians from a variety of specialities will be involved in the management of long-term sequelae. This article provides an overview of the treatment of severe burns and their commonest complications. Special attention is paid to initial emergency treatment (first aid) and to late complications, because physicians from multiple specialties are often involved in these phases of treatment. The data and guidelines that are summarized here were obtained through a selective Medline search and supplemented by the authors' experience in their own burn care center. Analgesia, careful fluid balance, and early intubation are important elements of the initial emergency treatment. Long-term complications of burns, such as disfiguring scars on exposed areas of skin and functionally significant contractures, often require surgical treatment. Early measures for scar care may improve the outcome. The effective treatment of severe burns is interdisciplinary, involving general practitioners and emergency physicians as well as plastic surgeons and physicians of other specialties. Knowledge of the basic principles of treatment enables physicians to care for patients with burns appropriately both in the acute setting and in the long term.

  3. Incidence of postoperative elbow contracture release in New York State.

    PubMed

    Schrumpf, Mark A; Lyman, Stephen; Do, Huong; Schreiber, Joseph J; Gay, David M; Marx, Robert; Daluiski, Aaron

    2013-09-01

    To determine the incidence of elbow contracture requiring release after surgically treated elbow trauma and to identify patient, injury, and treatment factors that may predict contracture development. The New York Statewide Planning and Research Cooperative System database identified 32,708 patients who were surgically treated for elbow trauma from 1997 to 2009. The database identified 270 of those patients who underwent subsequent contracture release. The median time from index fracture procedure to contracture release was 31 weeks. Patients requiring a contracture release were younger (43 vs 56 y) and more commonly male (57%). Injuries classified as severe were more common in the contracture group (11% vs 5%), as were open fractures (17% vs 11%). A multivariate regression analysis revealed that patients with burns were 16 times more likely to require surgical contracture release, and the use of internal fixation to treat the fracture was protective against contracture development. The incidence of elbow contractures treated with release after surgically treated elbow trauma was low but increased with the severity of the initial trauma. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand: Technique, hand function assessment and aesthetic outcomes.

    PubMed

    Byrne, Miriam; O'Donnell, Michelle; Fitzgerald, Lisa; Shelley, Odhran P

    2016-03-01

    Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in secondary burn reconstruction. The aim of this study was to review our experience with autologous fat transfer in relation to hand function, scarring and cosmesis, in patients undergoing secondary reconstruction after burns. Retrospective analysis of burn patients (2010-2013) who underwent autologous fat transfer to improve scarring, contour deformity and/or scar contracture was performed. Hand function was assessed using grip strength measurement, Total Active Movement (TAM), the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Patients' satisfaction was assessed using the Patient Observer Scar Assessment Scale (POSAS). Thirteen patients were included in this analysis. The average time from burns and from fat transfer were 2.3 years (10 months-3.9 years) and 9.1 months (3 months-1.3 years), respectively. There was a statistically significant improvement in TAM measurement. The total score, activity of daily living score and satisfaction score of the MHQ also statistically increased following fat transfer. The changes in function score, work score and pain score of the MHQ were not significant. Grip strength measurement and DASH score did not show improvement. For scar assessment, total score and overall score of POSAS improved significantly. Similarly, scores for scar colour, scar thickness, scar stiffness and scar regularity increased significantly. Autologous fat transfer directly replaces volume loss in the subcutaneous layer, physically releases tethered skin from underlying tissues and exerts downstream regenerative effects. Skin quality improvements combined with replacement of the subcutaneous adipose volume in the hand reduces overall scar tightness and tissue tethering and has the potential to enhance hand therapy. In our series, modest improvement in range of movement, scar

  5. Experience with corrective surgery for postburn contractures in Mumbai, India.

    PubMed

    Kim, Francis S; Tran, Huong H; Sinha, Indranil; Patel, Anup; Nelson, Rebecca A; Pandya, Ankur N; Keswani, Sunil; Watkins, James F

    2012-01-01

    Postburn contracture is a source of significant morbidity in India, even though its occurrence can be reduced significantly by comprehensive postburn injury care, including surgical intervention. This study investigates whether limited access to initial medical care after burn injury has been associated with increased contracture formation among lower socioeconomic class patients in Mumbai, India. During a surgical mission in Mumbai, India, patients presenting with functionally debilitating burn contractures and minimal income were surveyed for initial care received immediately after burn injury. The survey consisted of questions regarding the history of burn injury and details of any initial treatment. Demographic data were collected by chart review. Thirty-eight patients from the state of Maharashtra participated in the study (mean age 28.1 years). The most common etiology of burn injury was from kerosene stove blasts (74%), and the most common morbidities were contractures of the neck and upper extremity. On average, time elapsed since the original injury was 2.8 years. Nearly all patients sought initial medical care at hospitals (97%) with the majority receiving only dressing changes for their full-thickness or deep-dermal burns (61%). The most common reason for not seeking out delayed burn reconstruction was perceived cost (65%). Ultimately, 60 operations were performed, of which 9 (15%) developed postsurgical complications. These data suggest that a subset of lower socioeconomic class burn patients in Maharashtra received suboptimal initial intervention. Comprehensive initial therapy after burn injury may provide better outcomes and limit the number of patients requiring delayed reconstruction.

  6. Addition of platelet concentrate to dermo-epidermal skin graft in deep burn trauma reduces scarring and need for revision surgeries.

    PubMed

    Prochazka, Vaclav; Klosova, Hana; Stetinsky, Jiri; Gumulec, Jaromir; Vitkova, Katerina; Salounova, Dana; Dvorackova, Jana; Bielnikova, Hana; Klement, Petr; Levakova, Veronika; Ocelka, Tomas; Pavliska, Lubomir; Kovanic, Pavel; Klement, Giannoula Lakka

    2014-06-01

    [corrected] Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues. We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses. We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings. Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1-3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1-7 days), which normalized over the subsequent 7 and 90 days.

  7. Scarring, stem cells, scaffolds and skin repair.

    PubMed

    Markeson, Daniel; Pleat, Jonathon M; Sharpe, Justin R; Harris, Adrian L; Seifalian, Alexander M; Watt, Suzanne M

    2015-06-01

    The treatment of full thickness skin loss, which can be extensive in the case of large burns, continues to represent a challenging clinical entity. This is due to an on-going inability to produce a suitable tissue engineered substrate that can satisfactorily replicate the epidermal and dermal in vivo niches to fulfil both aesthetic and functional demands. The current gold standard treatment of autologous skin grafting is inadequate because of poor textural durability, scarring and associated contracture, and because of a paucity of donor sites in larger burns. Tissue engineering has seen exponential growth in recent years with a number of 'off-the-shelf' dermal and epidermal substitutes now available. Each has its own limitations. In this review, we examine normal wound repair in relation to stem/progenitor cells that are intimately involved in this process within the dermal niche. Endothelial precursors, in particular, are examined closely and their phenotype, morphology and enrichment from multiple sources are described in an attempt to provide some clarity regarding the controversy surrounding their classification and role in vasculogenesis. We also review the role of the next generation of cellularized scaffolds and smart biomaterials that attempt to improve the revascularisation of artificial grafts, the rate of wound healing and the final cosmetic and functional outcome.

  8. Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up.

    PubMed

    Hirche, C; Senghaas, A; Fischer, S; Hollenbeck, S T; Kremer, T; Kneser, U

    2016-02-01

    Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis. In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire. No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14. The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  9. Esthetic and functional reconstruction for burn deformities of the lower lip and chin with free radial forearm flap.

    PubMed

    Lee, Jong-Wook; Jang, Young-Chul; Oh, Suk-Joon

    2006-04-01

    Burn injury often has produced deformity both of contours and cover in face and neck. Hypertrophic burn scar contracture of the lower face and neck is one of the most difficult subjects to solve because it produces problems with function and appearance. In planning the correction, the restoration of normal form and function is the best way in reconstruction. From January 1998 to January 2002, we had 7 patients who had scar contractures of the lower face and neck. We reconstructed their deformities with free radial forearm flap and skin graft. We could get restoration of the facial form to normal shape, position, and quality of the facial skin cover homogeneity. No remarkable complications have been found in all 7 patients. For better outcomes, there are some considerations. The lowest margin of the flap should be limited to at least 1 finger breadth above the hyoid bone because low setting of the flap may deteriorate the cervicomental angle. The skin graft is undertaken in the cervical region. Adhesion between the flap dermis and wound bed may be necessary for reconstruction of the labiomental sulcus. Burn deformities of the lower face and neck area were resurfaced with free radial forearm flap and skin graft. Flaps did not look completely normal, but those were compatible with the adjacent skin. We could have an adequate functional resurfacing and optimal esthetic outcomes while minimizing recurrent contractures.

  10. A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities.

    PubMed

    As'adi, Kamran; Emami, Seyed Abolhassan; Salehi, Seyed Hamid; Shoar, Saeed

    2016-08-01

    Tissue expansion has evolved reconstruction surgery by providing a great source of additional tissue for large skin defects. Nevertheless, wide application of tissue expander reconstruction is challenging due to high complication rates and uncertainty about final outcomes. Recently, endoscopy has shown promise in reconstructive surgeries using tissue expander placement. This study aimed to compare outcomes between open and endoscopic-assisted neck tissue expander placement in reconstruction of post-burn facial scar deformities. Through a randomized clinical trial, 63 patients with facial burn scars were assigned to an open group or endoscopic group for placement of 81 tissue expanders. The complication rate, operative time, length of hospital stay, and time to full expansion were compared between the two groups. Thirty-one patients were assigned to the open group and 32 patients to the endoscopic group. The average operative time was significantly reduced in the endoscopic group compared with the open group (42.2 ± 3.6, 56.5 ± 4.5 min, p < 0.05). The complication rate was significantly lower in the endoscopic group than the open group (6 vs. 16, p < 0.05). Hospital stay was also significantly diminished from 26.3 ± 7.7 h in open group to 7.4 ± 4.5 h in endoscopic group (p < 0.0001). There was a significant reduction in time to full expansion in the endoscopic group as compared with the open group (93.5 ± 10.2 vs. 112.1 ± 14.2 days, p = 0.002). Endoscopic neck tissue expander placement significantly reduced operative time, the postoperative complication rate, length of hospital stay, and time to achieve full expansion and allowed early initiation of expansion and remote placement of the port in relation to the expander pocket. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to

  11. Management of the Acutely Burned Hand.

    PubMed

    Pan, Brian S; Vu, Anthony T; Yakuboff, Kevin P

    2015-07-01

    Despite contributing a small percentage to the total body surface area, hands are the most commonly burned body part and are involved in over 90% of severe burns. Although the mortality of isolated hand burns is negligible, morbidity can be substantial given our need for functioning hands when performing activities of daily living. The greatest challenges of treating hand burns are 2-fold. First, determining the depth of injury can be difficult even for the most experienced surgeon, but despite many diagnostic options, clinical examination remains the gold standard. Second, appropriate postoperative hand therapy is crucial and requires a multidisciplinary approach with an experienced burn surgeon, hand surgeon, and hand therapist. Ultimately, the goals of treatment should include preservation of function and aesthetics. In this review, we present an approach to the management of the acutely burned hand with discussion of both conservative and surgical options. Regardless of the initial treatment decision, subsequent care for this subset of patients should be aimed at preventing debilitating postburn scar contractures that can severely limit hand function and ultimately require reconstructive surgery. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Safety and efficacy of excision and direct closure in acute burns surgery: outcome analysis in a prospective series of 100 patients and a survey of UK burns surgeons' attitudes.

    PubMed

    Bain, Charles J; Wang, Tim; McArthur, Gordon; Williams, Greg; Atkins, Joanne; Jones, Isabel

    2014-12-01

    Many burns surgeons avoid excision and direct closure of acute burns owing to concerns over wound dehiscence, scarring and infection. There is no evidence in the literature to support this practice. We present outcomes of a prospective series of 100 patients who underwent excision and direct closure of 138 burns over a 2-year period, along with results from a survey sent to 33 senior burns surgeons to gauge attitudes towards direct closure in burns surgery. 47% of survey respondents never perform direct closure. Dehiscence was cited as the most common concern, followed by hypertrophic scarring (HTS). In our cohort, the superficial dehiscence rate was 12% and the HTS rate was 16%, with no scarring contractures. Patients with healing time greater than 14 days were more likely to develop HTS (p=0.008), as were those with wound dehiscence (p=0.014). Patients undergoing part-grafting in addition to direct closure took significantly longer to heal than those undergoing direct closure alone (p=0.0002), with the donor site or graft delaying healing in the majority. Excision and direct closure of acute burn wounds avoids donor site morbidity and has an acceptable complication rate. It is a safe and effective treatment for full thickness burns in selected cases. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  13. Addition of platelet concentrate to Dermo-Epidermal Skin Graft in deep burn trauma reduces scarring and need for revision surgeries

    PubMed Central

    Prochazka, Vaclav; Klosova, Hana; Stetinsky, Jiri; Gumulec, Jaromir; Vitkova, Katerina; Salounova, Dana; Dvorackova, Jana; Bielnikova, Hana; Klement, Petr; Levakova, Veronika; Ocelka, Tomas; Pavliska, Lubomir; Kovanic, Pavel; Klement, Giannoula Lakka

    2017-01-01

    Backround Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues. Methods We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses. Results We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings. Conclusions Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1–3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1–7 days), which normalized over the subsequent 7 and 90 days. PMID:24108222

  14. Flooding after fire: Impacts of the 2013 Colorado Front Range floods on the High Park Fire burn scar

    NASA Astrophysics Data System (ADS)

    Kampf, S. K.; Schmeer, S.; MacDonald, L. H.; Brogan, D. J.; Nelson, P. A.

    2014-12-01

    In June 2012, the High Park Fire west of Fort Collins, CO burned 350 km2 of steep forested terrain, leading to elevated runoff and erosion in watersheds draining the burned area. Under the auspices of a NSF RAPID grant we began monitoring precipitation, hillslope-scale sediment production, stream stage, and channel geomorphic change in Skin Gulch and Hill Gulch, two 15 km2 watersheds within the High Park Fire. Short-duration summer thunderstorms are typically the dominant cause of post-fire runoff and erosion in the central and southern Rocky Mountains, but in September 2013 an extreme, long duration storm dropped more than 200 mm of rain in 48 hours. This storm provided a unique opportunity to compare the hydrologic and geomorphic effects of smaller summer thunderstorms to those of the long duration, high magnitude September event. Mean June-August 2013 precipitation in these watersheds was 125 mm, less than half the total for the September 2013 event, but this summer precipitation led to a mean sediment yield of 8 Mg ha-1, about double the mean sediment yield of the much larger September storm. Hillslope sediment production was highest during summer storms that were shorter duration but had higher 5-15 minute precipitation intensities than the September storm. These localized summer 2013 storms led to flashy pulses of flow in the channel network that caused relatively small amounts of channel aggradation or incision. In contrast, the September 2013 event produced sustained high flows that led to substantial geomorphic change throughout the channel network, with more than 2 m of aggradation at the outlet of Skin Gulch. These results indicate that the high intensity summer thunderstorms were most effective at mobilizing sediment from hillslopes, but the more spatially uniform rainfall during the September event produced much more dramatic downstream channel geomorphic change.

  15. [The lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contraction of popliteal fossa].

    PubMed

    Zheng, Xin; An, Hong-Bin; Chen, Tao; Wang, Hai-Bao

    2013-02-01

    To discuss clinical results of the lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contracture of popliteal fossa. Form January 1999 to December 2011, 11 patients with scar contraction of popliteal fossa were treated with the lateral superior genicular artery perforator iliotibial band flap. Among the patients, 7 patients were male and 4 patients were female,ranging in age from 24 to 58 years old,with an average of 33 years old. The operation time ranged from 3 months to 1 year after trauma. Eight patients had injuries in the right side and 3 patients had the injuries in the left. Five patients had the injuries caused by traffic,3 patients had the injuries caused by hot compression and other 3 patients suffered from burns. The flap area ranged from 7.0 cm x 4.0 cm to 20.0 cm x 8.0 cm. All the flaps survived. Three patients had epidermis necrosis. After 5 months to 2 years follow-up period,the knee function recovered,the flap shape was favorable and the skin firmness was moderated. The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and an ideal donor in the reconstruction of popliteal fossa scar contracture.

  16. Burn wound healing: present concepts, treatment strategies and future directions.

    PubMed

    Oryan, A; Alemzadeh, E; Moshiri, A

    2017-01-02

    Burns are the most extensive forms of soft tissue injuries occasionally resulting in extensive and deep wounds and death. Burns can lead to severe mental and emotional distress, because of excessive scarring and skin contractures. Treatment of burns has always been a difficult medical problem and many different methods have been used to treat such injuries, locally. Biofilms are a collection of microorganisms that delay wound healing. One of the new methods of prevention and treatment of burn wound infections is application of antimicrobials, which act on biofilms and prevent the wound infection. Biofilm initiates a persistent, low-grade, inflammatory response, impairing both the epithelialisation and granulation tissue formation. Skin grafts have been shown to dramatically reduce deaths from infection. However, grafting has considerable limitations. Such injuries are long-lasting and many patients suffer from chronic pain for a long time. Tissue engineering is a new approach in reducing the limitations of conventional treatments and producing a supply of immunologically tolerant artificial tissue, leading to a permanent solution for damaged tissues; such criteria make it a cost-effective and reliable treatment modality. To overcome the present limitations of burn wound healing, knowledge about the latest findings regarding healing mechanisms is important. Here the authors discuss the most important events regarding burn wound healing and review the latest treatment strategies that have been used for burn wounds from in vitro to clinical levels. Finally, we discuss the role of tissue engineering and regenerative medicine in the future of burn wound healing, modelling and remodelling.

  17. Chemical burns from assault: a review of seven cases seen in a Nigerian tertiary institution.

    PubMed

    Tahir, C; Ibrahim, B M; Terna-Yawe, E H

    2012-09-30

    Chemical burns represent a major challenge for reconstructive surgeons. They are caused by exposure to acids, alkalis or other corrosive substances which result in various degrees of injury. This report highlights the challenges faced in managing such patients in a Nigerian teaching hospital. The medical records of seven patients (four females and three males) treated for chemical burns injury from January 2001 to December 2010 were retrospectively reviewed. All patients were younger than 30, with a mean age of 23.3. Most of them (85.7%) had sustained full thickness burns ranging from 8% to 33% of their body surface area. All cases were result of assaults. The male to female ratio was 1:1.3, and the average duration of hospital stay was 7.5 months. The face was affected in all patients. Patients presented with multiple deformities, like ectropion of eyelids, keratopathies, blindness, nasal deformities, microstomia, loss or deformities of the pinna, mentosternal contractures, and severe scarring of the face. Twenty-nine surgical procedures were performed, which included nasal and lip reconstruction, ectropion release, commissuroplasty, contracture release, and wound resurfacing. Management of chemical burns, especially in a developing country lacking specialised burn centres with appropriate facilities, is challenging. Prevention through public awareness campaigns, legislation for control of corrosive substances, and severe punishment for perpetrators of assaults using these substances will go a long way in reducing the incidence of chemical burns.

  18. Region-Oriented and Staged Treatment Strategy in Reconstruction of Severe Cervical Contracture

    PubMed Central

    Wang, Xi; Yang, Qun; Wang, Shoubao; Zhou, Xianyu; Qian, Yunliang; Yang, Jun; Levin, Lawrence Scott

    2015-01-01

    Introduction Severe cervical contracture after burns causes obvious impairment of neck movement and the aesthetic silhouette. Although various surgical techniques for treatment have been described, there is not a definitive strategy to guide treatment. Over the past 6 years, we have been utilizing a region-oriented and staged treatment strategy to guide reconstruction of severe cervical contracture. Satisfactory results have been achieved with this strategy. Methods The first stage of treatment focuses on the anterior cervical region and submental region. Procedures include cicatrix resection, contracture release, division and elevation of the platysma to form two platysma flaps, and skin grafting. Three to six months later, the second stage treatment is performed, which localize to the mental region. This includes scar resection, correction of the lower lip eversion, and reconstruction with free (para)scapular skin flap. Three subtypes of cervicomental angle that we proposed were measured as quantitative tool for evaluation of the reconstruction. Results 24 patients who completed the treatment were reviewed. By the 3rd postoperative month, their CM angles changed significantly: the soft tissue CM angle was reduced from 135.0° ± 17.3° to 111.1° ± 11.3°, the osseous CM angle increased from 67.1° ± 9.0° to 90.5° ± 11.6° and the dynamic CM angle increased from 21.9° ± 8.7° to 67.4° ± 13.1°. 22 in 24 (91.7%) of these patients gained notable improvement of cervical motion and aesthetic contour. Conclusions Our results suggest that the region-oriented and staged treatment strategy can achieve satisfactory functional and aesthetic results, combining usage of both skin graft and skin flap while minimizing the donor site morbidity. PMID:25855973

  19. Region-oriented and staged treatment strategy in reconstruction of severe cervical contracture.

    PubMed

    Luo, Xusong; Liu, Fei; Wang, Xi; Yang, Qun; Wang, Shoubao; Zhou, Xianyu; Qian, Yunliang; Yang, Jun; Levin, Lawrence Scott

    2015-01-01

    Severe cervical contracture after burns causes obvious impairment of neck movement and the aesthetic silhouette. Although various surgical techniques for treatment have been described, there is not a definitive strategy to guide treatment. Over the past 6 years, we have been utilizing a region-oriented and staged treatment strategy to guide reconstruction of severe cervical contracture. Satisfactory results have been achieved with this strategy. The first stage of treatment focuses on the anterior cervical region and submental region. Procedures include cicatrix resection, contracture release, division and elevation of the platysma to form two platysma flaps, and skin grafting. Three to six months later, the second stage treatment is performed, which localize to the mental region. This includes scar resection, correction of the lower lip eversion, and reconstruction with free (para)scapular skin flap. Three subtypes of cervicomental angle that we proposed were measured as quantitative tool for evaluation of the reconstruction. 24 patients who completed the treatment were reviewed. By the 3rd postoperative month, their CM angles changed significantly: the soft tissue CM angle was reduced from 135.0° ± 17.3° to 111.1° ± 11.3°, the osseous CM angle increased from 67.1° ± 9.0° to 90.5° ± 11.6° and the dynamic CM angle increased from 21.9° ± 8.7° to 67.4° ± 13.1°. 22 in 24 (91.7%) of these patients gained notable improvement of cervical motion and aesthetic contour. Our results suggest that the region-oriented and staged treatment strategy can achieve satisfactory functional and aesthetic results, combining usage of both skin graft and skin flap while minimizing the donor site morbidity.

  20. Emerging Therapies for Scar Prevention

    PubMed Central

    Block, Lisa; Gosain, Ankush; King, Timothy W.

    2015-01-01

    Significance: There are ∼12 million traumatic lacerations treated in the United States emergency rooms each year, 250 million surgical incisions created worldwide every year, and 11 million burns severe enough to warrant medical treatment worldwide. In the United States, over $20 billion dollars per year are spent on the treatment and management of scars. Recent Advances: Investigations into the management of scar therapies over the last decade have advanced our understanding related to the care of cutaneous scars. Scar treatment methods are presented including topical, intralesional, and mechanical therapies in addition to cryotherapy, radiotherapy, and laser therapy. Critical Issues: Current treatment options for scars have significant limitations. This review presents the current and emerging therapies available for scar management and the scientific evidence for scar management is discussed. Future Directions: Based upon our new understanding of scar formation, innovative scar therapies are being developed. Additional research on the basic science of scar formation will lead to additional advances and novel therapies for the treatment of cutaneous scars. PMID:26487979

  1. Reconstructive surgery after burns: a 10-year follow-up study.

    PubMed

    Hop, M J; Langenberg, L C; Hiddingh, J; Stekelenburg, C M; van der Wal, M B A; Hoogewerf, C J; van Koppen, M L J; Polinder, S; van Zuijlen, P P M; van Baar, M E; Middelkoop, E

    2014-12-01

    There is minimal insight into the prevalence of reconstructive surgery after burns. The objective of this study was to analyse the prevalence, predictors, indications, techniques and medical costs of reconstructive surgery after burns. A retrospective cohort study was conducted in the three Dutch burn centres. Patients with acute burns, admitted from January 1998 until December 2001, were included. Data on patient and injury characteristics and reconstructive surgery details were collected in a 10-year follow-up period. In 13.0% (n=229/1768) of the patients with burns, reconstructive surgery was performed during the 10-year follow-up period. Mean number of reconstructive procedure per patient were 3.6 (range 1-25). Frequently reconstructed locations were hands and head/neck. The most important indication was scar contracture and the most applied technique was release plus random flaps/skin grafting. Mean medical costs of reconstructive surgery per patient over 10-years were €8342. With this study we elucidated the reconstructive needs of patients after burns. The data presented can be used as reference in future studies that aim to improve scar quality of burns and decrease the need for reconstructive surgery. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  2. Scar revision

    PubMed Central

    Sharma, Mohit; Wakure, Abhijeet

    2013-01-01

    Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients. PMID:24516292

  3. Evaluating an outreach service for paediatric burns follow up.

    PubMed

    Cubitt, Jonathan J; Chesney, Amy; Brown, Liz; Nguyen, Dai Q

    2015-09-01

    Complications following paediatric burns are well documented and care needs to be taken to ensure the appropriate follow up of these patients. Historically this has meant follow up into adulthood however this is often not necessary. The centralisation of burns services in the UK means that patients and their parents may have to travel significant distances to receive this follow up care. To optimise our burns service we have introduced a burns outreach service to enable the patients to be treated closer to home. The aim of this study is to investigate the impact of the introduction of the burns outreach service and within this environment define the optimum length of time needed to follow up these patients. A retrospective analysis was carried out of 100 consecutive paediatric burns patients who underwent surgical management of their burn. During the follow up period there were 43 complications in 32 patients (32%). These included adverse scarring (either hypertrophic or keloid), delayed healing (taking >1 month to heal) and contractures (utilising either splinting or surgical correction). Fifty-nine percent of these complications occurred within 6 months of injury and all occurred within 18 months. Size of burn was directly correlated to the risk of developing a complication. The outreach service reduced the distance the patient needs to travel for follow up by more than 50%. There was also a significant financial benefit for the service as the follow up clinics were on average 50% cheaper with burns outreach than burns physician. Burns outreach is a feasible service that not only benefits the patients but also is cheaper for the burns service. The optimum length of follow up for paediatric burns in 18 months, after which if there have not been any complications they can be discharged. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  4. [Surgical treatment of sequelae of deep breast burns: a 25-year experience].

