Objective: We report our preoperative planning method for skin grafting for extensive burns (the gauze method) .
Method: Before surgery, we applied normal saline-soaked 15 x 15-cm square gauze to the burn wound. The summation of skin graft was estimated (eSg) by counting the number of gauze squares. The amount of skin graft harvested during the actual surgery (rSg) was compared with eSg.
Result: Six patients (mean age 69.9 years, TBSA 23.8 %) were recruited to this study. We performed the gauze method in 8 surgical procedures. The average operation time was 197.0 minutes. Debridement and skin harvesting were carried out simultaneously in all cases. The mean values of eSg and rSg were 558.8 and 571.3 cm², respectively. No significant difference was found (p=0.62, paired t test) .
Discussion: The gauze method is a simple procedure that does not require any special instrument or technique. It provided sufficient time to discuss the treatment plan preoperatively. We were able to assign surgical procedures（debridement and skin harvesting）to each team member. The gauze method was suggested to shorten the operative time and reduce associated complications.
Background: Our department has been actively involved in burn care and research. The aim of this study was to review the burn patient demographics in our department over 50 years.
Methods: This study was a retrospective observational study of changes in burn patient demographics from 1968 to 2017. The patient data were obtained from the clinical health records, and their age, sex, %TBSA, length of hospital stay, and outcome were examined over the study period. We assessed factors associated with the mortality by multivariable logistic regression analysis, and calculated the adjusted odds ratio (AOR) and 95% confidential interval (CI) .
Results: The number of burn patients gradually decreased, and the proportion of burn patients to all admitted cases decreased from approximately 10% to 1%. The %TBSA and mortality rate gradually decreased over the study period. The AOR (95%CI) in logistic regression analysis for death outcomes was 1.77 (1.58-2.01) for 10 years old, 0.49 (0.37-0.63) for 10 years of admission, and 2.09 (1.87-2.36) for 10%TBSA.
Conclusions: We found a decrease in the number of burn patients and severity over time. Burn care may be consolidated to a few burn centers for the future development of burn care and research.
The use of negative-pressure wound therapy（NPWT）was recently reported for the management of hand skin grafts. We present a case of skin graft management for burn injury on the dorsal side of both hands, which was treated by NPWT using RENASYS® cotton filler.
Case report: A 59-year-old male had deep dermal burns on the dorsal side of both hands. He was treated using split-thickness skin grafts via NPWT with RENASYS® cotton filler. At the 2-year postoperative follow-up, he had full range of motion of his fingers and the graft site was healing well.
Discussion: The cotton filler can be easily molded to any shape and can be adapted to fit in the space between fingers; these features enable appropriate management of skin grafts to be established more easily. In conclusion, NPWT using RENASYS® cotton filler may be useful for skin graft management of burn injuries to the hands.
Erosive pustular dermatosis (EPD) is an inflammatory dermatosis characterized by pustules, crusts, and erosions located on the scalp. The etiology is poorly understood, but known predisposing factors are trauma, surgery, and ultraviolet exposure.
A 55-year-old male sustained 60% TBSA flame burns due to a gas fire, which required skin grafting. He was transferred 3 months after injury. Six months after the transfer, he returned to our hospital because multiple ulcers and black crusts on the burn were observed.
Treatment of infection was unsuccessful. The patient was started on topical corticosteroid treatment, which significantly improved the lesions.
Based on the clinical course and nonspecific biopsy, a diagnosis of erosive pustular dermatosis (EPDS) was established. When pustules, crusts, and erosions are observed on burn scars, the possibility of EPD in addition to bacterial infection should be considered.
In cases of electrical injury, the Joules of heat produced in the body cause extensive thermal exposure-induced damage followed by progressive necrosis. We report the treatment challenges in a patient with electrical injury and subsequent progressive necrosis of the lower back. A 37-year-old man was hospitalized for electrical injuries sustained during occupational exposure to a 66,000-V electrical cable that came into contact with a cutter in his left chest-pocket. Third-degree burns covered 8% of the body surface area, with the severe area of the waist back accounting for 5%. On Day 14 of hospitalization, debridement and skin grafting were performed for the ulcers, but no graft take was observed. Progressive necrosis over the markedly damaged lower back was evident. On Day 28, the border of the necrotic and normal areas around the waist was visualized on contrast CT. There was judged to be no progressive necrosis in this area. On Day 35, a reverse latissimus dorsi muscle flap was applied. Identification of progressively necrotic tissue and areas with good vascularity is important in the treatment of electrical injuries. Wounds caused by electrical injury with progressive necrosis require daily observation and evaluation through imaging.
A 6-year-old boy fell into boiling-hot water at 4 years of age, resulting in DDB-DB scald burns from his lower back to his lower limbs. An autologous split-thickness skin graft from his buttocks was grafted to the popliteal area to release knee contracture. Although contracture was improved, marked hypertrophic scarring developed at the donor site. On his first medical examination at our hospital, it was difficult for him to sit due to contracture and severe pain. He and his family refused another autologous free skin graft because the results at the donor site were poor. Therefore, we combined autologous cultured epithelium with an allogeneic skin graft from his mother after approval by the ethics committee. During the primary surgery, we excised the hypertrophic scar to release the contracture, and the full-thickness skin defect was covered with skin from the abdominal region of his mother. We transplanted the autologous cultured epithelium at 16 days postoperatively. Three years after surgery, neither contracture nor indentation, which may cause cosmetic problems, was observed. The combination of an allogeneic skin graft from the parent and autologous cultured epithelium may be useful in certain cases.