In Japan, “burn injury” is a type of injury medical students must learn about. However, although it is in the curriculum, lectures differ depending on the university or department. We administered a questionnaire survey to all 81 medical schools in Japan to examine the actual state of education regarding burn injuries in Japan.
We found that lectures on burn injury are delivered by multiple departments such as plastic and reconstructive surgery, dermatology, emergency, etc. At many universities, students are equipped to evaluate the size and depth, and the cause of the burn. On the other hand, at some universities, students are equipped to provide mental support for burn injury and progressive aseptic necrosis, and rehabilitation thereafter. During clinical training, only 15% of the students have experience in treating a burn injury.
Burns are a common type of injury that many doctors encounter in daily practice. However, at almost all schools, the time allotted for lectures on burn injury is limited. Effective lectures to encourage students to learn by themselves are recommended.
We report a case of equinus deformity with Achilles tendon shortening caused by scar contracture as a result of extensive burn injury in childhood. We obtained good results by performing Achilles tendon lengthening 3 times during growth and covering the periarticular region with a free latissimus dorsi musculocutaneous flap.
In burn scar contracture, unlike nerve palsy or congenital clubfoot, the ankle joint is covered with hard and thick scar tissue, healthy tissue available for reconstruction is limited, and in children, recontracture during growth is a problem.
In this case, osteotomy of the lower leg was suggested by the orthopedic surgeon, but we selected Achilles tendon extension because it required release of the periarticular hard scar contracture. Shortening of the lower limbs became marked due to the high degree of contracture, requiring reoperation during growth.
Scar contracture of the skin requires careful surgical selection in consideration of growth, and should be treated differently from common equinus deformity, especially in children.
We report a rare case of a giant cutaneous horn originating from a burn scar. The patient was a 62-year-old female. She sustained a scald burn on her head and face when she was 2 years old, which was managed conservatively. She presented with a 1-year history of recurring erosion and crust formation on her occipital region that was gradually growing in size with a bonelike cutaneous horn. Examination revealed a large cone-shaped keratotic cutaneous horn of 4.5 cm in height and 4×3 cm in width at the base, in the center of the hairless burn scar measuring 12×7 cm in width on her occipital region. The cutaneous horn with surrounding burn scar was excised, and its examination revealed a hyperkeratotic horn without malignancy. Great care is needed when judging premalignant or malignant skin lesions at their base. Artificial dermis was directly applied on the exposed skull, enabling second-stage full thickness skin grafting. This case suggests that it is not always necessary to expose the diploe when grafting.
We report a case in which tissue loss of the vermilion border of the upper lip due to burn injury was successfully reconstructed through a series of operations. The patient was a female in her early thirties who sustained severe burns on her face two years ago. Most of her face was replaced with skin grafts. In the first surgery in this series, bilateral pedicled buccal musculomucosal flaps were applied to increase the amount of vermilion tissue. However, whistling deformity developed. Therefore, in the second surgery, this deformity was corrected using bilateral V-Y advancement flaps. In addition, the Cupid’s bow was reconstructed in the third surgery to create the natural morphology of the upper lip. As a result of these successive surgical procedures, the appearance of the upper lip was significantly improved.
Aim: An analytical study of textbooks was performed to extract and analyze appropriate data, and to compile the essential content necessary for burn nursing care in the emergency and intensive care units.
Method: We employed CiNii Books as a bibliographic database and used the following keywords: “burn nursing”, “emergency nursing”, “intensive care nursing”, “acute care nursing” and “critical care nursing”. In total, 241 textbooks were identified and 6 new editions that fit the purpose of this study were investigated. Descriptions related to nursing care for burns were analyzed qualitatively and descriptively.
Results: Nursing care strategies for burns comprised six major aspects: breath and circulation management, which enabled the early detection of abnormalities; nutrition therapy and early mobilization to promote recovery; infection prophylaxis locally on the burn wound and/or systemically; physical and psychosocial palliative care; concrete care strategies for the recovery of cognition and psychosocial functioning; and care for the family according to each stage throughout treatment.
Discussion: The extracted content provides a good understanding of realistic situations encountered in the clinical setting of caring for patients and their families.