    PubMed

    Ho Quoc, C; Bouguila, J; Brun, A; Voulliaume, D; Comparin, J-P; Foyatier, J-L

    2012-02-01

    Deep chest burns in prepubescent girl prevent the development of the mammary gland, because scar contracture becomes an inextensible envelope. In adults, scar contracture can deform the breast shape. The aim of this work is to define the interest of tissue expansion in breast reconstruction of prepubescent's and adult's post-burns scars. We conducted a 25-year retrospective study including patients treated surgically for deep thoracomammary burns. We studied following parameters: surgical techniques step by step, average time between each intervention, and morphologic and aesthetic results achieved. Twenty-eight patients have been operated between 1983 and 2008. Each patient has been operated on average 4.5 times (two to 12 times) during 6.3 years on average (1-19 years). Adult patients have showed a higher number of response (5.5 on average) than prepubescent girls (2.4 on average). Number of skin expansion has been 1.2 (0 to three) per patient. Sixty-two expanders have been placed (one to eight), 390cm(3) volume on average (180-1200). Delay of skin expansion has been about 7 months (4-10). Twenty-five breast implants have been raised on average 11 months (6-17) after debridement. Three changes of breast implant have occurred on average 5.3 years after insertion (3-8). Reconstruction of the areolonipple complex and controlateral symetrisation were conducted generally in the same time, 1 year after the last intervention. All patients will receive the possible additional volume (breast implant). Alternatives in breast volume reconstruction are lipomodelling and musculocutaneous expanded flaps. They are also discussed. Breast reconstruction in post-burns scars give clever cosmetic and morphologic despite of breast shape imperfections and apparent scars persistence satisfied cosmetic and morphologic results. These results, analyzed over a period of 25 years, show a qualitative change and decreased postoperative complications. Locoregional tissue expansion provide very

  5. "Onion" flap: a novel technique for reconstruction of burn nail deformities.

    PubMed

    Yang, Jui-Yung; Yang, Shih-Yi; Chen, Wei F

    2012-05-01

    Nail fold deformities from burn injury frequently result in eponychial retraction, proximal nail exposure, pain, and distal phalangeal function impairment. Secondary nail abnormalities including longitudinal ridges, surface cracks, and fragility are common sequelae to nail fold deformities. Surgical management of postburn nail fold deformity is challenging because of scar contractures involving the dorsum of digits and lack of surrounding healthy tissues that can be used as source of soft tissue for reconstruction. Previous reports have discussed several methods for reconstruction of these deformities. However, all of these methods are associated with significant donor site morbidities. From August 2008 to January 2010, "onion" flap reconstruction was performed for postburn nail fold contractures and deformities on 32 fingers of eight patients (five men and three women; average age, 44.4 years; age range, 23-54 years). This novel technique was used to release scar contractures in the eponychial area and allow soft tissue restoration by redraping the eponychium in a single-step procedure. All 32 fingers received single-stage "onion" flap reconstruction for their nail fold deformities at least 6 months after the initial injury. The follow-up period, with an average of 7.8 months, revealed that all nails had good esthetic and functional results. All experienced amelioration of nail abnormalities. The "onion" advancement flap had effectively released the scar contracture around the nail fold and simultaneously restored the eponychial fold. The "onion" flap technique provides superior results compared with those from conventional techniques. We recommend it as the mainstay of treatment for reconstruction of the postburn eponychial deformities. V, therapeutic study.

  6. Chemical Burn Injury in Kumasi: The Trend and Complications following and Their Management

    PubMed Central

    Akpaloo, Joseph; Chirurgie, Facharzt; Aboah, Ken; Klutsey, Ellen; Hoyte-Williams, Paa Ekow; Farhat, Boutros; Turkson, Edmund; Yorke, Joseph; Chirurgie, Facharzt; Ametih, Richard; Hussey, Romeo

    2015-01-01

    Background: A chemical burn refers to irritation and destruction of human tissue caused by exposure to a chemical, usually by direct contact with the chemical or its fumes. The study investigated the trend and complications following chemical burns and their management. Methods: The study involved a retrospective review of Burns Registry at the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital on patients who were admitted for burns from May 1, 2009 to April 30, 2013. Results: Chemical burns admissions accounted for 3.5% (n = 17) out of the total 487 burns cases, consisting of 12 males (70.6%) and 5 females (29.4%). Mean total burns surface area was 21.9%; mean length of stay in Burns Intensive Care Unit was 9.5 days. The etiological agents for the chemical burns included the following: hot caustic soda 1 (5.9%); acid 9 (53.9%)—the most common; hot ethanol 3 (17.6%); and other chemicals such as other bases, oxidizers, solvents, etc. accounted for 4 (23.5%) etiological agents. Outcome included 11 discharges (64.7%), 6 transferred out to other wards (35.3%), and 0 deaths (0.0%). The complications included severe scar contractures in 5 patients (29.4%), loss of vision: partial/total = 2 (11.8%), gross keloidal/hypertrophic scars = 10 (58.8%). Conclusions: Chemical burns are severe and often cause severe debilitating sequelae including partial/total loss of vision. But the current study showed that only a small population (3.5%) were affected by chemical burns and no death was recorded; society has to be continually conscious of chemicals, especially caustic agents, and hence take the necessary precautions so as to prevent these avoidable complications. PMID:26579354

  7. Avoiding unfavorable results in postburn contracture hand

    PubMed Central

    Bhattacharya, Sameek

    2013-01-01

    Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation. PMID:24501479

  8. Management of Head and Neck Burns-A 15-Year Review.

    PubMed

    Hamilton, Travis J; Patterson, Jeromy; Williams, Rachael Y; Ingram, Walter L; Hodge, Juvonda S; Abramowicz, Shelly

    2017-09-11

    The purpose of this project was to characterize patients with isolated head and neck burns admitted to the Grady Memorial Hospital (GMH) Burn Center (Atlanta, GA). This was a retrospective case series of patients admitted to the GMH Burn Center with the primary diagnosis of head and neck burns from 2000 through 2015. Demographic data (gender and age) were recorded. Burn details (etiology, mechanism, percentage of burned total body surface area, depth, and associated injuries) were summarized. Patient management and hospital course were documented. Data were collected using a standardized collection form. Descriptive statistics were computed. There were 5,938 patients admitted to burn unit at the GMH Burn Center during the study period. Of these, 2,547 patients had head and neck burns and 205 patients met the inclusion criteria. Most (n = 136; 66%) were male, with a mean age of 40 years. The most common burn depth was superficial partial thickness. Flame burns were the most likely mechanism related to full-thickness injury. Approximately one fourth of patients had an associated injury, such as inhalation or ocular injury. Surgical interventions consisted of tangential excision and split-thickness skin grafting, contracture release, excision of hypertrophic scars, and rotational flaps. Mean length of hospital stay for isolated head and neck burns was 4.4 days. Overall mortality was 2%. The results of this study show that superficial partial-thickness head and neck burns are more likely to occur from accidental exposure to flames in men older than 55 years. Owing to an increase in risk and mortality of inhalation injury associated with head and neck burns, airway protection and respiratory management are critical considerations of head and neck burn management. Copyright © 2017. Published by Elsevier Inc.

  9. Joint Contracture Orthosis (JCO)

    NASA Technical Reports Server (NTRS)

    Lunsford, Thomas R.; Parsons, Ken; Krouskop, Thomas; McGee, Kevin

    1997-01-01

    The purpose of this project was to develop an advanced orthosis which is effective in reducing upper and lower limb contractures in significantly less time than currently required with conventional methods. The team that developed the JCO consisted of an engineer, orthotist, therapist, and physician.

  10. A clinical trial of tension and compression orthoses for Dupuytren contractures.

    PubMed

    Brauns, Annelien; Van Nuffel, Maarten; De Smet, Luc; Degreef, Ilse

    can improve flexion contractures. The idea of a compression device is based on the treatment concept of hypertrophic burn scars. Tension and compression orthotic devices can be used as a nonoperative treatment of Dupuytren's disease in both early proliferative untreated hands and aggressive postsurgery recurrence. Although there is no statistically significant difference, compression orthoses appear to be more effective and are better tolerated. Nevertheless, adjustment of orthotic design and research on long-term results are needed. I (Randomized controlled trial, Therapeutic study). Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  11. Ablative fractionated erbium:YAG laser for the treatment of ice pick alar scars due to neodymium:YAG laser burns.

    PubMed

    Cohen, Joel L; Babcock, Michael J

    2009-01-01

    The authors present a case of ice pick scars forming in the nasal alar grooves of a patient who was treated with a 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for facial telangiectasias. Treatment options for these types of scars are reviewed and specifically we report the success of an ablative fractionated 2940-nm erbium:yttrium-aluminum-garnet (Er:YAG) laser.

  12. The inframammary extending lateral intercostal artery perforator flap for reconstruction of axillary contractures: a case report.

    PubMed

    Stillaert, F B; Casaer, B; Roche, N; Van Landuyt, K; Hamdi, M; Blondeel, P N; Monstrey, S

    2008-12-01

    Release and reconstruction of axillary scar contractures can be challenging due to the specific anatomic site and contouring of the axillary region. Pliable and unscarred skin coverage of resulting defects after scar release is needed which enhances the postoperative recovery and revalidation. When traditional donor regions of fasciocutaneous flaps are involved in the scarred area, options are few. We describe the design and versatility of an inframammary extended lateral intercostal artery perforator (LICAP) flap to reconstruct an axillary defect after wide scar release and debridement. The postoperative recovery was uneventful with restoration of the range of motion of the shoulder joint.

  13. [Integrated diagnosis and treatment of scar].

    PubMed

    Cen, Y; Chen, J J

    2016-11-20

    Scar is the common disease in the field of burn and plastic surgery, and its diagnosis and treatment should be involved in overwhelming majority hospitals. There are many substandard methods and medical hidden dangers in diagnosis and treatment of scar, due to the unevenness of doctors' clinical experience. According to the classification of integral scar and diabrotic scar, the problems related to diagnosis and treatment of scar are systemically summarized and normalized in this article for decrease in the incidence of adverse events and medical hidden dangers.

  14. Scar revision

    MedlinePlus

    ... corrects skin changes (disfigurement) caused by an injury, wound, poor healing, or previous surgery. Description Scar tissue forms as ... stiffening of the joint, you may need physical therapy after surgery. Apply sunscreen to keep sunlight from permanently ... Keloid revision; Hypertrophic scar revision; ...

  15. Burns functional disabilities among burn survivors: a study in Komfo Anokye Teaching Hospital, Ghana.

    PubMed

    Agbenorku, Pius

    2013-01-01

    To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. A total of 70 participants consented for the study. Their ages ranged from 8/12 - 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers' time and financial constrains.

  16. Burns functional disabilities among burn survivors: a study in Komfo Anokye Teaching Hospital, Ghana

    PubMed Central

    Agbenorku, Pius

    2013-01-01

    Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains. PMID

  17. Evaluation of nonablative fractional laser treatment in scar reduction.

    PubMed

    Gokalp, Hilal

    2017-08-12

    Fractional lasers have been used for the improvement of scar tissue in the recent years but there has not been extensive research on their impact. The purpose of this study was to evaluate the efficacy of nonablative fractional laser (NAFL) on acne, burn, and surgery/traumatic scar. The scars were also categorized as atrophic, hypertrophic, and keloid, and treatment efficacy was investigated accordingly. This is a retrospective, single-center study. Scar tissues were treated using a nonablative fractional 1550-nm Erbium glass laser in high-energy parameters at 4-week interval for 4-8 sessions. The scar regression score (SRS) was used to determine the decrease in scar appearance. Forty-six patients with acne (n:18), burn (n:13), or surgery/traumatic (n:15) scar were included. The number of sessions was higher for burn patients while SRS in burn patients was lower than in patients with acne or a surgical/traumatic scar. Evaluation according to scar types showed that atrophic scars had a significantly better response to NAFL treatment. This study indicates that NAFL treatment with the high-energy parameters has better outcomes in atrophic acne scars, while the success rate is considerably low in post-burn and keloid scars.

  18. Active range of motion outcomes after reconstruction of burned wrist and hand deformities.

    PubMed

    Afifi, Ahmed M; Mahboub, Tarek A; Ibrahim Fouad, Amr; Azari, Kodi; Khalil, Haitham H; McCarthy, James E

    2016-06-01

    This works aim is to evaluate the efficacy of skin grafts and flaps in reconstruction of post-burn hand and wrist deformities. A prospective study of 57 burn contractures of the wrist and dorsum of the hand was performed. Flaps were used only if there was a non-vascularized structure after contracture release, otherwise a skin graft was used. Active range of motion (ROM) was used to assess hand function. The extension deformity cohort uniformly underwent skin graft following contracture release with a mean improvement of 71 degrees (p<0.0001). The flexion deformity cohort was treated with either skin grafts (8 patients) or flaps (9 patients) with a mean improvement of 44 degrees (p<0.0001). Skin grafts suffice for dorsal hand contractures to restore functional wrist ROM. For flexion contractures, flaps were more likely for contractures >6 months. Early release of burn contracture is advisable to avoid deep structure contracture.

  19. Noninvasive Shock Wave Treatment for Capsular Contractures After Breast Augmentation: A Rabbit Study.

    PubMed

    Chen, Po Chou; Kuo, Shyh Ming; Jao, Jo Chi; Yang, Shiou Wen; Hsu, Ching Wen; Wu, Yu Chiuan

    2016-06-01

    Capsular contracture is the most common complication of breast augmentation. Although numerous procedures are intended to prevent capsular contracture, their efficacy does not satisfy surgeons or patients. In the present study, we used shock waves to develop innovative protocols to treat capsular contracture in rabbits. We used shock waves to treat capsular contracture in a rabbit model. Six clinical parameters were evaluated to determine the treatment efficacy of shock waves on the pathological histology of capsular contracture. Dual-flip-angle T1-mapping magnetic resonance imaging was used to confirm the pathological findings. Among the parameters, myxoid change, vascular proliferation, and lymphoplasma cell infiltration around the capsule increased more after treatment than they did in a control group. Capsular thickness, inner thinner collagen layer, and capsule wall collagen deposition decreased after shock wave treatment; only the inner thinner collagen layer and capsule wall collagen deposition changed significantly. The MRI findings for both scar thickness and water content were consistent with pathological biology findings. This was the first pilot study and trial to treat capsular contractures using shock waves. We found that shock waves can cause changes in the structure or the composition of capsular contracture. We conclude that the treatment could decrease water content, loosen structure, decrease collagen deposition, and might alleviate scar formation from capsular contracture. We believe that the treatment could be a viable remedy for capsular contractures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  20. Physiological characteristics of dysphagia following thermal burn injury.

    PubMed

    Rumbach, Anna F; Ward, Elizabeth C; Cornwell, Petrea L; Bassett, Lynell V; Muller, Michael J

    2012-09-01

    The study aim was to document the acute physiological characteristics of swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and fiberoptic evaluation of swallowing (FEES). FEES confirmed six individuals (32%) had no aspiration risk and were excluded from further analyses. Of the remaining 13, CSE confirmed that two had specific oral-phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal-phase deficits, with the major findings evident in greater than 50% being impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 50% (n = 6/12 penetration aspiration events) of the cases. Most events occurred post swallow. Findings support the fact that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral-stage swallow function. This study has identified a range of factors that may contribute to both oral- and pharyngeal-stage dysfunction in this clinical population and has highlighted the importance of using a combination of clinical and instrumental assessments to fully understand the influence of burn injury on oral intake and

  1. Volkmann ischemic contracture

    MedlinePlus

    ... the nerves and muscles, causing them to become stiff (scarred) and shortened. When the muscle shortens, it ... it were normally contracted. But because it is stiff, the joint remains bent and stuck. This condition ...

  2. Deltoid contracture: a case with multiple muscle contractures.

    PubMed

    Chen, Hsin-Chang; Huang, Tung-Fu; Chou, Po-Hsin; Chen, Tain-Hsiung

    2008-11-01

    Deltoid contracture is relatively uncommon. The literature consists primarily of case reports and few articles on large case series. The pathogenesis has been well studied. Muscle contractures can occur in the deltoid, biceps, triceps, gluteus and quadriceps muscles; however, cases of multiple muscle contractures are rare. We reported a patient with multiple contractures of the bilateral deltoid, bilateral gluteus, and bilateral quadriceps muscles, who had received repeated intramuscular injections during childhood and adulthood. The radiographic, including magnetic resonance imaging (MRI), features of the bone and joint abnormalities are presented. Some literatures reported that damage to the structures of the body due to intramuscular injection is related to the site of injection, age of the patient, and the volume, pH, chemical composition, and diffusional capacity of the injectate. Our patient had muscular contracture induced by needle injection regardless of her age, medication and injection site.

  3. Select practices in management and rehabilitation of burns: a survey report.

    PubMed

    Holavanahalli, Radha K; Helm, Phala A; Parry, Ingrid S; Dolezal, Cynthia A; Greenhalgh, David G

    2011-01-01

    The purpose of this study is to document the organization and current practices in physical rehabilitation across burn centers. An online survey developed for the specific purposes of this study sought information regarding a) logistics of the burn center; b) inpatient and outpatient treatment of patients with burn injury; and c) specific protocols in the treatment of a few complications secondary to burn injuries. Of the 159 responses received, 115 were received from the United States, 20 from Australia, 16 from Canada, and 7 from New Zealand. The overall sample included responses from 76 physical therapists (PTs) and 78 occupational therapists. Seventy-three of those surveyed considered themselves primarily a burn therapist. Nurses (86%) were reported as primarily responsible for wound care of inpatients, followed by wound care technicians (24%). Ninety-seven percent of the therapists reported following their own treatment plans. The trunk and areas of head and neck were treated by both PTs and occupational therapists, whereas the lower extremities continue to be treated predominantly by PTs. Some common practices regarding treatment of a few complications secondary to burn injuries such as splinting to prevent contractures, treatment of exposed or ruptured extensor tendons, exposed Achilles tendons, heterotopic ossification, postoperative ambulation, conditioning, scar massage, and use of compression garments are described. Opportunities exist for 1) developing a common document for practice guidelines in physical rehabilitation of burns; and 2) conducting collaborative studies to evaluate treatment interventions and outcomes.

  4. Scar Management in the Pediatric and Adolescent Populations.

    PubMed

    Krakowski, Andrew C; Totri, Christine R; Donelan, Matthias B; Shumaker, Peter R

    2016-02-01

    For most children and adolescents who have developed symptomatic scars, cosmetic concerns are only a portion of the motivation that drives them and their caregivers to obtain treatment. In addition to the potential for cosmetic disfigurement, scars may be associated with a number of physical comorbidities including hypertrichosis, dyshidrosis, tenderness/pain, pruritus, dysesthesias, and functional impairments such as contractures, all of which may be compounded by psychosocial factors. Although a plethora of options for treating scars exists, specific management guidelines for the pediatric and adolescent populations do not, and evidence must be extrapolated from adult studies. New modalities such as the scar team approach, autologous fat transfer, and ablative fractional laser resurfacing suggest a promising future for children who suffer symptomatically from their scars. In this state-of-the-art review, we summarize cutting-edge scar treatment strategies as they relate to the pediatric and adolescent populations. Copyright © 2016 by the American Academy of Pediatrics.

  5. Serial splintage: Preoperative treatment of upper limb contracture.

    PubMed

    Puri, Vinita; Khare, Nishant; Venkateshwaran, N; Bharadwaj, Sumit; Choudhary, Sushant; Deshpande, Omkarnath; Borkar, Rupali

    2013-09-01

    The present study aimed to study the efficacy of preoperative splints in treatment of upper limb contractures and to evaluate the response of contracture to splints depending on the etiology and the joint involved. Ninety joints of 42 patients were studied. Patients age, gender, etiology, duration of contracture, contracture site and joint and type of contracture was noted. The range of motion of the involved joint was recorded. Serial static splints made of thermoplastic material were applied after customizing them for each patient. The range of motion and percentage movement was recorded at weekly interval and the splints were modified as per need. Time taken to reach a plateau stage was noted. To compare the statistical significance between two groups and more than two groups of continuous variable unpaired t-test and one way ANOVA respectively was applied. We considered differences to be statistically significant when the p value was below 0.05. The strength of relationship between the two continuous variables was analyzed by Pearson correlation analysis. Etiological factors were thermal burns (36.7%), electrical burns (13.3%), post traumatic (35.6%) and post cellulitis (14.4%). Age ranged from 2 to 70 years with a mean of 28.9±13.4 years. Sixty-two patients treated were males (68.9%) and 28 were female (31.1%). The mean range of motion present across all joints before starting the therapy was 54.7±23.6 degrees. The mean improvement in contracture angle obtained by serial splintage was 37.4±28.1 degrees. The mean time taken to achieve plateau was 23.6±3.2 days. Maximum improvement was seen in thermal burn contractures (41.2±30.3 degrees). Least improvement was seen in contractures due to cellulitis (6.5±16.2 degrees). This finding was statistically significant [F(3,86)=4.25, p=0.005]. Significant difference was seen in response to therapy based on the joint involved [F(3,86)=3.36, p=0.02]. Highest improvement in the range of motion was seen in the

  6. The effect of positioning devices and pressure therapy on outcome after full-thickness burns of the neck.

    PubMed

    Sharp, Patricia A; Dougherty, Mary E; Kagan, Richard J

    2007-01-01

    The postoperative management of full-thickness burns of the neck can be a challenge for burn therapists despite the availability of many treatment modalities to minimize scar hypertrophy and contracture. Interventions include pressure appliances, massage, exercise, and positioning devices. The objective of this study was to identify factors associated with the development of neck contractures and optimal treatment strategies for their prevention. We performed a retrospective chart review of all patients admitted to our pediatric burn center between 1989 and 2003 with acute full-thickness neck burns. Rehabilitation protocols used for each patient were examined. The necessity of a reconstructive procedure was analyzed, as well as time from initial grafting to that procedure. We identified 49 eligible subjects. Patients ranged in age from 0.6 to 14.2 years at the time of injury. The number of factors present which inhibited both positioning and application of pressure to the neck was found to be significantly related to the need for neck reconstruction (P < .01). Patients who had tracheostomies had a mean time to neck reconstruction of 20.3 months compared with 43.4 months in patients without tracheostomies (P < .05). Also, although not statistically significant, greater than 80% of patients who were discharged with reduced range of motion of the neck required reconstruction compared with fewer than 65% of patients with normal neck range. Delayed pressure and positioning of the neck after skin grafting result in an earlier and more frequent need for neck reconstruction.

  7. Musculoskeletal management of the severely burned child.

    PubMed Central

    Birch, J. R.; Eakins, B.; Gosen, J.; Green, S.; Morton, M.

    1976-01-01

    Aggressive management of severe burns minimizes contractures and helps to maintain muscle tone, joint function and psychological well-being. The positioning, activity and exercise programs, splinting and bandaging, and skin care of burned children carried out by the burns team at the Hospital for Sick Children, Toronto is outlined. PMID:782680

  8. Asthma: a disuse contracture?

    PubMed

    Alexander, C J

    2005-01-01

    The incidence of asthma is increasing. There is no obvious explanation for this increase and current theory has no explanation for the occurrence of the disease in the non-allergic, the sudden onset of the asthma attack, the hyper-reactivity of the muscular wall, the association of the disease with obesity, or its precipitation by exercise. Biopsy studies have shown that the narrowing of air passages which characterises the disease is associated with thickening of their fibrous and muscular layers. As narrowing of air passages necessarily involves shortening of annular and helical components, this narrowing is in effect an annular contracture, analogous to those seen in underextended longitudinal structures such as muscles and tendons. The only common cause for such contractures is habitual underextension. As the only extending force in annular air passages is inspiration, this leads to the hypothesis that the basic cause of the disease is an insufficiency of aerobic exercise in childhood. Should the airways fail to develop their normal calibre, the narrowing will precipitate a sequence of events which can be predicted from the laws of physics. La Place's Law explains the instability of the muscle wall, the sudden onset of the attacks, reflecting episodes of critical collapse and the occurrence of the disease in the non-allergic. Bernoulli's Law explains the provocative effect of exercise and the postulated lack of exercise explains the increasing prevalence and the association with obesity. The hypothesis can be tested by comparative epidemiology. If it is correct, the disease should be preventable.

  9. Facial Scar Revision: Understanding Facial Scar Treatment

    MedlinePlus

    ... scar tissue. The appearance of the scar can range from nearly invisible to very obvious and disfiguring. ... treated first with injection of medications to reduce size. If this is not satisfactory, the scars can ...

  10. Early excision and skin grafting versus delayed skin grafting in deep hand burns (a randomised clinical controlled trial).

    PubMed

    Mohammadi, Ali Akbar; Bakhshaeekia, Ali Reza; Marzban, Saeed; Abbasi, Siroos; Ashraf, Ali Reza; Mohammadi, Mohammad Kazem; Toulide-Ie, Hamid Reza; Tavakkolian, Ahmad Reza

    2011-02-01

    Early excision and grafting (E&G) of burn wounds has been reported to decrease hospital stay, hospital costs and septic complications, and some purport reduced mortality while decreasing hospital costs. In today's practice, all burn wounds unlikely to achieve spontaneous closure within 3 weeks are excised and grafted. Early studies did not demonstrate dramatic differences in cosmetic or functional results. This is particularly true with burns of the face, hands and feet. In this study, early excision and skin grafting was compared with delayed skin grafting in deep hand burns. From September 2006 to February 2008, 50 patients with hand burns and average burn size less than 30% total body surface area (TBSA) deep second- and third-degree were randomly divided into early E&G group (group I) and delayed grafting group (group II). Gradual and careful limb and digit range of motion was started on about 10th-14th postoperative day. We used a questionnaire based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to evaluate final functional outcome. Further, hypertrophic scar formation, contracture and deformities were followed and managed accordingly. The most common site of involvement was the metacarpophalangeal (MCP) joint with frequency of 39% and 40% in groups I and II, respectively. There were no statistically significant differences between both groups regarding deformity severity, scar formation, sensation, major activities and overall satisfaction. In treating burns of the hand, the primary goal should always be to restore the functionality of the hand. Although early surgery shortens the healing time and lessens the hospital stay, our results did not show any significant difference between these two methods regarding the function, scar formation, daily activity limitation and overall satisfaction. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  11. Construction of Skin Graft Seams in Burn Patients: A Prospective Randomized Double-Blinded Study.

    PubMed

    Isaac, Kathryn; Umraw, Nisha; Cartotto, Robert

    Prominent scars and contractures may form along the seams between adjacent skin grafts. Seams may be constructed either by approximating the graft edges (AP), or by slightly overlapping the graft edges (OV), but it is not known if one technique creates a less conspicuous seam scar. The purpose of this study was to compare seam scars between seams constructed using the AP and OV techniques. This was a prospective within-patient and within-seam controlled study in adult burn patients treated at an American Burn Association-verified burn center. At skin graft application and seam construction, study seams were divided in half. One half of the seam was made by approximating the graft edges (AP group), while the other half was made by overlapping graft edges (OV group), before identical staple or suture fixation of each half. The AP or OV technique was randomly assigned to the medial or lateral ends of transversely oriented seams or to the proximal and distal ends of longitudinally oriented seams. At 3, 6, and 12 months post surgery, a blinded rater compared the two halves of each study seam scar using the Vancouver Scar Score (VSS). Subjects were also blinded and rated each half of their study seam using a 0 (poor) to 10 (excellent) visual analogue scale. Values are shown as the median (Q1-Q3). There were 44 study seams among 19 subjects (age 51 [36-70] years, with % TBSA burn 10 [7-18], % BSA full-thickness burn 8 [6-15]). Study seams were constructed at 10 (4-15) days post burn. Study seam length was 14.5 (10.3-18.0) cm, with 25% transversely oriented and 75% longitudinally oriented, and with 35/44 seams (80%) between meshed grafts and 9/44 (20%) between sheet grafts. There were no significant differences in any of the individual domain VSS scores (height, pliability, vascularity, and pigmentation) or total VSS score between AP and OV seams at 3, 6, and 12 months. At 12 months, among the 30 study seams that were visible to the subjects, the visual analogue scale

  12. Treatment of nasal burns: analysis of 150 cases.

    PubMed

    Prousskaia, E; El-Muttardi, N; Philp, B; Dziewulski, P; Shelley, O P

    2015-06-30

    Nasal burns present a challenge for the plastic surgeon in terms of immediate management, choice of primary treatment and secondary reconstruction with the goals of good aesthetic and functional outcome. We present a retrospective analysis of the management of 150 patients with nasal burns treated in our center between July 2005 and July 2011. We rationalized our conservative and all surgical treatments of this subset of burns patients and organized them in a simple and structured way. The reconstructive options for most complex full thickness nasal injury is determined by the integrity of adjacent facial tissues which would always be preferred when available. Microsurgical free tissue transfer is dependent upon the fitness of the patient and the availability of unburned skin at the donor site. Secondary nasal reconstruction is based on an assessment of the residual functional and cosmetic problems. Airways narrowing from scar contracture or loss of support are managed using standard plastic surgical and rhinoplasty principles. Cosmetic refinements range from flap debulking to the importation of new tissue on to the nose. Our experience with this challenging group of patients has led us to develop a simple treatment algorithm for the management of nasal burns.

  13. Treatment of nasal burns: analysis of 150 cases

    PubMed Central

    Prousskaia, E.; El-Muttardi, N.; Philp, B.; Dziewulski, P.; Shelley, O.P.

    2015-01-01

    Summary Nasal burns present a challenge for the plastic surgeon in terms of immediate management, choice of primary treatment and secondary reconstruction with the goals of good aesthetic and functional outcome. We present a retrospective analysis of the management of 150 patients with nasal burns treated in our center between July 2005 and July 2011. We rationalized our conservative and all surgical treatments of this subset of burns patients and organized them in a simple and structured way. The reconstructive options for most complex full thickness nasal injury is determined by the integrity of adjacent facial tissues which would always be preferred when available. Microsurgical free tissue transfer is dependent upon the fitness of the patient and the availability of unburned skin at the donor site. Secondary nasal reconstruction is based on an assessment of the residual functional and cosmetic problems. Airways narrowing from scar contracture or loss of support are managed using standard plastic surgical and rhinoplasty principles. Cosmetic refinements range from flap debulking to the importation of new tissue on to the nose. Our experience with this challenging group of patients has led us to develop a simple treatment algorithm for the management of nasal burns. PMID:27252610

  14. Congenital bilateral sternocleidomastoid contracture: a case report.

    PubMed

    Babu, Manohar K V; Lee, Peter; Mahadev, Arjandas; Lee, Eng Hin

    2009-05-01

    Unilateral sternocleidomastoid muscle contracture causing torticollis and other secondary deformities such as facial scoliosis, plagiocephaly and scoliosis of cervical spine are well known. The aetiology and pathogenesis is still intriguing. Although unilateral contracture of sternocleidomastoid is seen quite often, bilateral sternocleidomastoid contracture is almost unheard of. A review of the English literature revealed no cases of bilateral congenital sternocleidomastoid contracture being reported. We present a case report of a 19-year-old girl with congenital bilateral sternocleidomastoid contracture.

  15. The microsecond 1064 nm Nd:YAG laser as an adjunct to improving surgical scars following Mohs micrographic surgery.

    PubMed

    Ezra, Navid; Arshanapalli, Ashish; Bednarek, Robert; Akaishi, Satoshi; Somani, Ally-Khan

    2016-08-01

    Scarring following skin surgery is an unavoidable certainty. Scars resulting from Mohs Micrographic Surgery (MMS) can cause both cosmetic and functional problems. Various lasers have been used to treat scars, but the role of the microsecond pulsed 1064 nanometer neodymium-doped yttrium aluminum garnet (1064 nm Nd:YAG) in treating surgical scars is not well-defined. We aim to examine the clinical application of the 1064 nm Nd:YAG laser in improving surgical scars. Ten patients who were unhappy with cosmetic or functional outcomes of their surgical scars following MMS were treated with 1-3 sessions of the 1064 nm Nd:YAG laser to improve their scars. Therapy completion was determined by patient satisfaction with the appearance of their scars and/or resolution of any contractures that formed following surgery. All ten patients were pleased with the improved appearance of their scars. Four patients saw complete resolution of an ectropion or eclabium that formed secondary to scar contractures from MMS. The side effects of laser treatments were limited to 1-2 hours of erythema, and there were no incidences of adverse effects or recurrence of contractures. Our clinical experience with the 1064 nm Nd:YAG laser provides promising data on improving appearance of and functionality from post-surgical scars.

  16. Intrinsic contractures of the hand.

    PubMed

    Paksima, Nader; Besh, Basil R

    2012-02-01

    Contractures of the intrinsic muscles of the fingers disrupt the delicate and complex balance of intrinsic and extrinsic muscles, which allows the hand to be so versatile and functional. The loss of muscle function primarily affects the interphalangeal joints but also may affect etacarpophalangeal joints. The resulting clinical picture is often termed, intrinsic contracture or intrinsic-plus hand. Disruption of the balance between intrinsic and extrinsic muscles has many causes and may be secondary to changes within the intrinsic musculature or the tendon unit. This article reviews diagnosis, etiology, and treatment algorithms in the management of intrinsic contractures of the fingers. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Epidemiology and Outcome of Chemical Burn Patients Admitted in Burn Unit of JNMC Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India: A 5-year Experience

    PubMed Central

    Akhtar, Md Sohaib; Ahmad, Imran; Khurram, M. Fahud; Kanungo, Srikanta

    2015-01-01

    Aims and Objective: The objectives of this study were to evaluate the epidemiology, clinical variable of chemical burns, and their outcomes to prevent or reduce the frequency and morbidity of such injuries. Materials and Methods: A retrospective analysis was performed on all the patients with chemical burns admitted at author's center between November 2008 and December 2013. All the patients were evaluated in terms of age, sex, total body surface area, etiology, treatment given, morbidity, mortality, final outcome, and then educated regarding specific preventive measures. Results: A total of 96 patients (2.4% of total burn admissions) (42 males and 54 females) were admitted to our hospital with chemical burn injuries. Most of the patients were in the age group of 16–30 years. Incidence in females was slightly higher than in males. Acid was found to be the most common cause of injury. We found 55% patients admitted had <10% total body surface area (TBSA) involvement, 35% had burns involving between 11 and 20% TBSA, and 4% had burns involving 21–30% TBSA, and 6% had burns in >30% TBSA. Morbidity was noticed in the form of skin defect in 80% of cases, soft tissue defect with exposed tendon, bone, or vessels in 16% of cases, and 4% of patients developed contracture and hypertrophic scar. Eighty-six percent of patients required operative intervention. A total of three deaths (3%) were recorded. Conclusion: It was found that chemical burns, though not very common, are deeper burns and can be accidental or non-accidental, and the high-risk age group is 16–25 years. Chemical burns are largely preventable and if properly managed have a good outcome. PMID:25810999

  18. Dupuytren's Contracture: Fibroblast Contraction?

    PubMed Central

    Gabbiani, Giulio; Majno, Guido

    1972-01-01

    In 6 cases of Dupuytren's disease and 1 of Ledderhose's disease, the nodules of the palmar and plantar aponeurosis were examined by light and electron microscopy. The cells composing these nodules, presumably fibroblasts, showed three significant ultrastructural features: (1) a fibrillar system similar to that of smooth muscle cells; (2) nuclear deformations such as are found in contracted cells, the severest being recognizable by light microscopy (cross-banded nuclei); (3) cell-to-cell and cell-to-stroma attachments. Based on these data and on recent information about the biology of the fibroblasts, it is suggested that these cells are fibroblasts that have modulated into contractile cells (myofibroblasts), and that their contraction plays a role in the pathogenesis of the contracture observed clinically. ImagesFig 10Fig 5Fig 11Fig 6 and 7Fig 8Fig 1Fig 2Fig 9Fig 3Fig 4 PMID:5009249

  19. Hair follicle transplantation on scar tissue.

    PubMed

    Jung, Soyeon; Oh, Suk Joon; Hoon Koh, Sung

    2013-07-01

    Hair transplantation is a continuously evolving field. The procedure was originally developed by Dr. Orentreich in 1959, but he applied it only to the androgenic alopecia. Potential applications for hair grafting extend beyond treatment of hair loss. Our study group consisted of 25 cases of 23 patients. The causes of scar resulting to hair loss were burns, operation, and trauma. The scalp strips or follicular unit extracts were harvested from occipital, posterior auricular, dog-eared scalp, adjacent scalp area, and nuchal area. The recipient sites were scalp, eyebrow, lip, and eyelid. The follow-up cases over 6 months after operation were 18 among total 25 cases. The result after hair follicle transplantation was excellent (44.4%), good (38.9%), fair (11.1%), and poor (5.6%). The hair follicle transplantation on the scar tissue is more difficult than grafting on normal tissue because the scar is accompanied by poor blood circulation and stiffness of tissue. The patients with burned scar achieved more favorable result than did others. Incision scars are deeper than burned scars, and their success rates are poor. We should recommend the patients that hair follicle transplantation on the scar may need secondary or more operations for the aesthetically better result.

  20. The use of the artificial dermis (Integra) in combination with vacuum assisted closure for reconstruction of an extensive burn scar--a case report.

    PubMed

    Leffler, M; Horch, R E; Dragu, A; Bach, A D

    2010-01-01

    The artificial dermis Integra (Ethicon, Johnson & Johnson Medical, Norderstedt, Germany) is widely used in the treatment of excessive burn injuries. It is also used in reconstructive surgery when large soft-tissue defects could not be covered with local or free flaps. In this article a 25-year old patient who presented with an early childhood burn of the trunk and lower extremity was treated with Integra in combination with the vacuum assisted closure (V.A.C., KCI, Texas, U.S.A.) and split thickness skin grafting. The combination of the artificial dermal substitute with negative pressure therapy has lead to a complete healing of Integra and the skin graft. During the whole treatment sterile wound conditions were present and time-consuming dressing changes could be prevented. Hospital stay was shortened because the patient could be treated as an outpatient with an ambulant vacuum assisted closure device.

  1. Survey of early complications of primary skin graft and secondary skin graft (delayed) surgery after resection of burn waste in hospitalized burn patients.

    PubMed

    Enshaei, A; Masoudi, N

    2014-09-18

    Burning is the second most common cause of home injuries in Iran that is often the cause of conflicts between children and young adults. Burning can lead to early and late complications that scar and contracture are the most common. Burn waste treatment is done by two methods: excision and then skin graft after the formation of granulation tissue; and excision and graft simultaneously that in this study, these two methods are compared. This was performed as a quasi-experimental analysis and retrospective study on all patients who were hospitalized for burn scar. All patients who have associated with weak eningimmune diseases such as diabetes, acquired immunodeficiency or congenital, taking steroids and patients undergoing chemotherapy etc. are excluded. The method of grafting in patients is primary graft procedure that was compared with patients who are treated using secondary graft. Data collected through review of patients' hospital and clinic chart. The mean burn percentage in the primary repair group was 14.4% and in the delayed repair group was 16.6%, respectively. The incidence of hematoma in both groups was zero. Skin necrosis and graft rejection and infection in the primary repair group was in 3.7% of patients and in the delayed repair group was in 1.2% of cases (P=0.5) CONCLUSION: Based on the findings of this study, no difference was observed between the two methods of excision and primary graft with delayed graft in the incidence of graft rejection. Due to the shorter treatment of primary graft and patient satisfaction and also according to the findings of this study excision and primary graft method seems appropriate method for treating old waste burning

  2. Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol.

    PubMed

    Jaspers, Mariëlle E H; Brouwer, Katrien M; van Trier, Antoine J M; Groot, Marloes L; Middelkoop, Esther; van Zuijlen, Paul P M

    2017-01-01

    Nowadays, patients normally survive severe traumas such as burn injuries and necrotizing fasciitis. Large skin defects can be closed but the scars remain. Scars may become adherent to underlying structures when the subcutical fat layer is damaged. Autologous fat grafting provides the possibility of reconstructing a functional sliding layer underneath the scar. Autologous fat grafting is becoming increasingly popular for scar treatment, although large studies using validated evaluation tools are lacking. The authors therefore objectified the effectiveness of single-treatment autologous fat grafting on scar pliability using validated scar measurement tools. Forty patients with adherent scars receiving single-treatment autologous fat grafting were measured preoperatively and at 3-month follow-up. The primary outcome parameter was scar pliability, measured using the Cutometer. Scar quality was also evaluated by the Patient and Observer Scar Assessment Scale and the DSM II ColorMeter. To prevent selection bias, measurements were performed following a standardized algorithm. The Cutometer parameters elasticity and maximal extension improved 22.5 percent (p < 0.001) and 15.6 percent (p = 0.001), respectively. Total Patient and Observer Scar Assessment Scale scores improved from 3.6 to 2.9 on the observer scale, and from 5.1 to 3.8 on the patient scale (both p < 0.001). Color differences between the scar and normal skin remained unaltered. For the first time, the effect of autologous fat grafting on functional scar parameters was ascertained using a comprehensive scar evaluation protocol. The improved scar pliability supports the authors' hypothesis that the function of the subcutis can be restored to a certain extent by single-treatment autologous fat grafting. Therapeutic, IV.

  3. Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness burn, excision and grafting.

    PubMed

    Carlsson, Anders H; Rose, Lloyd F; Fletcher, John L; Wu, Jesse C; Leung, Kai P; Chan, Rodney K

    2017-02-01

    Current standard of care for full-thickness burn is excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact burns (100°C, 30s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, burn eschar was tangentially excised and covered with 12/1000th inch (300μm) split-thickness skin graft. For comparison, unburned wounds were created by sharp excision to fat before graft application. From 7 to 120days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p<0.05) in burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including burn-related inflammation, microscopically inadequate excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness burn, excision and skin replacement therapy has been

  4. A rare manifestation of burns after lightning strike in rural Ghana: a case report.

    PubMed

    Apanga, Paschal Awingura; Azumah, John Atigiba; Yiranbon, Joseph Bayewala

    2017-07-25

    Lightning is a natural phenomenon that mostly affects countries in the tropical and subtropical regions of the globe, including Ghana. Lightning strikes pose a global public health issue. Although strikes to humans are uncommon, it is associated with high morbidity and mortality. We present a case of a 10-year-old Ghanaian girl who got second-degree burns after being struck by lightning. She was put on an intravenous broad-spectrum antibiotic (ceftriaxone), Ringer's lactate, and her burns were dressed with sterile gauze impregnated with Vaseline (petroleum jelly) and silver sulfadiazine ointment. There was marked improvement on the 16(th) day of treatment despite the lack in capacity of the hospital to carry out some laboratory diagnostic tests. On the 21(st) day of treatment, the burns were completely healed without scars and contractures. This is evidence of burns due to lightning strike, despite its rare occurrence. This report will help inform those in doubt, particularly in communities where lightning injuries are associated with widespread superstition. The case report also revealed how rural healthcare can be challenging amid a lack of basic diagnostic equipment and logistics. However, in resource-limited settings, Vaseline (petroleum jelly) and silver sulfadiazine could be used in the treatment of burns.

  5. Full thickness facial burns: Outcomes following orofacial rehabilitation.

    PubMed

    Clayton, N A; Ward, E C; Maitz, P K M

    2015-11-01

    To document orofacial rehabilitation and outcomes after full thickness orofacial burn. Participants included 12 consecutive patients presenting with full thickness orofacial burns. A group of 120 age-matched healthy participants was recruited for normative comparison. Non-surgical exercise was initiated within 48 h of admission and continued until wounds had healed, circumoral scar tissue had stabilised and functional goals were achieved to the best of the patient's ability. Outcomes were documented using vertical and horizontal mouth opening measures at start and end of treatment and therapy duration was recorded. At commencement of treatment, participants had significantly (p<0.001) reduced vertical and horizontal mouth opening range compared to controls. Average duration of orofacial contracture management was 550 days, with half requiring >2 years rehabilitation. By end of treatment, significant (p<0.01) positive improvement in vertical and horizontal mouth opening had been achieved, however measures had returned to lower limits of normal function and remained significantly (p<0.05) reduced compared to the control group. This study demonstrates that although positive gains can be achieved through non-surgical exercise after full thickness burn, the duration of rehabilitation is considerable and some degree of long term loss in functional mouth opening remains. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  6. Pentazocine-induced fibromyositis and contracture

    PubMed Central

    Das, C; Thussu, A; Prabhakar, S; Banerjee, A

    1999-01-01

    We report a case of myopathy, accompanied by widespread contractures predominantly involving the elbow and knee joints, following long-standing pentazocine abuse.


Keywords: pentazocine; myopathy; contractures PMID:10435175

  7. Monitoring the influence of compression therapy on pathophysiology and structure of a swine scar model using multispectral imaging system

    NASA Astrophysics Data System (ADS)

    Ghassemi, Pejhman; Travis, Taryn E.; Shuppa, Jeffrey W.; Moffatt, Lauren T.; Ramella-Romana, Jessica C.

    2014-03-01

    Scar contractures can lead to significant reduction in function and inhibit patients from returning to work, participating in leisure activities and even render them unable to provide care for themselves. Compression therapy has long been a standard treatment for scar prevention but due to the lack of quantifiable metrics of scar formation scant evidence exists of its efficacy. We have recently introduced a multispectral imaging system to quantify pathophysiology (hemoglobin, blood oxygenation, melanin, etc) and structural features (roughness and collagen matrix) of scar. In this study, hypertrophic scars are monitored in-vivo in a porcine model using the imaging system to investigate influence of compression therapy on its quality.

  8. Facial Scar Revision: Understanding Facial Scar Treatment

    MedlinePlus

    ... Contact Us Trust your face to a facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment When ... face like the eyes or lips. A facial plastic surgeon has many options for treating and improving facial ...

  9. Values of a Patient and Observer Scar Assessment Scale to Evaluate the Facial Skin Graft Scar

    PubMed Central

    Chae, Jin Kyung; Kim, Eun Jung; Park, Kun

    2016-01-01

    Background The patient and observer scar assessment scale (POSAS) recently emerged as a promising method, reflecting both observer's and patient's opinions in evaluating scar. This tool was shown to be consistent and reliable in burn scar assessment, but it has not been tested in the setting of skin graft scar in skin cancer patients. Objective To evaluate facial skin graft scar applied to POSAS and to compare with objective scar assessment tools. Methods Twenty three patients, who diagnosed with facial cutaneous malignancy and transplanted skin after Mohs micrographic surgery, were recruited. Observer assessment was performed by three independent rates using the observer component of the POSAS and Vancouver scar scale (VSS). Patient self-assessment was performed using the patient component of the POSAS. To quantify scar color and scar thickness more objectively, spectrophotometer and ultrasonography was applied. Results Inter-observer reliability was substantial with both VSS and the observer component of the POSAS (average measure intraclass coefficient correlation, 0.76 and 0.80, respectively). The observer component consistently showed significant correlations with patients' ratings for the parameters of the POSAS (all p-values<0.05). The correlation between subjective assessment using POSAS and objective assessment using spectrophotometer and ultrasonography showed low relationship. Conclusion In facial skin graft scar assessment in skin cancer patients, the POSAS showed acceptable inter-observer reliability. This tool was more comprehensive and had higher correlation with patient's opinion. PMID:27746642

  10. Partial fasciectomy for Dupuytren's contractures.

    PubMed

    Mavrogenis, Andreas F; Spyridonos, Sarantis G; Ignatiadis, Ioannis A; Antonopoulos, Dimitrios; Papagelopoulos, Panayiotis J

    2009-01-01

    One hundred ninety-six patients with Dupuytren's contractures were treated by partial fasciectomy and adequate postoperative rehabilitation. All patients had flexion contracture of the proximal interphalangeal joint of >20 degrees ; 93 patients had flexion contracture of the associated metacarpophalangeal joint of >30 degrees ; 143 patients had risk factors for Dupuytren's disease. Primary skin closure and splinting were done in all patients. Range of motion was begun by the 1st week. Splinting was discontinued by the 2nd week, followed by night-time splinting until the 8th week. The mean follow-up was 6.6 years (range, 2-9 years). At the latest examination, 72.5% of the patients had complete range of motion of the metacarpophalangeal and proximal interphalangeal joints; 20.2% had 5 degrees -10 degrees of extension deficit and 7.3% had recurrent contractures of >20 degrees at the proximal interphalangeal joint and were subjected to reoperation. Complications included digital neurovascular injury in 5%, complex regional pain syndrome in 10.1%, and wound-healing problems and superficial infections in 15.1%.

  11. Co-Graft of Acellular Dermal Matrix and Autogenous Microskin in a Child with Extensive Burns

    PubMed Central

    Chen, X.L.; Xia, Z.F.; Fang, L.S.; Wang, Y.J.; Wang, C.H.

    2008-01-01

    Summary A 6-yr-old boy was the victim of a burns accident in a public bathhouse. The burns involved the face, neck, upper and lower extremities, anterior and posterior trunk, and both buttocks, covering 72% of the total body surface area (TBSA). The lesions in the lower extremities and parts of the right upper extremity were deep partial-thickness, comprising 40% TBSA. On day 5 post-burn, the lesions in both lower extremities were excised to the extent of the fascia under general anaesthesia. Meshed J1 Jayya Acellular Dermis®, a kind of acellular allodermal (ADM) matrix, was then placed on the left knee joint. The right knee joint served as control. The wounds in both lower extremities were then overlaid with microskin autografting. At 19 days post-application, the lesions in both lower extremities had almost completely resurfaced. Follow-up at six months revealed well-healed and stable skin of acellular ADM and microskin autografts on the left knee. However, the skin of the right knee was unstable and there was a chronic residual ulcer. Both legs showed some significant hypertrophic scars. The left knee joint (acellular ADM grafted site) showed mild contractures, while the right knee joint developed a significant contracture. The "skin" of the co-graft covered site appeared thicker and more elastic. The movement range of the left knee joint was much larger than that of the right knee joint. These results suggest that co-graft of acellular dermal matrix and autogenous microskin may be an effective way to repair this functional site in children with extensive burns and to improve the functional and cosmetic results. PMID:21991120

  12. Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies

    PubMed Central

    Gauglitz, Gerd G; Korting, Hans C; Pavicic, Tatiana; Ruzicka, Thomas; Jeschke, Marc G

    2011-01-01

    Excessive scars form as a result of aberrations of physiologic wound healing and may arise following any insult to the deep dermis. By causing pain, pruritus and contractures, excessive scarring significantly affects the patient’s quality of life, both physically and psychologically. Multiple studies on hypertrophic scar and keloid formation have been conducted for decades and have led to a plethora of therapeutic strategies to prevent or attenuate excessive scar formation. However, most therapeutic approaches remain clinically unsatisfactory, most likely owing to poor understanding of the complex mechanisms underlying the processes of scarring and wound contraction. In this review we summarize the current understanding of the pathophysiology underlying keloid and hypertrophic scar formation and discuss established treatments and novel therapeutic strategies. PMID:20927486

  13. Cytogenetic studies in Dupuytren contracture.

    PubMed Central

    Wurster-Hill, D H; Brown, F; Park, J P; Gibson, S H

    1988-01-01

    Dupuytren contracture is a connective tissue disease mainly confined to Caucasians. It is characterized by nodular growth and proliferation of collagen in the palmar and plantar fascias. Autosomal dominance with variable penetrance is considered the most likely mode of inheritance. The goal of the present study was to examine the cytogenetics of this common benign neoplasia. Chromosome studies were performed on the nodular growth of eight patients with Dupuytren contracture, all of whom showed chromosome abnormalities that included numerical and structural clones, random numerical and structural aberrations, prophasing, and premature centromere separation. Numerical clones of trisomies 7 and/or 8, as well as some random structural aberrations, were considered to represent in vivo abnormalities, whereas most structural clones appeared likely to be the results of rapid and selective in vitro growth of particular cells. The disease process occurring in Dupuytren contracture was found to involve marked chromosome instability, as well as some in vivo clonal formation. Transverse fascial tissue, usually considered to be uninvolved in the disease process, unexpectedly showed all the same types of abnormalities as the nodular tissue. This indicates a more widespread distribution of disease in the tissues than previously suspected. The findings in the present study are similar to those in various malignant and benign types of tumorous growth and suggest the importance of further cytogenetic investigation into other conditions of benign growth. Images Figure 2 Figure 3 Figure 4 PMID:3414684

  14. Acne scar subcision.

    PubMed

    Chandrashekar, Bs; Nandini, As

    2010-05-01

    Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It can easily be combined with other treatments such as laser, dermaroller and scar revisions for maximum efficacy.

  15. Acne Scar Subcision

    PubMed Central

    Chandrashekar, BS; Nandini, AS

    2010-01-01

    Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It can easily be combined with other treatments such as laser, dermaroller and scar revisions for maximum efficacy. PMID:21031076

  16. Visible vs hidden scars and their relation to body esteem.

    PubMed

    Lawrence, John W; Fauerbach, James A; Heinberg, Leslie; Doctor, Marion

    2004-01-01

    This study examined the relationship among burn scarring, severity and visibility, and body esteem. Previous work addressing this question has relied on case studies and small samples. We mailed a survey to 2500 members of a national burn survivor support group. Survivors were asked to complete and return the mailed survey or complete the survey on line at our Web site. Three hundred sixty-one survivors completed all questionnaires in the survey relevant to this study, which included measures of burn characteristics, social stigmatization, social support, depression, and body esteem. The sample characteristics were as follows: 52% were women, the mean age was 44.1 years, the mean age burned was 26 years, 88% were European American, 5% were African American, 4% were multiracial, 3% were other, the average TBSA was 48%, and the mean educational level was high school graduate. We measured scar visibility by asking survivors to rate "how often are your burn scars visible to others" on a six-point scale. We also asked them to rate the presence or absence of scars on 15 body parts, total TBSA, and number of surgeries. The correlation between visible scarring and different aspects of body esteem, that is, self-satisfaction with appearance (-.19) and perception of others reaction to your appearance (-.27), was statistically significant but low. Visible scarring was unrelated to self-satisfaction with weight (.01). Visible scarring had a low but significant correlation with perceived stigmatization (.23) and was not correlated with depression (0.01). Other measures of scarring also had low correlations with social and emotional outcome variables. Because scar severity and visibility are hypothesized to be particularly relevant to body esteem, we performed a multiple regression predicting body esteem. We entered the variables in three blocks: burn characteristics, demographic characteristics, and social and emotional characteristics. Burn characteristics accounted for less

  17. Surgical treatment of burns sequelae. our experience in the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo.

    PubMed

    Buja, Z; Arifi, H; Hoxha, E; Duqi, S

    2015-09-30

    Burn injuries are very frequent in Kosovo, leading to long-lasting physical, functional, aesthetic, psychological and social consequences directly proportional to the time of healing; the longer it takes for the burn wound to heal, the more serious are the sequelae. The objectives of the present study are to review the epidemiological, clinical and therapeutic aspects of burn patients presenting with post-burn sequelae and treated at the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo, from January 2005 until December 2011. This study included 188 patients with burns sequelae. The following variables were considered: age, sex, anatomical location, pathological types, and surgical procedure. There were 82 men (43.6%) and 106 women (56.4%), ranging in age from 0 to 67 years (mean age 33.5 years), most of the patients were children (139 = 73.9%). Burn contractures were observed in 135 (71.8%) patients, hypertrophic scars in 32 (17%), keloids in 10 (5.3%), alopecia in 6 (3.2%), syndactyly in 12 (6.4%), ectropion in 4 (2.1%) and ear deformity in 1 (0.53%) cases. To correct the deformities the most common choice was the Z-plasty technique, used in 31.4% of cases, followed by Z-plasty+full thickness skin grafts in 21.8%, full thickness skin grafts in 18.1%, tissue expansion in 8%, Z-plasty+local flaps in 4.8%, flaps (local, fascio-cutaneous, radial forearm) in 6.9% and direct closure in 6.4%. Timely wound closure and the development of an individual programme for surgical treatment of burns sequelae are crucial for optimal outcomes in patients with burns.

  18. Scar tissue classification using nonlinear optical microscopy and discriminant analysis.

    PubMed

    Kelf, Timothy Andrew; Gosnell, Martin; Sandnes, Bjornar; Guller, Anna E; Shekhter, Anatoly B; Zvyagin, Andrei V

    2012-02-01

    This paper addresses the scar tissue maturation process that occurs stepwise, and calls for reliable classification. The structure of collagen imaged by nonlinear optical microscopy (NLOM) in post-burn hypertrophic and mature scar, as well as in normal skin, appeared to distinguish these maturation steps. However, it was a discrimination analysis, demonstrated here, that automated and quantified the scar tissue maturation process. The achieved scar classification accuracy was as high as 96%. The combination of NLOM and discrimination analysis is believed to be instrumental in gaining insight into the scar formation, for express diagnosis of scar and surgery planning. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. Pediatric cutaneous bleach burns.

    PubMed

    Lang, Cathleen; Cox, Matthew

    2013-07-01

    Bleach is a common household product which can cause caustic injuries. Its effects on mucosal tissues and the eye have been well-described in the literature. However, there is little information published regarding the appearance and effect of bleach on a child's skin. We report three children who sustained chemical burns after contact with bleach. All three children sustained accidental bleach burns while at home, and each child had a distinct brown discoloration to the skin from the injury. All three children had treatment and follow-up for their burns. Two of the children sustained more severe burns, which were extensive and required more time to heal. There was also long-term scarring associated with the severe burns. Like most burns, pain control is required until the injury heals. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Nasal scarring by joss stick burns.

    PubMed

    Krishnan, G; Khanijow, V J

    1994-03-01

    Vasomotor rhinitis is a common condition in Malaysia. Patients' dissatisfaction with medical treatment of this recurring condition leads them to seek other forms of traditional cures. This paper highlights the complications in such patients who seek traditional cures for their chronic condition.

  1. Drought and Burn Scars in Southeastern Australia

    NASA Image and Video Library

    2003-03-05

    More than 2 million acres were consumed by hundreds of fires between December 2002 and February 2003 in southeastern Australia national parks, forests, foothills and city suburbs as seen by NASA Terra spacecraft.

  2. Genetic risk factors for hypertrophic scar development.

    PubMed

    Thompson, Callie M; Hocking, Anne M; Honari, Shari; Muffley, Lara A; Ga, Maricar; Gibran, Nicole S

    2013-01-01

    Hypertrophic scars (HTSs) occur in 30 to 72% patients after thermal injury. Risk factors include skin color, female sex, young age, burn site, and burn severity. Recent correlations between genetic variations and clinical conditions suggest that single-nucleotide polymorphisms (SNPs) may be associated with HTS formation. The authors hypothesized that an SNP in the p27 gene (rs36228499) previously associated with decreased restenosis after coronary stenting would be associated with lower Vancouver Scar Scale (VSS) measurements and decreased itching. Patient and injury characteristics were collected from adults with thermal burns. VSS scores were calculated at 4 to 9 months after injury. Genotyping was performed using real-time polymerase chain reaction. Logistic regression was used to determine risk factors for HTS as measured by a VSS score >7. Three hundred subjects had a median age of 39 years (range, 18-91); 69% were male and median burn size was 7% TBSA (range, 0.25-80). Consistent with literature, the p27 variant SNP had an allele frequency of 40%, but was not associated with reduced HTS formation or lower itch scores in any genetic model. HTS formation was associated with American Indian/Alaskan Native race (odds ratio [OR], 12.2; P = .02), facial burns (OR, 9.4; P = .04), and burn size ≥20% TBSA (OR, 1.99; P = .03). Although the p27 SNP may protect against vascular fibroproliferation, the effect cannot be generalized to cutaneous scars. This study suggests that American Indian/Alaskan Native race, facial burns, and higher %TBSA are independent risk factors for HTS. The American Indian/Alaskan Native association suggests that there are potentially yet-to-be-identified genetic variants.

  3. Preventing Scars after Injury with Partial Irreversible Electroporation.

    PubMed

    Golberg, Alexander; Villiger, Martin; Khan, Saiqa; Quinn, Kyle P; Lo, William C Y; Bouma, Brett E; Mihm, Martin C; Austen, William G; Yarmush, Martin L

    2016-11-01

    Preventing the formation of hypertrophic scars, especially those that are a result of major trauma or burns, would have enormous impact in the fields of regenerative and trauma medicine. In this report, we introduce a noninvasive method to prevent scarring based on nonthermal partial irreversible electroporation. Contact burn injuries in rats were treated with varying treatment parameters to optimize the treatment protocol. Scar surface area and structural properties of the scar were assessed with histology and non-invasive, longitudinal imaging with polarization-sensitive optical coherence tomography. We found that partial irreversible electroporation using 200 pulses of 250 V and 70 μs duration, delivered at 3 Hz every 20 days during a total of five therapy sessions after the initial burn injury, resulted in a 57.9% reduction of the scar area compared with untreated scars and structural features approaching those of normal skin. Unlike humans, rats do not develop hypertrophic scars. Therefore, the use of a rat animal model is the limiting factor of this work.

  4. The year in burns 2011.

    PubMed

    Wolf, Steven E; Arnoldo, Brett D

    2012-12-01

    For 2011, approximately 1746 original research articles in burns were published in English in scientific journals. This article reviews those with the most potential impact on for burn therapeutics and outcomes according to the Editor of one of the major journals (Burns) and his colleague. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterisation, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with editorial comment.

  5. [Burn child specificity].

    PubMed

    Plancq, M C; Goffinet, L; Duquennoy-Martinot, V

    2016-10-01

    Burn is still a frequent accident in children and particularly occurs in young children under 4years. The majority were caused by hot liquids (scalds) with mixed-dermal burns and is commonly treated conservatively with surgery performed at 10-15 days post-injury after healing of superficial burn. Patients with burns greater than 10% need early fluid resuscitation and adequate nutritional support to avoid deepening with infection, improve healing and survival. Hypovolemic shock could be very abrupt in children. Prophylactic prevention of infection and optimization of healing before 21 days improve quality of scar. Management with rehabilitation team is more important in children than in adults because hypertrophic scar and retraction can restrain growth and function particularly for palmar hand burns occurring at the beginning of walking. Follow-up is essential during the growth to assess scar tension requiring secondary surgery. Better knowledge of injury mechanisms should facilitate education and prevention programs and decrease the incidence. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Contemporary management of dupuytren contracture.

    PubMed

    Rizzo, Marco; Stern, Peter J; Benhaim, Prosper; Hurst, Lawrence C

    2014-01-01

    Dupuytren contracture is a condition that affects the palmar fascia. It most commonly affects men of northern European ancestry and initially presents at middle age. The diseased fascia may form cords that extend into the digits, resulting in limited motion and function. Treatment is aimed at either releasing or removing the diseased cord so that the finger can extend fully. Common interventions include surgery, needle aponeurotomy, and collagenase injection. Surgery remains the gold standard in treatment and most commonly includes a limited fasciectomy. Although often successful, surgery carries inherent risks and may involve a lengthy recovery with extensive therapy. Needle aponeurotomy and collagenase injections are office-based alternatives that aim to weaken the cord and release the contracture. Needle aponeurotomy involves repeated needling along the cord in intervals and collagenase injections to dissolve a portion of the cord. Despite being less invasive, problems such as nerve and/or tendon injury, skin tears, and autoimmune reactions have been reported. Regardless of treatment, recurrence remains a concern.

  7. Differential item functioning in the Observer Scale of the POSAS for different scar types.

    PubMed

    van der Wal, Martijn B A; Tuinebreijer, Wim E; Lundgren-Nilsson, Åsa; Middelkoop, Esther; van Zuijlen, Paul P M

    2014-09-01

    To investigate whether the Observer Scale of the Patient and Observer Scar Assessment Scale (POSAS) can serve as a generic measure for scar quality across different scar types. A collection of POSAS scores derived from several clinical trials on burn (n = 404), linear (n = 384), and keloidal scars (n = 282) was analyzed using the partial credit model of the Rasch analysis package RUMM2030. Differential item functioning (DIF) was observed for the Observer Scale of the POSAS between the three scar types for the items pliability, thickness, and surface area, which could be solved by item splitting. The items pigmentation and thickness showed disordered thresholds, considerable misfit, and unpredictability. Users of the Observer Scale of the POSAS must be aware that the raw scores obtained from burn, linear, and keloidal scars cannot be compared without the scar-specific DIF adjustment of the items pliability, thickness, and surface area.

  8. Functional and mechanistic investigation of Shikonin in scarring.

    PubMed

    Xie, Yan; Fan, Chen; Dong, Ying; Lynam, Emily; Leavesley, David I; Li, Kun; Su, Yonghua; Yang, Yinxue; Upton, Zee

    2015-02-25

    Scarring is a significant medical burden; financially to the health care system and physically and psychologically for patients. Importantly, there have been numerous case reports describing the occurrence of cancer in burn scars. Currently available therapies are not satisfactory due to their undesirable side-effects, complex delivery routes, requirements for long-term use and/or expense. Radix Arnebiae (Zi Cao), a perennial herb, has been clinically applied to treat burns and manage scars for thousands of years in Asia. Shikonin, an active component extracted from Radix Arnebiae, has been demonstrated to induce apoptosis in cancer cells. Apoptosis is an essential process during scar tissue remodelling. It was therefore hypothesized that Shikonin may induce apoptosis in scar-associated cells. This investigation presents the first detailed in vitro study examining the functional responses of scar-associated cells to Shikonin, and investigates the mechanisms underlying these responses. The data obtained suggests that Shikonin inhibits cell viability and proliferation and reduces detectable collagen in scar-derived fibroblasts. Further investigation revealed that Shikonin induces apoptosis in scar fibroblasts by differentially regulating the expression of caspase 3, Bcl-2, phospho-Erk1/2 and phospho-p38. In addition, Shikonin down-regulates the expression of collagen I, collagen III and alpha-smooth muscle actin genes hence attenuating collagen synthesis in scar-derived fibroblasts. In summary, it is demonstrated that Shikonin induces apoptosis and decreases collagen production in scar-associated fibroblasts and may therefore hold potential as a novel scar remediation therapy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Management of scars: updated practical guidelines and use of silicones.

    PubMed

    Meaume, Sylvie; Le Pillouer-Prost, Anne; Richert, Bertrand; Roseeuw, Diane; Vadoud, Javid

    2014-01-01

    Hypertrophic scars and keloids resulting from surgery, burns, trauma and infection can be associated with substantial physical and psychological distress. Various non-invasive and invasive options are currently available for the prevention and treatment of these scars. Recently, an international multidisciplinary group of 24 experts on scar management (dermatologists; plastic and reconstructive surgeons; general surgeons; physical medicine, rehabilitation and burns specialists; psychosocial and behavioural researchers; epidemiologists; beauticians) convened to update a set of practical guidelines for the prevention and treatment of hypertrophic and keloid scars on the basis of the latest published clinical evidence on existing scar management options. Silicone-based products such as sheets and gels are recommended as the gold standard, first-line, non-invasive option for both the prevention and treatment of scars. Other general scar preventative measures include avoiding sun exposure, compression therapy, taping and the use of moisturisers. Invasive treatment options include intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical excision. All of these options may be used alone or as part of combination therapy. Of utmost importance is the regular re-evaluation of patients every four to eight weeks to evaluate whether additional treatment is warranted. The amount of scar management measures that are applied to each wound depends on the patient's risk of developing a scar and their level of concern about the scar's appearance. The practical advice presented in the current guidelines should be combined with clinical judgement when deciding on the most appropriate scar management measures for an individual patient.

  10. Management of posttraumatic proximal interphalangeal joint contracture.

    PubMed

    Houshian, Shirzad; Jing, Shan Shan; Chikkamuniyappa, Chandrasekar; Kazemian, Gholam Hussein; Emami-Moghaddam-Tehrani, Mohammad

    2013-08-01

    Chronic flexion contracture of the proximal interphalangeal (PIP) joint presents a common yet challenging problem to hand surgeons. Over the years, multiple treatment modalities have been described for this problem, producing limited results. Nonoperative treatment using serial casting and splints should be tried before attempting open surgical release, which should be done in selected patients. The use of external fixation for treating PIP contracture has been encouraging and can be a useful alterative. This review provides an update on the current management of PIP joint contractures and presents a flowchart of treatment to aid decision making.

  11. [Mastopexy with minimal scar].

    PubMed

    Tepavicharova-Romanska, P; Romanski, R K

    2004-01-01

    The image of the breast as a symbol of femininity plays an essential role in the way a woman looks at herself and contributes to her personal and social development. Fashion nowadays uncovers rather than covers a woman's body, and long scars resulting from mammaplasty are less accepted now than they were in the past, more so because the scar quality is unforeseeable. The main concern of mastopexy is to limit the scars, creating a nice breast shape. Ideally scarring is confined to the periareolar circle.

  12. Human hypertrophic and keloid scar models: principles, limitations and future challenges from a tissue engineering perspective

    PubMed Central

    van den Broek, Lenie J; Limandjaja, Grace C; Niessen, Frank B; Gibbs, Susan

    2014-01-01

    Most cutaneous wounds heal with scar formation. Ideally, an inconspicuous normotrophic scar is formed, but an abnormal scar (hypertrophic scar or keloid) can also develop. A major challenge to scientists and physicians is to prevent adverse scar formation after severe trauma (e.g. burn injury) and understand why some individuals will form adverse scars even after relatively minor injury. Currently, many different models exist to study scar formation, ranging from simple monolayer cell culture to 3D tissue-engineered models even to humanized mouse models. Currently, these high-/medium-throughput test models avoid the main questions referring to why an adverse scar forms instead of a normotrophic scar and what causes a hypertrophic scar to form rather than a keloid scar and also, how is the genetic predisposition of the individual and the immune system involved. This information is essential if we are to identify new drug targets and develop optimal strategies in the future to prevent adverse scar formation. This viewpoint review summarizes the progress on in vitro and animal scar models, stresses the limitations in the current models and identifies the future challenges if scar-free healing is to be achieved in the future. PMID:24750541

  13. Human hypertrophic and keloid scar models: principles, limitations and future challenges from a tissue engineering perspective.

    PubMed

    van den Broek, Lenie J; Limandjaja, Grace C; Niessen, Frank B; Gibbs, Susan

    2014-06-01

    Most cutaneous wounds heal with scar formation. Ideally, an inconspicuous normotrophic scar is formed, but an abnormal scar (hypertrophic scar or keloid) can also develop. A major challenge to scientists and physicians is to prevent adverse scar formation after severe trauma (e.g. burn injury) and understand why some individuals will form adverse scars even after relatively minor injury. Currently, many different models exist to study scar formation, ranging from simple monolayer cell culture to 3D tissue-engineered models even to humanized mouse models. Currently, these high-/medium-throughput test models avoid the main questions referring to why an adverse scar forms instead of a normotrophic scar and what causes a hypertrophic scar to form rather than a keloid scar and also, how is the genetic predisposition of the individual and the immune system involved. This information is essential if we are to identify new drug targets and develop optimal strategies in the future to prevent adverse scar formation. This viewpoint review summarizes the progress on in vitro and animal scar models, stresses the limitations in the current models and identifies the future challenges if scar-free healing is to be achieved in the future. © 2014 The Authors. Experimental Dermatology. Published by John Wiley & Sons Ltd.

  14. [External ear reconstruction using expanded postauricular scar flap and Medpor framework].

    PubMed

    Song, Chun-qiong; Zhuang, Hong-xing; Wang, Shu-jie; Hu, Xiao-gen; He, Le-ren

    2006-11-01

    To investigate the possibility of external ear reconstruction using expanded postauricular scar flap and Medpor framework in burn cases. External ear reconstruction using expanded postauricular scar flap in combination with Medpor framework was performed in 17 cases whose ear had burn injury. Of the 17 cases, 15 cases achieved success; 2 cases experienced partial exposure of the framework due to inadequate wrapping of the subcutaneous fascia flap and later injury. The longest follow-up was three years, and the final result was satisfactory. External ear reconstruction using expanded postauricular scar flap in combination with Medpor framework is a reliable method for adult (over 25 years) who has ear defect from burn injury.

  15. Solanidine and tomatidine trigger scar pruritus.

    PubMed

    Alonso, Pedro E; Rioja, Luis F

    2016-05-01

    Scar pruritus is frequently encountered in clinical practice (particularly in burn patients) owing to its poorly known pathogenesis and difficult treatment. In previous work, we demonstrated the usefulness of a diet excluding edible solanaceae (viz., potatoes, tomatoes, peppers and aubergines) in patients with antihistamine-resistant scar pruritus. We hypothesized that alkaloids in solanaceae (particularly their secondary metabolites or aglycones) might be the actual pruritogens. In order to test this hypothesis, we conducted a single-blind prospective study on patients responding favourably to a solanaceae-free diet whose scar pruritus could be ascribed to one of the four foods. The study involved applying the aglycones solanidine and tomatidine to each scar and checking whether, and which, had a pruritogenic effect. A total of 18 patients (90%) responded by developing pruritus; also, the triggering aglycone coincided with that prevailing in the pruritogenic food. We concluded that solanaceae aglycones are directly involved in the pathogenesis of scar pruritus. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  16. Rehabilitation methods for the burn injured individual.

    PubMed

    Spires, M Catherine; Kelly, Brian M; Pangilinan, Percival H

    2007-11-01

    Physiatrists play a critical role in managing the medical and functional consequences of serious burn injuries. Goals of rehabilitation include wound healing, scar prevention, hypertrophic scarring suppression, full range of motion, strengthening, and independent mobility and activities of daily living. This article is an overview of burn rehabilitation principles and patient management. The ultimate rehabilitation goal is independence in all spheres of an individual's life. Achievement of independence depends on the commitment of the injured individual and the entire health care team.

  17. [Physical therapy for scars].

    PubMed

    Masanovic, Marguerite Guillot

    2013-01-01

    Physical therapy consists notably of hand or mechanical massages, pressure therapy using various fabrics or splints, cryotherapy, laser therapy, etc. It forms part of the range of therapies used to treat pathological scars, including medical and surgical treatment. While the results are often satisfactory for hypertrophic scars, they remain uncertain for major keloids.

  18. Improving posttraumatic facial scars.

    PubMed

    Ardeshirpour, Farhad; Shaye, David A; Hilger, Peter A

    2013-10-01

    Posttraumatic soft-tissue injuries of the face are often the most lasting sequelae of facial trauma. The disfigurement of posttraumatic scarring lies in both their physical deformity and psychosocial ramifications. This review outlines a variety of techniques to improve facial scars and limit their lasting effects. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Laser scar revision.

    PubMed

    Lupton, Jason R; Alster, Tina S

    2002-01-01

    A variety of lasers can be used to treat scars and striae effectively. It is of paramount importance that the type of scar be properly classified on initial examination so that the most appropriate method of treatment can be chosen. Classification also allows the laser surgeon to discuss with the patient the anticipated response to treatment. The 585-nm pulsed dye laser (PDL) is the most appropriate system for treating hypertrophic scars, keloids, erythematous scars, and striae. The PDL carries a low risk of side effects and complications when operated at appropriate treatment parameters and time intervals. Atrophic scars are best treated with ablative CO2 and Er:YAG lasers; however, proliferative keloids and hypertrophic scars should not be vaporized because of the high risk of scar recurrence or progression. The appropriate choice and use of lasers can significantly improve most scars. As research in laser-skin interaction continues, further refinements in laser technology coupled with the addition of alternate treatment procedures will allow improved clinical efficacy and predictability.

  20. Laser Scar Management Technique

    PubMed Central

    Ohshiro, Toshio; Sasaki, Katsumi

    2013-01-01

    Background and Aims: Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. Methods: Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. Results and Conclusions: Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual. PMID:24511202

  1. [Clinical aspects of corneal burns].

    PubMed

    Borderie, V

    2004-12-01

    Clinical aspects and prognosis of corneal burns mainly depend on the agent responsible for the trauma. The most severe burns are caustic burns, which should be classified as burns caused by basic agents, associated with deep and prolonged injuries, and burns caused by acidic agents, associated with more superficial injuries. At the acute stage, caustic burns induce epithelial defects, corneal edema, and ischemic necrosis of the limbus, conjunctiva, iris and ciliary body. At the early stage, reepithelialization occurs and is often associated with corneal vascularization and stromal infiltrates, followed by corneal scar formation. At the chronic stage, the following complications are possible: corneal scars, limbal stem cell insufficiency, lachrymal insufficiency, irregular astigmatism, ocular surface fibrosis, cataract, glaucoma, decreased intraocular pressure, and ocular atrophy. The Ropper-Hall classification is based on the extent of limbal ischemia. Thermal burns induce epithelial defects at the acute stage, with the more severe forms giving the same complications as caustic burns. Radiation-related burns can be caused by ultraviolet radiations (acute epithelial keratitis, pterygium, droplet-like keratitis), microwaves, infrared radiations, ionizing radiations or, laser radiations. Electrical burns are often a result of torture and give corneal stroma opacification.

  2. Plantarflexion Contracture in the mdx Mouse

    PubMed Central

    Garlich, Michael W.; Baltgalvis, Kristen A.; Call, Jarrod A.; Dorsey, Lisa L.; Lowe, Dawn A.

    2012-01-01

    Objective Contractures are a major clinical issue for patients with muscular dystrophies. However, it is unknown whether contractures are present in the widely used mdx mouse model of Duchenne muscular dystrophy. Therefore, the objectives of this study were to develop methods to measure muscle contractures in mice, to determine whether plantarflexion contractures are present in mdx mice, and to analyze the composition of the major muscles involved. Design Hindlimbs of eight wild type and six mdx mice were assessed every 2 wks during the course of a 12-wk study. Assessments included range of motion and in vivo torques about the ankle. At the end of the study, mice were euthanized, and muscles were analyzed for composition. Results The mdx mice had ~10 degrees less dorsiflexion, increased passive torque moving the ankle into dorsiflexion, and an increased passive-to-active torque ratio relative to wild type mice. Gastrocnemius muscle composition alterations included increased wet mass, decreased protein content, and increased collagen. Conclusions The results indicate that mdx mice have plantarflexion contractures similar to those seen in children with Duchenne muscular dystrophy. In future studies, these measures can be used to assess strategies to slow the progression of contractures that occur with muscular dystrophies. PMID:21403594

  3. Nonsurgical scar management of the face: does early versus late intervention affect outcome?

    PubMed

    Parry, Ingrid; Sen, Soman; Palmieri, Tina; Greenhalgh, David

    2013-01-01

    Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity.

  4. Atrophic Acne Scarring

    PubMed Central

    Graber, Emmy M.

    2015-01-01

    Background: Scarring is an unfortunate and frequent complication of acne, resulting in significant psychological distress for patients. Fortunately, numerous treatment options exist for acne scarring. Objectives: To extensively review the literature on treatment options for atrophic acne scarring. Materials and methods: A comprehensive literature search was conducted on the following topics: dermabrasion, subcision, punch techniques, chemical peels, tissue augmentation, and lasers. Results: The literature supports the use of various treatment modalities; superior results may be achieved when multiple modalities are combined for a multi-step approach to scarring. Conclusion: The safety and efficacy of various treatment devices for acne scarring is well established, but there is a paucity of split-face trials comparing modalities. PMID:25610524

  5. Assessment of burn depth and burn wound healing potential.

    PubMed

    Monstrey, Stan; Hoeksema, Henk; Verbelen, Jos; Pirayesh, Ali; Blondeel, Phillip

    2008-09-01

    The depth of a burn wound and/or its healing potential are the most important determinants of the therapeutic management and of the residual morbidity or scarring. Traditionally, burn surgeons divide burns into superficial which heal by rapid re-epithelialization with minimal scarring and deep burns requiring surgical therapy. Clinical assessment remains the most frequent technique to measure the depth of a burn wound although this has been shown to be accurate in only 60-75% of the cases, even when carried out by an experienced burn surgeon. In this article we review all current modalities useful to provide an objective assessment of the burn wound depth, from simple clinical evaluation to biopsy and histology and to various perfusion measurement techniques such as thermography, vital dyes, video angiography, video microscopy, and laser Doppler techniques. The different needs according to the different diagnostic situations are considered. It is concluded that for the initial emergency assessment, the use of telemetry and simple burn photographs are the best option, that for research purposes a wide range of different techniques can be used but that, most importantly, for the actual treatment decisions, laser Doppler imaging is the only technique that has been shown to accurately predict wound outcome with a large weight of evidence. Moreover this technique has been approved for burn depth assessment by regulatory bodies including the FDA.

  6. Burns - resources

    MedlinePlus

    Resources - burns ... The following organizations are good resources for information on burns : Burns Recovered -- brsg.org Model Systems Knowledge Translation Center - Burn Model Systems -- www.msktc.org/burn

  7. Expanded flap to repair facial scar left by radiotherapy of hemangioma.

    PubMed

    Zhao, Donghong; Ma, Xinrong; Li, Jiang; Zhang, Lingfeng; Zhu, Baozhen

    2014-09-01

    This study explored the feasibility and clinical efficacy of expanded flap to repair facial scar left by radiotherapy of hemangioma. From March 2000 to April 2011, 13 cases of facial cicatrices left by radiotherapy of hemangioma have been treated with implantation surgery of facial skin dilator under local anesthesia. After water flood expansion for 1-2 months, resection of facial scar was performed, and wound repairing with expansion flap transfer was done. Thirteen patients were followed up from 5 months to 3 years. All patients tolerated flap transfer well; no contracture occurred during the facial expansion flap transfer. The incision scar was not obvious, and its color and texture were identical to surrounding skin. In conclusion, the use of expanded flap transfer to repair the facial scar left by radiotherapy of hemangioma is advantageous due to its simplicity, flexibility, and large area of repairing. This method does not affect the subsequent facial appearance.

  8. A new flap design for release of parallel contracture bands: dual opposing five-flap z-plasty.

    PubMed

    Ersoy, Burak

    2014-12-01

    Skin contractures secondary to burn and other types of trauma can be encountered on almost every part of human body, best addressed by a custom treatment protocol tailored for each patient. Skin graft, local flap as well as distant flap options are available, each with intrinsic advantages and disadvantages. In the presence of weblike contracture the utilization of local tissue, when available, is a prefered approach for a relatively better appearance through a reasonably simpler surgical intervention, compared to skin graft applications and distant flap options. Among many other techniques and modalities utilized for this purpose, the dual opposing five-flap z-plasty method which is a novel method designed as a modification of the paired five-flap z-plasty technique promises to be a useful treatment option for the release of parallel contracture bands with satisfactory results in selected patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  9. Establishing a Reproducible Hypertrophic Scar following Thermal Injury: A Porcine Model

    PubMed Central

    Rapp, Scott J.; Rumberg, Aaron; Visscher, Marty; Billmire, David A.; Schwentker, Ann S.

    2015-01-01

    Background: Our complete understanding of hypertrophic scarring is still deficient, as portrayed by the poor clinical outcomes when treating them. To address the need for alternative treatment strategies, we assess the swine animal burn model as an initial approach for immature scar evaluation and therapeutic application. Methods: Thermal contact burns were created on the dorsum of 3 domestic swine with the use of a branding iron at 170°F for 20 seconds. Deep partial-thickness burns were cared for with absorptive dressings over 10 weeks and wounds evaluated with laser and negative pressure transduction, histology, photographic analysis, and RNA isolation. Results: Overall average stiffness (mm Hg/mm) increased and elasticity (mm) decreased in the scars from the initial burn injury to 8 weeks when compared with normal skin (P < 0.01). Scars were thicker, more erythematous, and uniform in the caudal dorsum. The percent change of erythema in wounds increased from weeks 6 to 10. Histology demonstrated loss of dermal papillae, increased myofibroblast presence, vertically oriented vessels, epidermal and dermal hypercellularity, and parallel-layered collagen deposition. Immature scars remained elevated at 10 weeks, and minimal RNA was able to be isolated from the tissue. Conclusions: Deep partial-thickness thermal injury to the back of domestic swine produces an immature hypertrophic scar by 10 weeks following burn with thickness appearing to coincide with the location along the dorsal axis. With minimal pig to pig variation, we describe our technique to provide a testable immature scar model. PMID:25750848

  10. Short- and long-term outcomes of small auto- and cryopreserved allograft skin grafting in those with >60%TBSA deep burn wounds.

    PubMed

    Shizhao, Ji; Yongjun, Zheng; Lisen, Zhang; Pengfei, Luo; Xiaopeng, Zheng; Guangyi, Wang; Shihui, Zhu; Xiaoyan, Hu; Shichu, Xiao; Zhaofan, Xia

    2017-02-01

    The shortage of autologous skin sources not only adds difficulty to the repair of extremely large-area deep burn wounds but affects the healing quality. The aim of the present study is to explore an ideal method for repairing large-areas burn wounds with low scar formation. Between 2002 and 2014, we used grafting of small auto- and cryopreserved allo-skin to repair large-area residual burn wounds in wounds after 21 days 21 patients, and after early excision in 17 patients. The wound healing rate and quality were observed. The skin expansion rate was 1:9-1:16, and the mean area of wounds repaired after three weeks was 64.8±7.3%TBSA, the wound healing rate was 91.8±3.7%. The mean area of the early excision group was 65.9±9.8 TBSA, where the healing rate was 94.5±5.6%. After small auto- and cryopreserved allograft skin grafting, the epidermis of the auto-skin gradually replaced the allo-epidermis, and the allo-dermis persisted for a prolonged period. The dermal collagen fibers at the allo-skin grafting sites were well arranged. At 1-2-year follow-up, observation showed that the Vancouver Scar Scale total score was 4·304±2·363, and we did not discern significant contracture and dysfunction in the large joints of the four extremities. Small auto- and cryopreserved allograft skin grafting of small auto- and allo-skin not only raised the graft expansion rate but offers a stable wound healing rate. This new technique may provide an option for repair of large-area deep burn wounds. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  11. [Scalp burns due to hair bleach].

    PubMed

    Wagenblast, Lene

    2011-02-28

    We present two cases of scalp burn or possible chemical reaction due to use of hair highlight products. One case was treated with serial excision of the scarred bald area after the burn, and the other case was treated with implantation of expanders and subsequent excision of the bald area.

  12. Dupuytren contracture in the pediatric population: a systematic review.

    PubMed

    Izadpanah, Ali; Viezel-Mathieu, Alex; Izadpanah, Arash; Luc, Mario

    2015-04-01

    Dupuytren contracture of the palm is a relatively common benign fibroproliferative disease of the palmar fascia typically affecting the adult population. There have however been several reported cases of Dupuytren contracture in children. We sought to review the literature for Dupuytren contracture and highlight the main clinical features and management of the disease in children.

  13. Sensory innervation of rat contracture shoulder model.

    PubMed

    Ochiai, Nobuyasu; Ohtori, Seiji; Kenmoku, Tomonori; Yamazaki, Hironori; Ochiai, Satoko; Saisu, Takashi; Matsuki, Keisuke; Takahashi, Kazuhisa

    2013-02-01

    To date, few studies have investigated the cause of pain experienced by patients with frozen shoulder. The purposes of this study were to establish a rat contracture model and clarify the innervation pattern of the glenohumeral (GH) joint and subacromial bursa (SAB) using immunohistochemistry in the dorsal root ganglion (DRG) neurons. The rat contracture models were made by tying the animal's humerus and scapula with No. 2-0 FiberWire (Arthrex, Naples, FL, USA). Contracture was confirmed on x-ray images taken 8 weeks after the operation. Subsequently, two kinds of neurotracers, Fluoro-Gold (FG) (Fluorochrome, Denver, CO, USA) and 1,1'-dioctadecyl-3,3,3',3'-tetramethyl-indocarbocyanine perchlorate (DiI) (Molecular Probes, Eugene, OR, USA), were used to detect the GH joints and SAB separately. FG tracers were injected into GH joints, and DiI tracers were injected into the SAB. At 7 days after injection, DRGs were harvested between C1 and T1. Immunohistochemistry by use of calcitonin gene-related peptide (CGRP) was performed. CGRP is thought to be one of the causes of pain sensation in joint disease. We evaluated the percentages of FG-labeled CGRP-immunoreactive (CGRP-ir) neurons in the total number of FG-labeled neurons and of DiI-labeled CGRP-ir neurons in the total number of DiI-labeled neurons. Abduction and total arc of the rotation were statistically significantly decreased in the contracture group. Furthermore, the percentage of CGRP-ir DRG neurons was significantly higher in the contracture group in both the GH joint and SAB. These results show that pain sensation in rat shoulder contracture may be induced by the up-regulation of CGRP expression in DRG neurons. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  14. Process of Hypertrophic Scar Formation: Expression of Eukaryotic Initiation Factor 6

    PubMed Central

    Yang, Qing-Qing; Yang, Si-Si; Tan, Jiang-Lin; Luo, Gao-Xing; He, Wei-Feng; Wu, Jun

    2015-01-01

    Background: Hypertrophic scar is one of the most common complications and often causes the disfigurement or deformity in burn or trauma patients. Therapeutic methods on hypertrophic scar treatment have limitations due to the poor understanding of mechanisms of hypertrophic scar formation. To throw light on the molecular mechanism of hypertrophic scar formation will definitely improve the outcome of the treatment. This study aimed to illustrate the negative role of eukaryotic initiation factor 6 (eIF6) in the process of human hypertrophic scar formation, and provide a possible indicator of hypertrophic scar treatment and a potential target molecule for hypertrophic scar. Methods: In the present study, we investigated the protein expression of eIF6 in the human hypertrophic scar of different periods by immunohistochemistry and Western blot analysis. Results: In the hypertrophic scar tissue, eIF6 expression was significantly decreased and absent in the basal layer of epidermis in the early period, and increased slowly and began to appear in the basal layer of epidermis by the scar formation time. Conclusions: This study confirmed that eIF6 expression was significantly related to the development of hypertrophic scar, and the eIF6 may be a target molecule for hypertrophic scar control or could be an indicator of the outcomes for other treatment modalities. PMID:26481747

  15. Fire scar mapping in a southern African savanna

    Treesearch

    Andrew T. Hudak; Bruce H. Brockett; Carol A. Wessman

    1998-01-01

    Multitemporal principal components analyses (PCAs) of pre- and post-burn Landsat Thematic Mapper images were used to map fire scars in Madikwe Game Reserve (MGR), South Africa. Prior to MGR's inception in 1991, when the land was used for extensive cattle ranching, overgrazing and fire suppression lead to bush encroachment. Fire is currently being used to control...

  16. Injection-induced gluteus muscle contractures: diagnosis with the "reverse Ober test" and surgical management.

    PubMed

    Scully, William F; White, Klane K; Song, Kit M; Mosca, Vincent S

    2015-03-01

    Adoption rates are increasing in the United States and other developed countries. A large proportion of adopted children have been found to have unsuspected medical diagnoses, including orthopedic problems. One condition, termed injection-induced gluteus maximus contracture, has been previously described in several case series and can be difficult to diagnose if unfamiliar with this condition. By reviewing the etiology and pathoanatomy of this problem, as well as the typical examination findings, including the near-pathognomonic-positive "reverse Ober test," treating providers will be better prepared to recognize and properly treat this condition. This is a retrospective review of 4 patients treated at our institution for injection-induced gluteus maximus contracture. Patient history, physical examination findings, and treatment outcomes were recorded. All had undergone surgical treatment through a longitudinal incision along the posterior margin of the iliotibial band, with division of thickened, contracted gluteus tissue down to the ischial tuberosity. All 4 of the patients were adopted from orphanages in developing countries. Chief complaints of the patients varied, but physical examination findings were very consistent. Three of the 4 patients had undergone rotational osteotomies for presumed femoral retroversion before their diagnosis and treatment for injection-induced gluteus maximus contracture. All patients had concave, atrophic buttock contours and numerous punctate buttock scars. All walked with an out-toed gait and had marked apparent femoral retroversion. Each patient was found to have full hip adduction when the hip was extended but a hip abduction contracture when the hip was flexed. This finding of increasing abduction as an extended/adducted hip is flexed to 90 degrees is described as a positive "reverse Ober test." After surgical treatment, all hips could adduct to neutral from full extension to full flexion. Although common in some countries

  17. Arthrogryposis Multiplex Congenita: Multiple Congenital Joint Contractures

    PubMed Central

    Sucuoglu, Hamza; Ornek, Nurettin Irem; Caglar, Cagkan

    2015-01-01

    Arthrogryposis multiplex congenita (AMC) is a syndrome characterized by nonprogressive multiple congenital joint contractures. The etiology of disease is multifactorial; it is most commonly suspected from absent fetal movements and genetic defects. AMC affects mainly limbs; also it might present with other organs involvement. It is crucial that the diagnosis of AMC should be kept in mind by musculoskeletal physicians in newborns with multiple joint contractures and patients must begin rehabilitation in early stage after accurate diagnosis in terms of functional independence. We present the diagnosis, types, clinical features, and treatment approaches of this disease in our case with literature reviews. PMID:26604929

  18. Anatomopathological findings in scars: comparative study between different specimens.

    PubMed

    Munteanu, Andrada Despina; Bedereag, Ştefan Iulian; NiŢescu, Cristian; Florescu, Ioan Petre

    2015-01-01

    In spite of the remarkable progress science and medicine have experienced, many facts concerning healing processes and pathological scars are still unknown or incompletely explained. This paper is part of a larger study (research for a PhD thesis) concerning new approaches in the prevention and treatment of pathological post-burn scars. We present and analyze the cases of some patients who developed abnormal scars in order to understand and point out the characteristics, that different types of pathological scars have in common and how we can differentiate them. Knowing what issue to address is the key to any successful therapy. Thus, the information we obtained will help us in applying more appropriate and efficient methods of treatment and in our further research: comparing the efficiency of newer therapies to that of older ones.

  19. Acute Marjolin's Ulcer in a Postauricular Scar after Mastoidectomy

    PubMed Central

    Bukhari, Sumaiyah M.; Hajjaj, Mutawakel F.

    2016-01-01

    Background. Marjolin's ulcer is a rare, aggressive cutaneous malignancy that arises primarily in burn scars but can occur in other types of scars. Squamous cell carcinoma is the most common variant, and while malignant degeneration usually takes a long time, it can develop acutely. Case Report. a 30-year-old man who developed Marjolin's ulcer acutely in a right postauricular scar after mastoidectomy and the incision and drainage of a mastoid abscess. To the best of our knowledge, this report is the first to describe a Marjolin's ulcer in a postauricular surgical scar. However, it has been reported in others areas in the head and neck. Conclusion. Marjolin's ulcer is most commonly observed after postburn scars, but it may be observed after any type of scars, as our patient developed an SCC with a postsurgical scar. Early diagnosis is essential, and a biopsy should be performed on any nonhealing wound or chronic wound that undergoes a sudden change. Tissue samples should be taken from both the centre and the margins of the wound. PMID:28050297

  20. Reliability and validity testing of the Patient and Observer Scar Assessment Scale in evaluating linear scars after breast cancer surgery.

    PubMed

    Truong, Pauline T; Lee, Junella C; Soer, Benjamin; Gaul, Catherine A; Olivotto, Ivo A

    2007-02-01

    The Patient and Observer Scar Assessment Scale is a promising new method incorporating observer and patient ratings in evaluating burn scars. The authors compared this tool to the Vancouver Scar Scale in a cohort of women with linear scars from breast cancer surgery. Twenty women with newly diagnosed breast cancer were prospectively accrued. Thirty-one scars were evaluated. The median time from surgery to scar assessment was 8 weeks (range, 3 to 25 weeks). Observer assessment was performed by three independent raters using the Vancouver scale and the observer component of the new tool. Patient self-assessment was performed using the patient component of the tool. Internal consistency, interobserver reliability, and convergent validity were examined. Internal consistency was acceptable for the Vancouver scale and both components of the new tool (Cronbach's alpha, 0.71, 0.74, and 0.77, respectively). Interobserver reliability was substantial with both the Vancouver scale and the observer tool (average measure intraclass coefficient correlation, 0.78 and 0.60, respectively). The observer tool and Vancouver scale correlated significantly with each other (p < 0.001), but only the observer tool correlated well with patients' ratings (p = 0.04). In surgical scar assessment, the new Patient and Observer Scar Assessment Scale and Vancouver Scar Scale were both associated with acceptable internal consistency and interobserver reliability. The new tool is more comprehensive and has higher correlation with patients' ratings. These findings support the use of the new tool as a reliable, valid, and comprehensive approach to assess linear surgical scars.

  1. Effects of contracture on gait kinematics: A systematic review.

    PubMed

    Attias, Michael; Chevalley, Odile; Bonnefoy-Mazure, Alice; De Coulon, Geraldo; Cheze, Laurence; Armand, Stéphane

    2016-03-01

    Contractures of a major joint in the lower limbs may impair human walking in addition to other daily living activities. A contracture is defined as the inability of a joint to perform the full range of motion and excessive resistance during passive mobilization of the joint. Few studies have reported methods describing how to evaluate contractures. Understanding the association among all of these studies seems essential to improve patient management. Therefore, we conducted a systematic review on this topic to elucidate the influence of contractures on gait kinematics. An electronic search in the literature will be conducted. Studies were screened by title and abstract and full texts were evaluated secondarily for definitive inclusion. The quality of the included studies was assessed independently by the two review authors with the Modified Quality Assessment Checklist. The included studies were separated into three categories: pathological contracture versus healthy controls (descriptive), simulated contracture versus healthy controls (experimental), and pre- and post-kinematics after surgical muscle lengthening (surgery). From a total of 4402 references, 112 original articles were selected, and 28 studies were identified in this systematic review. No significant difference between raters was observed on the total score of the Modified Quality Assessment Checklist. Contractures influence walking depending on the location (muscle) and the contracture level (muscle-tendon length). After giving a definition of contracture, this review identified some contracture alterations, such as plantarflexion, knee flexion and hip flexion contractures, with a kinematic description and presented possible different compensations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Hair bleaching and skin burning

    PubMed Central

    Forster, K.; Lingitz, R.; Prattes, G.; Schneider, G.; Sutter, S.; Schintler, M.; Trop, M.

    2012-01-01

    Summary Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation. PMID:23766754

  3. Hair bleaching and skin burning.

    PubMed

    Forster, K; Lingitz, R; Prattes, G; Schneider, G; Sutter, S; Schintler, M; Trop, M

    2012-12-31

    Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.

  4. Novel burn device for rapid, reproducible burn wound generation

    PubMed Central

    Kim, J.Y.; Dunham, D.M.; Supp, D.M.; Sen, C.K.; Powell, H.M.

    2016-01-01

    Introduction Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. Methods A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200 ± 5 °C) and pressed into the skin for 40 s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40 s at a constant pressure and at pressures of 1 or 3 lbs with a constant contact time of 40 s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). Results The custom burn device

  5. Novel burn device for rapid, reproducible burn wound generation.

    PubMed

    Kim, J Y; Dunham, D M; Supp, D M; Sen, C K; Powell, H M

    2016-03-01

    Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200±5°C) and pressed into the skin for 40s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40s at a constant pressure and at pressures of 1 or 3lbs with a constant contact time of 40s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). The custom burn device maintained both its internal

  6. Rapid healing of scar-associated chronic wounds after ablative fractional resurfacing.

    PubMed

    Shumaker, Peter R; Kwan, Julia M; Badiavas, Evangelos V; Waibel, Jill; Davis, Stephen; Uebelhoer, Nathan S

    2012-11-01

    Skin compromised by traumatic scars and contractures can manifest decreased resistance to shearing and other forces, while increased tension and skin fragility contribute to chronic erosions and ulcerations. Chronic wounds possess inflammatory mediator profiles and other characteristics, such as the presence of biofilms, that can inhibit healing. Three patients with multiple traumatic scars related to blast injuries initiated a course of ablative fractional laser therapy for potential mitigation of contractures, poor pliability, and textural irregularity. Patients also had chronic focal erosions or ulcerations despite professional wound care. All patients experienced incidental rapid healing of their chronic wounds within 2 weeks of their initial ablative fractional laser treatment. Healing was sustained throughout the treatment course and beyond and was associated with gradual enhancements in scar pliability, texture, durability, and range of motion. The unique pattern of injury associated with ablative fractional laser treatment may have various potential wound-healing advantages. These advantages include the novel concept of photomicrodebridement, including biofilm disruption and the stimulation of de novo growth factor secretion and collagen remodeling. If confirmed, ablative fractional resurfacing could be a potent new addition to traditional wound and scar treatment paradigms.

  7. Readability of online materials for Dupuytren's contracture.

    PubMed

    Santos, Pauline Joy F; Daar, David A; Badeau, Austin; Leis, Amber

    2017-08-23

    Descriptive. Dupuytren's contracture is a common disorder involving fibrosis of the palmar fascia. As patients are increasingly using online materials to gather health care information, it is imperative to assess the readability and appropriateness of this content. The recommended grade level for patient educational materials is seventh to eighth grade according to the National Institutes of Health. This study aims to assess the readability and content of online patient resources for Dupuytren's contracture. Evaluate readability of online patient education materials for Dupuytren's contracture. The largest public search engine, Google, was queried using the term "Dupuytren's contracture surgery" on February 26, 2016. Location filters were disabled, and sponsored results were excluded to avoid any inadvertent search bias. The 10 most popular Web sites were identified, and all relevant patient-directed information within 1 click from the original site was downloaded and saved as plain text. Readability was analyzed using 6 established analyses (Readable.io, Added Bytes, Ltd, UK). Analysis of 10 Web sites demonstrates an average grade level of at least 11th grade (Flesch-Kincaid grade level, 10.2; Gunning-Fog grade level, 13.1; Coleman-Liau grade level, 14.4; Simple Measure of Gobbledygook grade level, 10.0; automated readability grade level, 9.7; and average grade level, 11.5). Overall Flesch-Kincaid reading ease index was 46.4, which is difficult. No single article was at the recommended reading level. Online materials available for treatment of Dupuytren's contracture are above recommended reading levels and do not include a comprehensive explanation of treatment options, which may negatively impact decision making in patients seeking treatment for this condition. Surgeons and hand therapists alike should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials. V. Copyright © 2017 Hanley & Belfus

  8. Can Acne Scars Be Removed?

    MedlinePlus

    ... Surgery? A Week of Healthy Breakfasts Shyness Can Acne Scars Be Removed? KidsHealth > For Teens > Can Acne ... eliminar las cicatrices del acné? Different Types of Acne Scars from acne can seem like double punishment — ...

  9. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

    Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

  10. Scar revision - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100098.htm Scar revision - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  11. [Physical rehabilitation in extensively burned patients].

    PubMed

    Martín Martínez, V; Díez Sanz, Ma J; Corona Fernández, O; García Aragón, A; González Fraile, L

    2014-02-01

    The rehabilitation of the extensively burned patient aims to prevent and minimize consequences of the own lesion this is supported by three pillars: 1) postural treatment to prevent contractures; 2) kinesiotherapy to maintain/restore joint range of movement and muscle strength; 3) functional recovery. Physical therapy is essential in the multidisciplinary team. A coordinated team assures better results and positively influences the quality of life of the patients.

  12. [Forum on tissue expansion. Repair of sequelae of facial burns by cervical cutaneous expansion].

    PubMed

    Foyatier, J L; Comparin, J P; Latarjet, J; Delay, E; Spitalier, P; Masson, C L

    1993-02-01

    Burn scars of the lower part of the face are a difficult problem in plastic surgery. Full thickness skin graft or local flaps usually give poor cosmetic result. Over the last 5 years, we used 24 skin expanders in the neck area to cover burn scars of the chin and jaw. Discussion of the method and 4 cases are reported.

  13. Involvement of impaired desmosome-related proteins in hypertrophic scar intraepidermal blister formation.

    PubMed

    Tan, Jianglin; He, Weifeng; Luo, Gaoxing; Wu, Jun

    2015-11-01

    Hypertrophic scar is one of the unique fibrotic diseases in human. Intraepidermal blister is a common clinical symptom following the hypertrophic scar formation. However, little is known about the reason of blister creation. In this study, we selected three patients with hypertrophic scar as manifested by raised, erythematous, pruritic, blister and thickened appearance undergoing scar resection. The first scar sample was 6 months after burn from the neck of a 3 years old male patient with 10 score by Vancouver Scar Scale (VSS). The second scar sample was 12 months after burn from the dorsal foot of a 16 years old female patient with 13 score by VSS. The third one was 9 months after burn from the elbow of a 34 years old male patients with 13 score by VSS. In order to understand the molecular mechanism of blister formation, we screened the different protein expression between hypertrophic scar and normal skin tissue by means of isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology and high throughput 2D LC-MS/MS. There were 48 proteins found to be downregulated in hypertrophic scar. Among the downregulated ones, plakophilin1 (PKP1), plakophilin3 (PKP3) and desmoplakin (DSP) were the desmosome-related proteins which were validated by immunohistochemistry and western blotting assay. Transmission electron microscopy further showed the considerably reduced size and intensity of hemidesmosome and desmosome in hypertrophic scar tissue, compared to control normal skin. Our data indicted for the first time that downregulation of DSP, PKP1 and PKP3 in hypertrophic scar might be responsible for intraepidermal blister formation.

  14. The year in burns 2013.

    PubMed

    Wolf, Steven E; Phelan, Herbert A; Arnoldo, Brett D

    2014-12-01

    Approximately 3415 research articles were published with burns in the title, abstract, and/or keyword in 2013. We have continued to see an increase in this number; the following reviews articles selected from these by the Editor of one of the major journals (Burns) and colleagues that in their opinion are most likely to have effects on burn care treatment and understanding. As we have done before, articles were found and divided into the following topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. The articles are mentioned briefly with notes from the authors; readers are referred to the full papers for details.

  15. [Scars, physiology, classification and assessment].

    PubMed

    Roques, Claude

    2013-01-01

    A skin scar is the sign of tissue repair following damage to the skin. Once formed, it follows a process of maturation which, after several months, results in a mature scar. This can be pathological with functional and/or aesthetic consequences. It is important to assess the scar as it matures in order to adapt the treatment to its evolution.

  16. The role of ablative lasers in cutaneous scars: tissue regeneration to restore function (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Uebelhoer, Nathan

    2017-02-01

    Many laser wavelengths with various power and pulse characteristics have been used in an attempt to improve cutaneous scars. No single configuration has produced such dramatic changes in quality of life as the high energy, low density, sub-millisecond pulsed ablative infrared laser. Hundreds of wounded military service members with burn and traumatic scars that resulted in disabling restriction in range of motion have been treated since 2008. By fractionating the pulse to produce a uniform thermal injury less than 400um wide and to a depth of 3mm into the scar, we have observed dramatic reductions in scar-induced pain, pruritus, and most significantly, improvements in range of motion. The clinical and histologic changes seen in restrictive scars following treatment correlates with a regeneration of tissue that appears and functions more like normal tissue rather than scar. This lecture will describe our experience in the military and the latest research to support our observations.

  17. The successful treatment of pain associated with scar tissue using acupuncture.

    PubMed

    Fang, Sheng

    2014-10-01

    In this case report, a 48-year-old female who had suffered severe scar pain for 3 months was treated with acupuncture using the Wei Ci technique (surrounding the dragon). Scar tissue usually forms after deep trauma, such as piercings, burns, and surgery, to the dermis. In Chinese Medicine, scar tissue causes local Qi and blood stagnation which lead to pain. The Wei Ci technique (surrounding the dragon) and distal points Hegu-LI-4, Taichong-LIV-3, Zusanli-ST-36 were used. The patient received a total of eight treatments in 5 weeks. The scar pain decreased from 7 to 1 or 2 on a Likert scale of 0-10, with 0 being no pain and 10 being the worst pain. Acupuncture may have a good short-term pain-relieving effect on scar pain but its long-term scar-pain-relieving effects are still unclear. Copyright © 2014. Published by Elsevier B.V.

  18. Burn Rehabilitation and Research: Proceedings of a Consensus Summit

    DTIC Science & Technology

    2009-08-01

    tool has yet to be de- signed. Accurate instrumentation is necessary to study the efficacy of scar treatment, such as the ability of pressure garments to...reduce hypertrophic scar. A variety of electronic instruments for possible burn scar research application are now commercially avail- able, some of...sured and assessed with a variety of devices: 1. Pliability: a number of different instruments have been proposed and tested, including the durometer,148

  19. Matrix metalloproteinases and tissue inhibitors of metalloproteinases in patients with different types of scars and keloids.

    PubMed

    Ulrich, Dietmar; Ulrich, Franziska; Unglaub, Frank; Piatkowski, Andrzej; Pallua, Norbert

    2010-06-01

    Hypertrophic scars and keloids are fibroproliferative skin disorders characterised by progressive deposition of collagen. Our study is designed to investigate the expression and concentration of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in different types of scars and keloids. Total RNA from 19 proliferative hypertrophic scar samples of patients with extended burns (total body surface area (TBSA): 21+/-12%), 18 mature hypertrophic scar samples from patients after elective surgery, 14 keloid samples and 18 normotrophic scar samples was, respectively, extracted, and then mRNA was isolated. Besides, biopsies were obtained from non-scarred skin of the patients and extraction of total RNA performed. Relative mRNA expression of MMP 2, MMP 9, TIMP 1 and TIMP 2 was measured with reverse transcriptase polymerase chain reaction (RT-PCR). Serum concentrations of MMP-1, -2, -9, TIMP-1, and -2 were determined using an enzyme-linked immunosorbent assay (ELISA). Patients with extended hypertrophic scars after burn trauma presented a significantly higher TIMP-1 concentration (p<0.05) in their sera than the other patients. The relative expression of MMP 2 was significantly higher in samples of proliferative hypertrophic scars after burn injury. The relative expression of TIMP 1 and TIMP 2 was significantly higher in scar tissue of patients with proliferative and mature hypertrophic scars and keloids than in their regular skin and in scar samples of patients with normotrophic scars. The expression of TIMP 1 was significantly higher in samples of patients with keloids than in patients with hypertrophic scars. The concentration of TIMP-1 in sera of patients varies depending on the size of the involved fibrotic scar tissue. A decrease in MMP-to-TIMP expression in scar tissue may contribute to increased synthesis and deposition of collagen, leading to a severe fibrotic reaction with pathologic scar formation. The results implicate non

  20. Interventions for acne scars.

    PubMed

    Abdel Hay, Rania; Shalaby, Khalid; Zaher, Hesham; Hafez, Vanessa; Chi, Ching-Chi; Dimitri, Sandra; Nabhan, Ashraf F; Layton, Alison M

    2016-04-03

    Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person's psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring. To assess the effects of interventions for treating acne scars. We searched the following databases up to November 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included studies and relevant reviews for further references to randomised controlled trials. We include randomised controlled trials (RCTs) which allocated participants (whether split-face or parallel arms) to any active intervention (or a combination) for treating acne scars. We excluded studies dealing only or mostly with keloid scars. Three review authors independently extracted data from each of the studies included in this review and evaluated the risks of bias. We resolved disagreements by discussion and arbitration supported by a method expert as required. Our primary outcomes were participant-reported scar improvement and any adverse effects serious enough to cause participants to withdraw from the study. We included 24 trials with 789 adult participants aged 18 years or older. Twenty trials enrolled men and women, three trials enrolled only women and one trial enrolled only men. We judged eight studies to be at low risk of bias for both sequence generation and allocation concealment. With regard to blinding we judged

  1. Treatment of hypertrophic scars using a long-pulsed dye laser with cryogen-spray cooling.

    PubMed

    Kono, Taro; Erçöçen, Ali Rza; Nakazawa, Hiroaki; Nozaki, Motohiro

    2005-05-01

    Hypertrophic scars are common and cause functional and psychologic morbidity. The conventional pulsed dye laser (585 nm) has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars, with improvement in scar texture, color, and pliability, with minimal side effects. This prospective study was performed to determine the effectiveness of the long-pulsed dye laser (595 nm) with cryogen-spray cooling device in the treatment of hypertrophic scars. Fifteen Asian patients with 22 hypertrophic scars were treated by the long-pulsed dye laser (595 nm) with cryogen-spray cooling device. In 5 patients, the scar area was divided into halves, one half of which was treated with the laser, whereas the other half was not treated and was used as a negative control. All patients received 2 treatments at 4-week intervals, and evaluations were done by photographic and clinical assessment and histologic evaluation before the treatment and 1 month after the last laser treatment. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. Symptoms such as pain, pruritus, and burning of the scar improved significantly. VGH scores improved in all treated sites, and there was a significant difference between the baseline and posttreatment scores, corresponding to an improvement of 51.4 +/- 14.7% (P < 0.01). Compared with the baseline, the mean percentage of scar flattening and erythema elimination was 40.7 +/- 20.7 and 65.3 +/- 25.5%, respectively (P < 0.01). The long-pulsed dye laser (595-nm) equipped with cryogen spray cooling device is an effective treatment of hypertrophic scars and can improve scar pliability and texture and decrease scar erythema and associated symptoms.

  2. [Functional reconstruction of multiple severe deformities after extensive deep burn].

    PubMed

    Chen, Bi; Jia, Chi-yu; Hu, Da-hai; Zhu, Xiong-xiang; Han, Jun-tao; Yao, Qing-jun; Xu, Ming-da

    2008-10-01

    To explore new measures for functional reconstruction of multiple severe deformities as a result of extensive deep burn (total burn surface area > or = 90% TBSA, including deep burn > or = 70%TBSA) in late stage. Twelve severe burn patients with above-mentioned deformities were hospitalized in our ward during 1960--2005, the scars resulted from burns were distributed from head to foot with 173 deformities, including 27 scar ulcers. All patients lacked of self-care ability, among them some could not stand. Due to inadequate skin source, deformities were corrected by skin from matured scars expanded with subcutaneous balloon at late postburn stage. Following our former clinical experience, anatomic investigation and experimental research, we chose the following methods to correct deformities and restore functions: application of split-thickness scar skin after expansion (88 wounds); use of scar skin flap/scar-Achilles tendon flaps (59 wounds); combination of thin split-thickness skin grafts from scar and allogeneic acellular dermal matrix (composite skin, 40 wounds). All grafts survived, the appearance and function were improved obviously without complications. Follow-up 1-40 years, all patients could take care themselves with satisfactory function and appearance, and among them 8 patients returned to work (one had worked for 40 years), 2 patients married and had children. The above-mentioned measures are safe, reliable and effective for functional reconstruction of deformities.

  3. [Scar revision in children: Clinical situations and solutions].

    PubMed

    Duquennoy-Martinot, V; Belkhou, A; Pasquesoone, L; Depoortère, C; Guerreschi, P

    2016-10-01

    The scar of soft tissues is a permanent stigma of a trauma but it can sometimes be improved. It is more or less accepted by the patient and may be the source of a significant physical and psychosocial impact that leads to a request for a scar revision. Even if the child presents generally an excellent ability to heal, the quality of the scar depends on many factors such as the age, the type of scar or trauma and the affected body area. Thus, its aesthetic impact, functional but also on the growth of the child will be different. Moreover, these scars have a number of origins: neonatal surgery, natural history of congenital lesions or after a surgical management; surgeries for orthopedic, cardiac, craniofacial or hand birth defects and congenital malformations; or infectious or traumatic as in the case of burns and animal bites. We have many ways to try to correct or improve these scars, which use all the plastic surgery techniques. However, we need to establish for each case an appropriate management strategy with the objective of not inducing additional sequelae, respecting the growth of the child. Several techniques can be combined and the chronology of the surgical procedures must consider the school, social and family integration of the child. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. [Collagenase Clostridum histolyticum in the management of Dupuytren's contracture].

    PubMed

    Holzer, L A; Holzer, G

    2011-10-01

    Dupuytren's contracture is a fibroproliferate disease of the palmar aponeurosis with a formation of nodules and cords. Surgical treatment is the gold standard for Dupuytren's contracture at the moment. A short while ago Collagenase clostridium histolyticum was licensed as a non-surgical method to treat Dupuytren's contracture. Collagenase clostridium histolyticum is injected directly into the Dupuytren's cord and after 24 h the contracture is distended by manual rupturing. Collagenase clostridium histolyticum causes a depletion of collagen, however neurovascular structures are spared. 2 clinical phase III studies showed that contractures could be effectively reduced when using Collagenase clostridium histolyticum. However, there are no long-term results regarding effectiveness and side effects, or comparative studies using surgical methods. This paper presents a review of Collagenase clostridium histolyticum and its role in the management of Dupuytren's contracture. Indication, technical procedure, treatment results and complications are described. Georg Thieme Verlag KG Stuttgart · New York.

  5. Complications Following Collagenase Treatment for Dupuytren Contracture.

    PubMed

    Wozniczka, Jennifer; Canepa, Clifford; Mirarchi, Adam; Solomon, Joel S

    2017-09-01

    Collagenase Clostridium histolyticum (CCH) injection and manipulation is a relatively new method for treating Dupuytren contracture that is growing in popularity. Although side effects such as swelling and ecchymosis are common, they are typically mild and self-limited. Major complications are rare but have included flexor tendon rupture and complex regional pain syndrome. This study describes a case report of 2 patients seen at our institution. Here, we report 2 patients seen at our institution each with different, yet serious complications after CCH injection and manipulation. One patient had extensive skin loss and chose amputation over reconstruction. The other patient had loss of perfusion and required finger amputation. Although it is unclear how directly the administration of CCH is connected to the observed complications, physicians should recognize the potential for serious rare complications in any treatment of Dupuytren contracture.

  6. Fire-scar formation in Jeffrey pine - mixed conifer forests in the Sierra San Pedro Martir, Mexico

    Treesearch

    Scott L. Stephens; Danny L. Fry; Brandon M. Collins; Carl N. Skinner; Ernesto Franco-Vizcaino; Travis J. Freed

    2010-01-01

    Little is known about the probability of fire-scar formation. In this study, we examined all mixed conifer trees for fire-scar formation in a 16 ha watershed that burned as part of a 2003 wildfire in Sierra San Pedro Ma´rtir National Park (SSPM), Mexico. In addition, we examine the probability of fire-scar formation in relation to the previous fire interval in forests...

  7. Update on hypertrophic scar treatment

    PubMed Central

    Rabello, Felipe Bettini; Souza, Cleyton Dias; Júnior, Jayme Adriano Farina

    2014-01-01

    Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin. PMID:25141117

  8. Update on hypertrophic scar treatment.

    PubMed

    Rabello, Felipe Bettini; Souza, Cleyton Dias; Farina Júnior, Jayme Adriano

    2014-08-01

    Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin.

  9. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

    PubMed Central

    Headon, Hannah; Kasem, Adbul

    2015-01-01

    Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer. PMID:26430623

  10. Joint contracture following prolonged stay in the intensive care unit

    PubMed Central

    Clavet, Heidi; Hébert, Paul C.; Fergusson, Dean; Doucette, Steve; Trudel, Guy

    2008-01-01

    Background Prolonged immobility during a critical illness may predispose patients to the development of joint contracture. We sought to document the incidence of, the risk factors for and the reversibility of joint contractures among patients who stayed in a tertiary intensive care unit (ICU) for 2 weeks or longer. Methods We conducted a chart review to collect data on the presence of and risk factors for joint contractures in the shoulders, elbows, hips, knees and ankles among patients admitted to the ICU between January 2003 and March 2005. Results At the time of transfer out of the ICU, at least 1 joint contracture was recorded in 61 (39%) of 155 patients; 52 (34%) of the patients had joint contractures of an extent documented to impair function. Time spent in the ICU was a significant risk factor for contracture: a stay of 8 weeks or longer was associated with a significantly greater risk of any joint contracture than a stay of 2 to 3 weeks (adjusted odds ratio [OR] 7.09, 95% confidence interval (CI) 1.29–38.9; p = 0.02). Among the variables tested, only the use of steroids conferred a protective effect against joint contractures (adjusted OR 0.35, 95% CI 0.14–0.83; p = 0.02). At the time of discharge to home, which occurred a median of 6.6 weeks after transfer out of intensive care, 50 (34%) of the 147 patients not lost to follow-up still had 1 or more joint contractures, and 34 (23%) of the patients had at least 1 functionally significant joint contracture. Interpretation Following a prolonged stay in the ICU, a functionally significant contracture of a major joint occurred in more than one-third of patients, and most of these contractures persisted until the time of discharge to home. PMID:18332384

  11. Collagenase clostridium histolyticum for Dupuytren's contracture.

    PubMed

    Desai, Shaunak S; Hentz, Vincent R

    2010-09-01

    Dupuytren's disease is a non-malignant, progressive disorder of the hands that can severely limit hand function and diminish overall quality of life. With global life expectancy increasing, the prevalence of this disease appears to be increasing amongst all ethnic groups. Treatment has traditionally remained surgical with few effective, nonsurgical options. However, with the introduction of collagenase clostridium histolyticum to treat Dupuytren's contractures, physicians and surgeons may be provided with a new, office-based, non-surgical option to treat this disease. The literature behind the use of collagenase to treat Dupuytren's disease; including its mechanism of action, safety, efficacy and clinical evidence behind its recent FDA approval. The latest information available on collagenase through a comprehensive review of PubMed and the websites of licensing organizations for medicinal products. Phase III, clinical trials on collagenase for treatment of Dupuytren's contractures have recently been completed. Meeting primary and secondary objectives, collagenase has obtained FDA approval for clinical use. Collagenase now provides a non-operative option for Dupuytren's disease. Although short-term results show that collagenase is safe and efficacious, long-term effects of repeat injections and contracture recurrence rates have yet to be examined.

  12. Biomass Burning

    Atmospheric Science Data Center

    2015-07-27

    Projects:  Biomass Burning Definition/Description:  Biomass Burning: This data set represents the geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ...

  13. Burn Institute

    MedlinePlus

    ... a resource to the community. Learn more The Burn Institute reaches thousands of children and adults each year through fire and burn prevention education, burn survivor support programs and the ...

  14. Outcomes of outpatient management of pediatric burns.

    PubMed

    Brown, Matthew; Coffee, Tammy; Adenuga, Paul; Yowler, Charles J

    2014-01-01

    The literature surrounding pediatric burns has focused on inpatient management. The goal of this study is to characterize the population of burned children treated as outpatients and assess outcomes validating this method of burn care. A retrospective review of 953 patients treated the burn clinic and burn unit of a tertiary care center. Patient age, burn etiology, burn characteristics, burn mechanism, and referral pattern were recorded. The type of wound care and incidence of outcomes including subsequent hospital admission, infection, scarring, and surgery served as the primary outcome data. Eight hundred and thirty children were treated as outpatients with a mean time of 1.8 days for the evaluation of burn injury in our clinic. Scalds accounted for 53% of the burn mechanism, with burns to the hand/wrist being the most frequent area involved. The mean percentage of TBSA was 1.4% for the outpatient cohort and 8% for the inpatient cohort. Burns in the outpatient cohort healed with a mean time of 13.4 days. In the outpatient cohort, nine (1%) patients had subsequent admissions and three (0.4%) patients had concern for infection. Eight patients from the outpatient cohort were treated with excision and grafting. The vast majority of pediatric burns are small, although they may often involve more critical areas such as the face and hand. Outpatient wound care is an effective treatment strategy which results in low rates of complications and should become the standard of care for children with appropriate burn size and home support.

  15. Leg contracture in mice: an assay of normal tissue response

    SciTech Connect

    Stone, H.B.

    1984-07-01

    Leg contracture, defined as the difference in extensibility of the control and irradiated hind legs of mice, was found to correlate with single doses of radiation from about 20 to 80 Gy. The time of development of the early phase of the response coincided with that reported for the appearance of the acute skin response, and in some cases, partially reversed as this reaction healed. The contracture then progressed again at a moderate rate through 90 days, and then more slowly through one year. Skin contraction, measured by decrease in intertattoo distance, was assayed in the same mice. It followed the same time course as leg contracture, but had a different dose-response relationship. To determine the contribution of skin contraction to the overall leg contracture response, mice were sacrificed and the leg contracture measured before and after the removal of the skin of the leg. After doses of up to 30 Gy, little contracture remained from skinning the leg, indicating that skin contraction was largely responsible for leg contracture in this dose range. After doses of about 45 Gy and above, some contracture remained in the skinned legs, although less than in intact legs. There was little or no enhancement of either skin contraction or leg contracture by the hypoxic cell sensitizers metronidazole or misonidazole.

  16. Prevention and management of limb contractures in neuromuscular diseases.

    PubMed

    Skalsky, Andrew J; McDonald, Craig M

    2012-08-01

    Limb contractures are a common impairment in neuromuscular diseases. They contribute to increased disability from decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living, and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures compared with neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve range of motion in neuromuscular diseases in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from contractures.

  17. Modified McCash Technique for Management of Dupuytren Contracture.

    PubMed

    Lesiak, Alex C; Jarrett, Nicole J; Imbriglia, Joseph E

    2017-05-01

    Despite recent advancements in the nonsurgical treatment for Dupuytren contracture, a number of patients remain poor nonsurgical candidates or elect for surgical management. The traditional McCash technique releases contractures while leaving open palmar wounds. Although successful in alleviating contractures, these wounds are traditionally large, transverse incisions across the palm. A modification of this technique has been performed that permits the surgeon to utilize smaller wounds while eliminating debilitating contractures. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. PREVENTION AND MANAGEMENT OF LIMB CONTRACTURES IN NEUROMUSCULAR DISEASES

    PubMed Central

    Skalsky, Andrew J.; McDonald, Craig M.

    2012-01-01

    Synopsis Limb contractures are a common impairment in neuromuscular diseases (NMD). They contribute to increased disability due to decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living (ADL), and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures in comparison to neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve ROM in NMD in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from the contractures. PMID:22938881

  19. Quantitative measurement of hypertrophic scar: interrater reliability and concurrent validity.

    PubMed

    Nedelec, Bernadette; Correa, José A; Rachelska, Grazyna; Armour, Alexis; LaSalle, Léo

    2008-01-01

    Research into the pathophysiology and treatment of hypertrophic scar (HSc) remains limited by the heterogeneity of scar and the imprecision with which its severity is measured. The objective of this study was to test the interrater reliability and concurrent validity of the Cutometer measurement of elasticity, the Mexameter measurement of erythema and pigmentation, and total thickness measure of the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar, and HSc. Three independent investigators evaluated 128 sites (severe HSc, moderate or mild HSc, donor site, and normal skin) on 32 burn survivors using all of the above measurement tools. The intraclass correlation coefficient, which was used to measure interrater reliability, reflects the inherent amount of error in the measure and is considered acceptable when it is >0.75. Interrater reliability of the totals of the height, pliability, and vascularity subscales of the mVSS fell below the acceptable limit ( congruent with0.50). The individual subscales of the mVSS fell well below the acceptable level (< or =0.3). The Cutometer reading of elasticity provided acceptable reliability (>0.89) for each study site with the exception of severe scar. Mexameter and DermaScan C reliability measurements were acceptable for all sites (>0.82). Concurrent validity correlations with the mVSS were significant except for the comparison of the mVSS pliability subscale and the Cutometer maximum deformation measure comparison in severe scar. In conclusion, the Mexameter and DermaScan C measurements of scar color and thickness of all sites, as well as the Cutometer measurement of elasticity in all but the most severe scars shows high interrater reliability. Their significant concurrent validity with the mVSS confirms that these tools are measuring the same traits as the mVSS, and in a more objective way.

  20. Burn severity influences postfire CO2 exchange in arctic tundra.

    PubMed

    Rocha, Adrian V; Shaver, Gaius R

    2011-03-01

    Burned landscapes present several challenges to quantifying landscape carbon balance. Fire scars are composed of a mosaic of patches that differ in burn severity, which may influence postfire carbon budgets through damage to vegetation and carbon stocks. We deployed three eddy covariance towers along a burn severity gradient (i.e., severely burned, moderately burned, and unburned tundra) to monitor postfire net ecosystem exchange of CO2 (NEE) within the large 2007 Anaktuvuk River fire scar in Alaska, USA, during the summer of 2008. Remote sensing data from the MODerate resolution Imaging Spectroradiometer (MODIS) was used to assess the spatial representativeness of the tower sites and parameterize a NEE model that was used to scale tower measurements to the landscape. The tower sites had similar vegetation and reflectance properties prior to the Anaktuvuk River fire and represented the range of surface conditions observed within the fire scar during the 2008 summer. Burn severity influenced a variety of surface properties, including residual organic matter, plant mortality, and vegetation recovery, which in turn determined postfire NEE. Carbon sequestration decreased with increased burn severity and was largely controlled by decreases in canopy photosynthesis. The MODIS two-band enhanced vegetation index (EVI2) monitored the seasonal course of surface greenness and explained 86% of the variability in NEE across the burn severity gradient. We demonstrate that understanding the relationship between burn severity, surface reflectance, and NEE is critical for estimating the overall postfire carbon balance of the Anaktuvuk River fire scar.

  1. [Razemon's lateral digital rotation flap in severe Dupuytren contracture of the fifth finger].

    PubMed

    Ould-Slimane, M; Guinet, V; Foulongne, E; Melconian, A; Beccari, R; Milliez, P-Y; Auquit-Auckbur, I

    2013-10-01

    In Dupuytren's disease, correction of severe contracture deformities and excision of dermal lesions are often responsible for palmar skin defects. This study aimed to assess the results of the lateral digital flap described by Razemon. Thirty-seven patients were analysed retrospectively for functional and trophic results. Twelve months of follow-up were at least required. The lack of extension was appreciated through Thomine's coefficient. Subjective patient's opinion was noted about function of fifth finger and hand. The flap trophicity was evaluated through softness, coverage quality and esthetic aspect. In the preoperative period, the average lack of extension was 105°; 89% of the patients were ranked as stages 3 or 4 of Tubiana's classification. At the 12th month, the average Thomine's coefficient was 0.74; 70% of the patients were very satisfied. Two patients exhibited some lack of suppleness and seven a dyschromic scars. The lateral digital rotation flap is a quite simple surgical procedure. It allows satisfactory results corresponding to functional and trophic coverage in severe Dupuytren's contracture involving the fifth finger.

  2. Mapping Fire Scars in the Brazilian Cerrado Using AVHRR Imagery

    NASA Technical Reports Server (NTRS)

    Hlavka, C. A.; Ambrosia, V. G.; Brass, J. A.; Rezendez, A.; Alexander, S.; Guild, L. S.; Peterson, David L. (Technical Monitor)

    1995-01-01

    The Brazilian cerrado, or savanna, spans an area of 1,800,000 square kilometers on the great plateau of Central Brazil. Large fires covering hundreds of square kilometers, frequently occur in wildland areas of the cerrado, dominated by grasslands or grasslands mixed with shrubs and small trees, and also within area in the cerrado used for agricultural purposes, particularly for grazing. Smaller fires, typically extending over arm of a few square kilometers or less, are associated with the clewing of crops, such as dry land rice. A method for mapping fire scars and differentiating them from extensive areas of bare sod with AVHRR bands 1 (.55 -.68 micrometer) and 3 (3.5 - 3.9 micrometers) and measures of performance based on comparison with maps of fires with Landsat imagery will be presented. Methods of estimating total area burned from the AVHRR fire scar map will be discussed and related to land use and scar size.

  3. Mapping Fire Scars in the Brazilian Cerrado Using AVHRR Imagery

    NASA Technical Reports Server (NTRS)

    Hlavka, C. A.; Ambrosia, V. G.; Brass, J. A.; Rezendez, A.; Alexander, S.; Guild, L. S.; Peterson, David L. (Technical Monitor)

    1995-01-01

    The Brazilian cerrado, or savanna, spans an area of 1,800,000 square kilometers on the great plateau of Central Brazil. Large fires covering hundreds of square kilometers, frequently occur in wildland areas of the cerrado, dominated by grasslands or grasslands mixed with shrubs and small trees, and also within area in the cerrado used for agricultural purposes, particularly for grazing. Smaller fires, typically extending over arm of a few square kilometers or less, are associated with the clewing of crops, such as dry land rice. A method for mapping fire scars and differentiating them from extensive areas of bare sod with AVHRR bands 1 (.55 -.68 micrometer) and 3 (3.5 - 3.9 micrometers) and measures of performance based on comparison with maps of fires with Landsat imagery will be presented. Methods of estimating total area burned from the AVHRR fire scar map will be discussed and related to land use and scar size.

  4. Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type.

    PubMed

    Zaleski-Larsen, Lisa A; Fabi, Sabrina G; McGraw, Timothy; Taylor, Mark

    2016-05-01

    Acne scarring can be classified into atrophic icepick, boxcar, and rolling scars in addition to keloidal and hypertrophic scars. Additionally, these scars can be erythematous, hyperpigmented, and/or hypopigmented. Each scar type has a different structural cause warranting a customized approach. Many cosmetic options exist to address these changes individually, but little literature exists about the safety and efficacy of combining such procedures and devices. A Medline search was performed on combination treatments because it relates to facial acne scarring, and results are summarized. Practical applications for these combinations of procedures are also discussed. Studies examining the efficacy and safety of ablative, nonablative, fractionated, and nonfractionated lasers, dermabrasion, chemical peels, needling, subcision, radiofrequency, stem cell therapy, fat transplantation, platelet-rich plasma, and hyaluronic acid dermal fillers for acne scars were found. The authors review their experience in combining these techniques. Review of the literature revealed multiple single options for facial acne scarring treatment with minimal evidence in the literature found on the safety and efficacy of combining such procedures and devices. The authors' experience is that combining acne scar treatment techniques can be performed safely and synergistically with optimal patient outcomes.

  5. Comparative study of the efficacy and tolerability of a unique topical scar product vs white petrolatum following shave biopsies.

    PubMed

    Kircik, Leon H

    2013-01-01

    An excess of 70 million cutaneous surgical procedures are conducted annually in the United States that may result in scarring. Skin scars are a normal outcome of the tissue repair process. However, individuals with abnormal scarring may have aesthetic, psychological, and social consequences. As a result, there is a high patient demand for products that will reduce the scarring. The principles underlying scar formation are now better understood. Products are being developed to address those critical components of the wound-healing process, namely inflammation, hydration, and collagen maturation. A multicomponent scar product was previously shown effective in preventing exaggerated scarring in patients undergoing various surgical procedures. The present outpatient study was conducted in patients undergoing shave biopsies. Following reepithelialization, this investigator-blinded, randomized, 8-week trial compared twice-daily application of either the scar product or the standard of care, white petrolatum. Evaluation visits were conducted at baseline and at weeks, 1, 2, 4 and 8. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at each visit, and subjects completed a self-assessment questionnaire regarding treatment effectiveness and satisfaction. Twenty-eight subjects completed the 8-week study. The scar product provided earlier improvements than the white petrolatum. At week 1, 70% of subjects receiving the scar product demonstrated at least 50% global improvement in scar appearance vs only 42% of the subjects receiving white petrolatum. The more rapid improvement was accompanied by greater reductions in stinging/burning and itching with the scar product at all visits. Importantly, there was also greater subject satisfaction with the scar product at all visits. This scar product may be useful in hastening the healing of cutaneous shave biopsies and reducing the

  6. Topical management of facial burns.

    PubMed

    Leon-Villapalos, Jorge; Jeschke, Marc G; Herndon, David N

    2008-11-01

    The face is the central point of the physical features of the human being. It transmits expressions and emotions, communicates feelings and allows for individual identity. It contains complex musculature and a pliable and unique skin envelope that reacts to the environment through a vast network of nerve endings. The face hosts vital areas that make phonation, feeding, and vision possible. Facial burns disrupt these anatomical and functional structures creating pain, deformity, swelling, and contractures that may lead to lasting physical and psychological sequelae. The management of facial burns may include operative and non-operative treatment or both, depending on the depth and extent of the burn. This paper intends to provide a review of the available options for topical management of facial burns. Topical agents will be defined as any agent applied to the surface of the skin that alters the outcome of the facial burn. Therefore, the classic concept of topical therapy will be expanded and developed within two major stages: acute and rehabilitation. Comparison of the effectiveness of the different treatments and relevant literature will be discussed.

  7. Update on Postsurgical Scar Management

    PubMed Central

    Commander, Sarah Jane; Chamata, Edward; Cox, Joshua; Dickey, Ryan M.; Lee, Edward I.

    2016-01-01

    Postoperative scar appearance is often a significant concern among patients, with many seeking advice from their surgeons regarding scar minimization. Numerous products are available that claim to decrease postoperative scar formation and improve wound healing. These products attempt to create an ideal environment for wound healing by targeting the three phases of wound healing: inflammation, proliferation, and remodeling. With that said, preoperative interventions, such as lifestyle modifications and optimization of medical comorbidities, and intraoperative interventions, such as adherence to meticulous operative techniques, are equally important for ideal scarring. In this article, the authors review the available options in postoperative scar management, addressing the benefits of multimodal perioperative intervention. Although numerous treatments exist, no single modality has been proven superior over others. Therefore, each patient should receive a personalized treatment regimen to optimize scar management. PMID:27478420

  8. Cutaneous Scar Prevention and Management

    PubMed Central

    Al-Shaqsi, Sultan; Al-Bulushi, Taimoor

    2016-01-01

    Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management. PMID:26909210

  9. An automated image processing method to quantify collagen fiber organization within cutaneous scar tissue

    PubMed Central

    Quinn, Kyle P.; Golberg, Alexander; Broelsch, G. Felix; Khan, Saiqa; Villiger, Martin; Bouma, Brett; Austen, William G.; Sheridan, Robert L.; Mihm, Martin C.; Yarmush, Martin L.; Georgakoudi, Irene

    2014-01-01

    Standard approaches to evaluate scar formation within histological sections rely on qualitative evaluations and scoring, which limits our understanding of the remodeling process. We have recently developed an image analysis technique for the rapid quantification of fiber alignment at each pixel location. The goal of this study was to evaluate its application for quantitatively mapping scar formation in histological sections of cutaneous burns. To this end, we utilized directional statistics to define maps of fiber density and directional variance from Masson’s Trichrome stained sections for quantifying changes in collagen organization during scar remodeling. Significant increases in collagen fiber density are detectable soon after burn injury in a rat model. Decreased fiber directional variance in the scar was also detectable between 3 weeks and 6 months after injury, indicating increasing fiber alignment. This automated analysis of fiber organization can provide objective surrogate endpoints for evaluating cutaneous wound repair and regeneration. PMID:25256009

  10. Contribution of denervated muscle to contractures after neonatal brachial plexus injury: not just muscle fibrosis.

    PubMed

    Nikolaou, Sia; Liangjun, Hu; Tuttle, Lori J; Weekley, Holly; Christopher, Wylie; Lieber, Richard L; Cornwall, Roger

    2014-03-01

    We investigated the contribution of muscle fibrosis to elbow flexion contractures in a murine model of neonatal brachial plexus injury (NBPI). Four weeks after NBPI, biceps and brachialis fibrosis were assessed histologically and compared with the timing of contracture development and the relative contribution of each muscle to contractures. Modulus of elasticity and hydroxyproline (collagen) content were measured and correlated with contracture severity. The effect of halofuginone antifibrotic therapy on fibrosis and contractures was investigated. Elbow contractures preceded muscle fibrosis development. The brachialis was less fibrotic than the biceps, yet contributed more to contractures. Modulus and hydroxyproline content increased in both elbow flexors, but neither correlated with contracture severity. Halofuginone reduced biceps fibrosis but did not reduce contracture severity. Contractures after NBPI cannot be explained solely by muscle fibrosis, arguing for investigation of alternate pathophysiologic targets for contracture prevention and treatment. Copyright © 2013 Wiley Periodicals, Inc.

  11. Burn wound: How it differs from other wounds?

    PubMed Central

    Tiwari, V. K.

    2012-01-01

    Management of burn injury has always been the domain of burn specialists. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Even after complete epithelisation of burn wound, remodelling phase is prolonged. It may take years for scar maturation in burns. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds. PMID:23162236

  12. Recipient Wound Bed Characteristics Affect Scarring and Skin Graft Contraction

    DTIC Science & Technology

    2015-02-13

    Recipient wound bed characteristics affect scarring and skin graft contraction Lloyd F. Rose, PhD; Jesse C. Wu, MS; Anders H. Carlsson, PhD; David I...use of autograft skin is essential in the treatment of full thickness burns and large cutaneous defects. Both autograft thickness and condition of the... skin grafting onto hypodermis vs. onto fascia. Compared to autografts grafted onto fascia, identical thickness autografts grafted onto fat demonstrated

  13. Dune Avalanche Scars

    NASA Technical Reports Server (NTRS)

    2004-01-01

    05 August 2004 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows large, low albedo (dark) sand dunes in Kaiser Crater near 47.2oS, 340.4oW. The dunes are--ever so slowly--moving east to west (right to left) as sand avalanches down the steeper, slip face slopes of each. Avalanching sand in the Kaiser dune field has left deep scars on these slopes, suggesting that the sand is not loose but is instead weakly cemented. The image covers an area approximately 3 km (1.9 mi) wide and is illuminated by sunlight from the upper left.

  14. Periorbital Scar Correction.

    PubMed

    Chambers, Christopher B; Moe, Kristen S

    2017-02-01

    Periorbital scarring with eyelid retraction can have serious visual effects and can lead to loss of vision or even loss of the eye. Understanding of eyelid anatomy and the delicate balance of its structural supports is critical for the identification of the eyelid disorder responsible for the cicatrix and helps to guide treatment. The 2-finger test and lateral distraction of the lid can also be of significant help in proper diagnosis of the underlying disorder. Proper reconstruction with respect to the anterior and posterior lamellae helps to ensure a favorable outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Potassium-induced contractures in crab (Callinectes danae) muscle fibers.

    PubMed

    Leal-Cardoso, J H; Suarez-Kurtz, G

    1984-01-01

    The contractures induced by 20-200 mM [K+]o in single crab muscle fibers were resolved into two components. The first component, consisting of single twitches or brief tetanic contractions, was associated with electrogenic membrane responses. The second occurred after spiking subsided with an amplitude that increased linearly with the [K+]o between 20 and 90 mM. The amplitude and time course of the contractures elicited by a given [K+]o differed markedly between different fibers. Contracture reproducibility of a single fiber was best when 90 mM [K+]o was used. The K-induced contractures were abolished after brief (3 min) exposure of the fibers to a calcium-free solution and were greatly depressed by 8 mM procaine. The data suggest that the contractures require both Ca2+-influx across the sarcolemma and release of Ca2+ stored in the sarcoplasmic reticulum.

  16. Injectable collagenase clostridium histolyticum for Dupuytren's contracture.

    PubMed

    Hurst, Lawrence C; Badalamente, Marie A; Hentz, Vincent R; Hotchkiss, Robert N; Kaplan, F Thomas D; Meals, Roy A; Smith, Theodore M; Rodzvilla, John

    2009-09-03

    Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with serious potential complications. Injection of collagenase clostridium histolyticum, an office-based, nonsurgical option, may reduce joint contractures caused by Dupuytren's disease. We enrolled 308 patients with joint contractures of 20 degrees or more in this prospective, randomized, double-blind, placebo-controlled, multicenter trial. The primary metacarpophalangeal or proximal interphalangeal joints of these patients were randomly assigned to receive up to three injections of collagenase clostridium histolyticum (at a dose of 0.58 mg per injection) or placebo in the contracted collagen cord at 30-day intervals. One day after injection, the joints were manipulated. The primary end point was a reduction in contracture to 0 to 5 degrees of full extension 30 days after the last injection. Twenty-six secondary end points were evaluated, and data on adverse events were collected. Collagenase treatment significantly improved outcomes. More cords that were injected with collagenase than cords injected with placebo met the primary end point (64.0% vs. 6.8%, P < 0.001), as well as all secondary end points (P < or = 0.002). Overall, the range of motion in the joints was significantly improved after injection with collagenase as compared with placebo (from 43.9 to 80.7 degrees vs. from 45.3 to 49.5 degrees, P < 0.001). The most commonly reported adverse events were localized swelling, pain, bruising, pruritus, and transient regional lymph-node enlargement and tenderness. Three treatment-related serious adverse events were reported: two tendon ruptures and one case of complex regional pain syndrome. No significant changes in flexion or grip strength, no systemic allergic reactions, and no nerve injuries were observed. Collagenase clostridium histolyticum significantly reduced

  17. Burns: Treatment and Outcomes

    PubMed Central

    Burd, Andrew

    2010-01-01

    Burns can cause extensive and devastating injuries of the head and neck. Prevention of the initial injury must always be a priority, but once an injury has occurred, then prevention of progression of the damage together with survival of the patient must be the immediate goals. The acute care will have a major influence on the subsequent scarring, reconstructive need, and long-term outcome. In the majority of cases, the reconstruction will involve restoration of form and function to the soft tissues, and the methods used will depend very much on the extent of scarring locally and elsewhere in the body. In nearly all cases, a significant improvement in functional and aesthetic outcomes can be achieved, which, in conjunction with intensive psychosocial rehabilitation, can lead to high-quality patient outcomes. With the prospect of facial transplantation being a clinical reality, the reconstructive spectrum has opened up even further, and, with appropriate reconstruction and support, no patient should be left economically deprived or socially isolated after a burn injury. PMID:22550448

  18. [Gluteal muscle contracture release for the treatment of gluteal muscle contracture induced knee osteoarthritis: a report of 52 cases].

    PubMed

    Wang, Cheng-xiang; Gong, Yu-suo; Li, Sheng-hua; Liu, Hai-ping; Chai, Xi-ping

    2011-07-01

    To investigate clinical efficacy and significance of gluteal muscle contracture release for the treatment of gluteal muscle contracture induced knee osteoarthritis. From January 2008 to June 2010,52 patients with gluteal muscle contracture induced knee osteoarthritis were reviewed. Among the patients,15 patients were male and 37 patients were female, ranging in age from 15 to 45 years, with an average of 35 years. Eighteen patients had left knee osteoarthritis, 30 patients had right osteoarthritis, and 4 patients had double knee osteoarthritis. All the patients were treated with gluteal muscle contracture release. Lysholm knee score was used to evaluate therapeutic effects before and after operation. All the patients were followed up,and the duration ranged from 12 to 37 years,with a mean of 15 months. The Lysholm knee score improved from preoperative (68.12 +/- 0.78) points to postoperative (91.23 +/- 0.47) points at the last follow-up, the difference had statistical difference (t=31.269, P<0.01). Gluteal muscle contracture release is effective to relieve symptoms of gluteal muscles contracture and knee osteoarthritis. The patients with gluteal muscle contracture should be treated early so as to prevent effects of gluteal muscle contracture on knee joint, slow down degeneration of knee joint at early stage, and prevent occurrence of knee osteoarthritis.

  19. The use of collagen-glycosaminoglycan copolymer (Integra) for the repair of hypertrophic scars and keloids.

    PubMed

    Clayman, Mark A; Clayman, Scott M; Mozingo, David W

    2006-01-01

    Integra dermal matrix (Integra Life Sciences Corp., Plainsboro, NJ) was introduced in 1981, and its use in acute surgical burns is well established. However, Integra also has been found to be useful in the surgical treatment of scars. The Integra neodermis is placed at the time of scar excision and then overgrafted several weeks later with a very thin (6/1000-inch) skin graft. The stabilized matrix appears to resist recurrence better than traditional skin grafts, which have a reported recurrence rate of 59%. Many surgeons have had anecdotal success using Integra for both hypertrophic and keloidal scars. This case series presents several patients who underwent reconstructive surgery with the use of Integra to treat their debilitating scar formation. None of the patients developed significant scar morbidity at the donor site when the skin was harvested for grafting during the second stage of the procedure. All patients had documented success with improved appearance, range of motion, and skin quality.

  20. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule criteria...

  1. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule criteria...

  2. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule criteria...

  3. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule criteria...

  4. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule criteria...

  5. Comparison of the effectiveness of nonablative fractional laser versus ablative fractional laser in thyroidectomy scar prevention: A pilot study.

    PubMed

    Kim, Hei Sung; Lee, Ji Hae; Park, Young Min; Lee, Jun Young

    2012-04-01

    A scar is a mark that remains after the healing of a wound or other morbid processes. In the past, treatment was mainly focused on severe scarring, such as the hypertrophic and burn scars. However, scars from relatively minor wounds can also be stressful. The site of an open thyroidectomy is the anterior neck, a prominently exposed part of the body, where postoperative scarring can cause patients distress. The cosmetic outcome of the scar after thyroidectomy is of particular importance to women, who constitute the majority of patients with thyroid disease. Active prevention is more likely to yield better cosmetic results and would require fewer treatment sessions and less expense than scar revision procedures. Many interventions have been proposed, but there is yet no universal consensus on optimal treatment. Recently, focus has been made on 'laser scar prevention', where various types of lasers have been used to improve the appearance of scars. The purpose of this study was to improve the appearance of scars, by laser intervention of the wound healing process. In this pilot study, we comparatively examined the effect of non-ablative 1550-nm fractional Er: glass laser and ablative 2940-nm fractional Er: YAG laser on fresh surgical scars of patients with Fitzpatrick skin type III-IV.

  6. Updated scar management practical guidelines: non-invasive and invasive measures.

    PubMed

    Monstrey, Stan; Middelkoop, Esther; Vranckx, Jan Jeroen; Bassetto, Franco; Ziegler, Ulrich E; Meaume, Sylvie; Téot, Luc

    2014-08-01

    Hypertrophic scars and keloids can be aesthetically displeasing and lead to severe psychosocial impairment. Many invasive and non-invasive options are available for the plastic (and any other) surgeon both to prevent and to treat abnormal scar formation. Recently, an updated set of practical evidence-based guidelines for the management of hypertrophic scars and keloids was developed by an international group of 24 experts from a wide range of specialities. An initial set of strategies to minimize the risk of scar formation is applicable to all types of scars and is indicated before, during and immediately after surgery. In addition to optimal surgical management, this includes measures to reduce skin tension, and to provide taping, hydration and ultraviolet (UV) protection of the early scar tissue. Silicone sheeting or gel is universally considered as the first-line prophylactic and treatment option for hypertrophic scars and keloids. The efficacy and safety of this gold-standard, non-invasive therapy has been demonstrated in many clinical studies. Other (more specialized) scar treatment options are available for high-risk patients and/or scars. Pressure garments may be indicated for more widespread scarring, especially after burns. At a later stage, more invasive or surgical procedures may be necessary for the correction of permanent unaesthetic scars and can be combined with adjuvant measures to achieve optimal outcomes. The choice of scar management measures for a particular patient should be based on the newly updated evidence-based recommendations taking individual patient and wound characteristics into consideration. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Quantitative measurement of hypertrophic scar: intrarater reliability, sensitivity, and specificity.

    PubMed

    Nedelec, Bernadette; Correa, José A; Rachelska, Grazyna; Armour, Alexis; LaSalle, Léo

    2008-01-01

    The comparison of scar evaluation over time requires measurement tools with acceptable intrarater reliability and the ability to discriminate skin characteristics of interest. The objective of this study was to evaluate the intrarater reliability and sensitivity and specificity of the Cutometer, the Mexameter, and the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar (donor sites), and hypertrophic scar (HSc). A single investigator evaluated four tissue types (severe HSc, less severe HSc, donor site, and normal skin) in 30 burn survivors with all four measurement tools. The intraclass correlation coefficient (ICC) for the Cutometer was acceptable (> or =0.75) for the maximum deformation measure for the donor site and normal skin (>0.78) but was below the acceptable range for the HSc sites and all other parameters. The ICC for the Mexameter erythema (>0.75) and melanin index (>0.89) and the DermaScan C total thickness measurement (>0.82) were acceptable for all sites. The ICC for the total of the height, pliability, and vascularity subscales of the mVSS was acceptable (0.81) for normal scar but below the acceptable range for the scar sites. The DermaScan C was clearly able to discriminate HSc from normal scar and normal skin based on the total thickness measure. The Cutometer was less discriminating but was still able to discriminate HSc from normal scar and normal skin. The Mexameter erythema index was not a good discriminator of HSc and normal scar. Receiver operating characteristic curves were generated to establish the best cutoff point for the DermaScan C total thickness and the Cutometer maximum deformation, which were 2.034 and 0.387 mm, respectively. This study showed that although the Cutometer, the DermaScan C, and the Mexameter have measurement properties that make them attractive substitutes for the mVSS, caution must be used when interpreting results since the Cutometer has a ceiling effect when

  8. Muscle contracture diagnosis: the role of sonoelastography.

    PubMed

    Bruschetta, Daniele; Milardi, Demetrio; Trimarchi, Fabio; DI Mauro, Debora; Valenti, Andrea; Arrigo, Alessandro; Valenti, Barbara; Santoro, Giuseppe; Cascio, Filippo; Vaccarino, Gianluigi; Cacciola, Alberto

    2016-12-01

    Sonoelastography plays today a major role in musculoskeletal disease, showing minor muscle injuries not well appreciable in conventional B-mode ultrasonography and integrating it in major muscle injuries diagnosis. The aim of this study was to demonstrate the ability of elastosonography in the diagnosis of muscular contracture in football players presenting negative basic echography. We examined twenty-two football players using basic echography and elastosonography approximately 24-48 hours after the traumatic event and we subsequently re-evaluated them after two weeks. Conventional echography showed, in the early stage, no muscle injuries; in twenty-two out of twenty-two patients, sonoelastography had instead underlined a heterogeneous colorimetric map, related to decreased elasticity in the area of the muscle contracture. An evaluation effected 1-2 weeks later showed a clear improvement of the sonoelastographic appearance. This information will be useful for prognostication, post-traumatic monitoring and to detect subclinical changes in MIs even before there are changes on the routine B-mode ultrasound.

  9. Simultaneous bilateral contracture of the infraspinatus muscle.

    PubMed

    Franch, J; Bertran, J; Remolins, G; Fontecha, P; Díaz-Bertrana, M C; Durall, I

    2009-01-01

    A case of bilateral fibrotic contracture of the infraspinatus muscles in a five-year-old Belgian Shepherd dog is described. The dog was presented with progressive forelimb lameness with postural and gait abnormalities three months after an episode of overexertion. When walking, the lower part of both forelimbs swung in a lateral arc causing a circumduction movement and in the standing position, the dog showed elbow adduction with external rotation of the distal part of both front limbs. Orthopaedic examination revealed bilateral atrophy of both infraspinatus and supraspinatus muscles and restriction in the range of motion of both shoulders, especially when attempting abduction and flexion. No specific findings were observed in the shoulder or elbow radiographs but hyperechogenic areas were evident in the ultrasonographic examination of both infraspinatus muscles. A diagnosis of fibrotic contracture of both infraspinatus muscles was established and bilateral tenectomy of the insertion tendons of the infraspinatus muscles was performed. Complete recovery of the animal was achieved after the surgery, which was confirmed in a long-term follow-up (10 months). In conclusion, physical examination and ultrasonography allowed a proper diagnosis of the condition, and tenectomy of the infraspinatus muscles resulted in a complete recovery of the patient even with bilateral involvement.

  10. New innovations in scar management.

    PubMed

    Widgerow, A D; Chait, L A; Stals, R; Stals, P J

    2000-01-01

    As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. With this in mind, a scar management program has been adopted based on the modalities of wound support, hydration, and hastened maturity, all factors gleaned from scientific evidence published over the past 25 years. Tension on a scar in one axis will result in a stretched scar, probably initiated by neutrophils and their neutral proteases [18,26]. Tension on a scar from many directions or intermittently will result in a hypertrophic scar, possibly initiated by lymphocytes but definitely related to a prolongation of the inflammatory process, with increased fibroblast activity and overabundant extracellular matrix secretion [24,26]. The common initiating factor is the tension on the scar, and the critical element needed to counteract this tension is scar support. Clinical experience has shown us that the most reliable way to support a scar is by using microporous tape. Hydration is a second beneficial influence on scar control and is the basis of the use of silicone sheeting and gel [7,29,36]. Alpha Centella cream has two main components. The first is an extract from the plant Bulbine frutescens. This increases hydration under the tape by leaving a layer of fatty vesicles of glycoprotein on the skin surface. This also has antibacterial properties. The second component is the principal terpenoids extracted from the Centella asiatica plant. These include asiatic acid, madecassic acid, and asiaticoside. Centella asiatica has been documented to aid wound healing in a large number of scientific reports [5,12,21,22,33,34,40]. The most beneficial effect appears to be the stimulation of maturation of the scar by the production of type I collagen [4,19] and the resulting decrease in the inflammatory reaction and myofibroblast production. Thus these components have been incorporated into

  11. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions.

    PubMed

    Werker, Paul M N; Pess, Gary M; van Rijssen, Annet L; Denkler, Keith

    2012-10-01

    To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English. The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up. Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions. Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long

  12. Mortality, scarring, and growth in an oak woodland following prescribed fire and commercial thinning in the Ozark Highlands

    Treesearch

    C.S. Kinkead; M.C. Stambaugh; J.M. Kabrick

    2017-01-01

    Oak-dominated (Quercus Spp.) woodlands are commonly thinned and burned in the Ozark Highlands to prevent canopy closure and regenerate desired species, despite a lack of information regarding tree mortality, scarring, and growth in residual stands. Our study compared stand- and tree-level responses after two prescribed burns across four treatments...

  13. Functional Outcomes Following Burn Injury.

    PubMed

    Ryan, Colleen M; Parry, Ingrid; Richard, Reginald

    Major advances in functional recovery following burn injury over the last ten years include the development of conceptual framework for disability assessment and its application burn recovery, the description of the long-term outcomes in the burn population, and progress in basic science research leading to new treatments that improve long-term functional outcomes. Future tasks and challenges include the development of common data elements and standards for burn recovery in order to measure and optimize the path toward functional recovery. The development of patient-reported outcome measures with benchmarks for recovery over time has the potential to improve patient-provider communication and quality of patient-centered care. The study of burn recovery should include an examination of resiliency along with the study of disabilities following burn injury. Better understanding of the mechanisms, impact and modulation of hypermetabolism and inflammation following burn injury is essential to improve functional recovery. Continued basic science and clinical research must focus on scar modulation and skin replacements and address recalcitriant problems such as heterotopic ossification. Health tracking technologies should be leveraged to understand and optimize physical therapy interventions.

  14. [Rehabilitation of patients with deformations after periorbital burns].

    PubMed

    Korotkova, N L; Ivanov, S Iu; Mitrofanov, N V; Muraev, A A

    2013-01-01

    The study involved 152 patients with facial burns consequences (including 118 patients with burns of the mouth). Specific post-burn deformities were revealed: I type - deformity of the anatomical unit caused by scar tissue traction from adjacent regions (the unit itself preserved); II type - distortion caused by single scars without significant tissue defect; III type - post-burn deformities with total or subtotal skin scarring; IV type - tissue defects characterized by loss of anatomical unit with deep anatomical structures down to the bone and possible exposition of the paranasal sinuses and face cavities. Such classification based on the amount of tissue loss dictates the choice of surgical technique, allowing optimal functional and aesthetic treatment results.

  15. Scars of Erosion

    NASA Image and Video Library

    2017-02-16

    This large crescent dune in Kaiser Crater shows the scars of many types of seasonal erosional activities. Along its downwind slope are large gullies which are active during winter, when frost drives dune material downslope, carving out channels and creating fan-shaped aprons. On the upwind slope (bottom), dust devil tracks are visible: dark lines and curliques created during the spring season by small wind vortices vacuuming up a thin layer of dust and exposing the dark dune sand. Note: Both the cutout and the above image are rotated so that North is to the right. The map is projected here at a scale of 25 centimeters (9.8 inches) per pixel. [The original image scale is 25.3 centimeters (10 inches) per pixel (with 1 x 1 binning); objects on the order of 76 centimeters (30 inches) across are resolved.] North is up. http://photojournal.jpl.nasa.gov/catalog/PIA21458

  16. Keloids: scar revision.

    PubMed

    Brown, L A; Pierce, H E

    1986-01-01

    The treatment of keloids can be a long-term, and at times, vexing, dermatologic surgical management problem arising in both white and non-white patients. This paper reviews a number of conventional, as well as novel, therapeutic approaches for the management of this disease of uncontrolled scar growth. Additionally, fundamental aspects of this disease are covered, including clinical, histologic, biochemical, immunologic, endocrinologic, and epidemiologic factors. An understanding of these latter aspects may be useful to the clinician in realizing the best possible therapeutic results. It must be emphasized that, regardless of the technique employed, an observation period of at least 2 years is necessary to effectively limit the chance and degree of recurrence.

  17. Custom Knee Device for Knee Contractures After Internal Femoral Lengthening.

    PubMed

    Bhave, Anil; Shabtai, Lior; Ong, Peck-Hoon; Standard, Shawn C; Paley, Dror; Herzenberg, John E

    2015-07-01

    The development of knee flexion contractures is among the most common problems and complications associated with lengthening the femur with an internal device or external fixator. Conservative treatment strategies include physical therapy, serial casting, and low-load prolonged stretching with commercially available splinting systems. The authors developed an individually molded, low-cost custom knee device with polyester synthetic conformable casting material to treat knee flexion contractures. The goal of this study was to evaluate the results of treatment with a custom knee device and specialized physical therapy in patients who had knee flexion contracture during femoral lengthening with an intramedullary lengthening femoral nail. This retrospective study included 23 patients (27 limbs) who underwent femoral lengthening with an internal device for the treatment of limb length discrepancy. All patients had a knee flexion contracture raging from 10° to 90° during the lengthening process and were treated with a custom knee device and specialized physical therapy. The average flexion contracture before treatment was 36°. The mean amount of lengthening was 5.4 cm. After an average of 3.8 weeks of use of the custom knee device, only 2 of 27 limbs (7.5%) had not achieved complete resolution of the flexion contracture. The average final extension was 1.4°. Only 7 of 27 limbs (26%) required additional soft tissue release. The custom knee device is an inexpensive and effective method for treating knee flexion contracture after lengthening with an internal device.

  18. Contractures and involuntary muscle overactivity in severe brain injury.

    PubMed

    Pohl, Marcus; Mehrholz, Jan; Rockstroh, Günter; Rückriem, Stefan; Koch, Rainer

    2007-04-01

    The aim of the present study was to evaluate the association of contractures with an increase or reduction of non-spastic muscle overactivity due to severe cerebral damage. Forty-five patients with tetraparesis after severe cerebral damage were investigated. Three groups were defined based on the presence of spasticity (revealed as resistance to passive stretch (= hypertonia)), and the presence of contracture of the relevant knee joint: Group(s) (17 patients with hypertonia without contracture), Group(s+c) (20 patients with hypertonia and contracture), and Group(c) (eight patients without hypertonia and with contracture). In all groups spontaneous involuntary muscle activity was assessed continuously over a 12-hour period through isometric measurement of knee joint flexion torque. A mathematical algorithm differentiated an hourly muscle activity spectrum (PI(h)). The frequency of peaks (peaks(h)) from the activity spectrum was determined. We revealed that Group(s) had higher PI(h) and more frequent peaks(h) compared with Group(s+c) and Group(c) (p<0.05). Group(c) had comparable PI(h) and peaks(h) compared with Group(s+c) (p>0.05). The presence of contractures was associated with lower involuntary muscle overactivity in terms of lower PI(h) and less frequent peaks(h), indicating that contractures may be associated with reduced non-spastic positive features of the upper motor neurone syndrome in patients with severe brain damage.

  19. [Clinical classification of gluteal muscle contracture under arthroscopy].

    PubMed

    Liu, Yu-Jie; Wang, Zhi-Gang; Wang, Jun-Liang; Li, Shu-Yuan; Li, Hai-Feng; Qu, Feng; Xue, Jing; Qi, Wei; Liu, Chang; Zhu, Juan-Li

    2013-06-01

    To explore clinical effects of gluteal muscle contracture and minimum invasive surgery under the arthroscopy. Totally 358 patients with gluteus contracture were treated,which included 175 males and 183 females with an average age of (19.7 +/- 6.8) years old (ranged, 14 to 41). All patients have a history of repetitive intramuscular injection of penicillin with benzyl alcohol solvent. According to clinical characteristics and intraoperative situation, patients were classified into four groups:cable strip (118 cases), fanshaped (107 cases), mixed (87 cases), tensor fasciae latae contracture(46 cases). The curative effects were evaluated according to postoperative function evaluation standard of gluteus contracture. All patients were followed up and 37 cases withdrew. The following up time ranged from 1.5 to 8 years with an average of 3.5 years. According to evaluation standard of gluteus contracture, 303 cases got excellent results, 13 cases good,and 5 cases fair at the final follow-up. No recurrence, infection and neurovascular injury occurred. The classification of gluteal muscle contracture is beneficial for choose surgical strategy and improve curative effect. The advantage of plasma knife minimally invasive solution in treating gluteal muscle contracture with radiofrequency under arthroscopy is minimally invasive, safe, and benefit for early functional exercises.

  20. Myofibroblast Upregulators are Elevated in Joint Capsules in Posttraumatic Contractures

    PubMed Central

    Hildebrand, Kevin A.; Zhang, Mei; Hart, David A.

    2010-01-01

    We hypothesized specific growth factors are increased in the elbow capsules of patients with post traumatic elbow contractures. A model of surgically induced joint contracture in rabbit knees was developed to study the growth factor expression in joint contractures. This study demonstrates this model mimics the human condition and analyzes how the growth factor levels decrease with time in rabbit knees with contractures. Reverse transcription polymerase chain reaction was used to measure mRNA levels of transforming growth factor-β1, connective tissue growth factor, ED-A of fibronectin, and α-smooth muscle actin normalized to a housekeeping gene, glyceraldehyde-3-phosphate dehydrogenase. In the joint capsules of patients with elbow contractures, mRNA levels were increased for transforming growth factor- β1, connective tissue growth factor, and α-smooth muscle actin. In the joint capsules of rabbit knees with contractures, mRNA levels were increased for transforming growth factor- β1, connective tissue growth factor, ED-A of fibronectin, and α-smooth muscle actin. The mRNA levels for transforming growth factor-β1, connective tissue growth factor, and α-smooth muscle actin decreased with time in rabbit knees. The elevated levels of these myofibroblast up-regulators and fibrogenic growth factors could explain the previously reported increase in myofibroblasts and collagen mRNA levels. The rabbit knee model correlated well with the human post traumatic elbow contractures. PMID:17195814

  1. Collagenase clostridium histolyticum injection for the treatment of Dupuytren's contracture.

    PubMed

    Kaplan, F T D

    2011-09-01

    Collagenase clostridium histolyticum is a novel treatment for Dupuytren's contracture, approved by the U.S. Food and Drug Administration in February 2010. Prior to its availability, surgery was the only treatment for contracture related to this disorder. Dupuytren's disease is a benign, progressive fibroproliferative disorder affecting the palms of the hands. It is characterized by the formation of collagen- rich nodules and cords, which gradually shorten by the action of myofibroblasts, resulting in finger contractures. Intralesional use of clostridial collagenase has been evaluated in a total of 1,082 patients receiving 2,630 injections during its clinical development, including 2 large prospective, randomized, double-blind, placebo-controlled trials: Collagenase Option for Reduction of Dupuytren's I (CORD I) and CORD II. Both studies showed a statistically significant reduction in contracture compared to placebo and treatment was well-tolerated with the majority of adverse events self-limited. Serious adverse events related to collagenase activity were rare. Maximal improvement was seen in patients with less severe contractures and with contractures of the metacarpophalangeal joint. This first-in-class biologic, injectable clostridial collagenase histolyticum, provides a safe, effective alternative to surgery for patients with Dupuytren's contracture. Copyright 2011 Prous Science, S.A.U. or its licensors. All rights reserved.

  2. Scar management practice and science: a comprehensive approach to controlling scar tissue and avoiding hypertrophic scarring.

    PubMed

    Widgerow, Alan David; Chait, Laurence A

    2011-12-01

    A meta-analysis of the literature forms the basis of a treatment regimen focused on the principles of support, controlled inflammation, hydration, and hastened collagen remodeling. The presented clinical trial avoided hypertrophic scarring in more than 80% of cases, validating the theory of targeting many areas of scar control in 1 approach.

  3. Burn Wise

    EPA Pesticide Factsheets

    Burn Wise is a partnership program of the U.S. Environmental Protection Agency that emphasizes the importance of burning the right wood, the right way, in the right appliance to protect your home, health, and the air we breathe.

  4. Burns (image)

    MedlinePlus

    ... degree burns damage the outer layer of skin (epidermis) and cause pain, redness and swelling (erythema). Second degree burns damage the epidermis and the inner layer, the dermis, causing erythema ...

  5. Early dermabrasion of deep dermal burns with sandpaper. Case reports.

    PubMed

    Floccard, B; Tixier, F; Chatot-Henry, D; Lacotte, B; Mehdaoui, H; Drault, J N

    1998-12-01

    Deep dermal burns are initially difficult to evaluate, and they sometimes heal spontaneously. We present our experience of dermabrasion with sandpaper in four patients. It is a useful alternative to early excision of the scar. Skin grafts are not always required and the aesthetic results are excellent. Dermabrasion should be considered routinely for all deep dermal burns and particularly for facial burns and those caused by scalds.

  6. Case of extreme growth deceleration after burns.

    PubMed

    Bline, Cheryl; Dylewski, Maggie L; Driscoll, Daniel N; Fuzaylov, Gennadiy

    2014-05-01

    Studies have demonstrated deceleration in both weight and height following burns in children. It is expected patients will display catch up growth and return to normal weight within three years but continued height deficiency may remain in cases of severe burns. We describe a case of severe growth retardation of 8 years old orphan child from Ukraine who suffered of burn less than 40% of total body surface area when he was a 3 years of life. His case was complicated by domestic abuse, neglect and limited medical care. He initially presented to the United States for surgical care of his contractures but his treatment quickly focused on his profound growth retardation. Despite aggressive nutritional supplementation and evaluation he did not demonstrate any weight gain.

  7. Hand function and quality of life before and after fasciectomy for Dupuytren contracture.

    PubMed

    Engstrand, Christina; Krevers, Barbro; Nylander, Göran; Kvist, Joanna

    2014-07-01

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol. The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time. After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Evidence-based medicine: Dupuytren contracture.

    PubMed

    Eaton, Charles

    2014-05-01

    After studying this article, the participant should be able to: (1) Describe features and clinical importance of Dupuytren diathesis. (2) Explain the difference between the new definition of recurrence used in collagenase studies compared with prior definitions of recurrence. (3) Compare and list the main advantage/main disadvantage of fasciectomy versus minimally invasive treatment (collagenase injection or needle aponeurotomy) of Dupuytren contracture. The large body of existing literature o