The efficacy of micrograft spray in wound healing has been reported overseas; however, in Japan, there are no reports on the use of micrograft spray in the treatment of burns. Here, we report 2 cases of burns treated with micrograft spray using the RIGENERA® system (HBW, Italy) . In case 1, a burn wound on the upper limb of a woman in her 60s was treated with an artificial dermis to construct subcutaneous tissue, followed by the use of 1:3 mesh and patch grafting. In case 2, burn wounds on the upper limb, chest, and abdomen of a man in his 80s were treated with an artificial dermis to construct subcutaneous tissue, followed by the use of 1:3 mesh and patch grafting. In both cases, micrograft spray was used in combination with a split skin graft to epithelialize the mesh gap and to expand the patch graft, resulting in good wound closure.
This technique is simple and does not require culture; therefore, split skin grafting combined with micrograft spray is expected to be a new option for burn treatment in the future.
We encountered a case of a 78-year-old man with extensive burns complicated by heparin-induced thrombocytopenia (HIT) who was treated with the application of bedside skin grafts (BSGs) . He had been injured while extinguishing a fire when his son died of suicide by self-immolation at home. On the first visit, second- (27.5%) and third-degree (20%) burns were observed on the head and neck, trunk, upper limbs, and left lower limb. After admission, he was suspected of having HIT, and heparin administration was discontinued. Blood tests were positive for anti-HIT antibodies, and echoangiography confirmed lower limb venous thrombosis. Therefore, he was treated with argatroban and underwent BSG application with anesthetic induction using ketamine. On the 77th day of hospitalization, the thrombus disappeared, and the patient’s bed rest restrictions were discontinued. The burn wound healed after the application of five BSGs and the application of a skin graft on the face under general anesthesia. The patient eventually underwent gait rehabilitation and reconstruction for contracture of the facial wound. The patient was transferred to another hospital for the continuation of rehabilitation on the 250th day of hospitalization.
The patient, a 24-year-old woman, incurred a 2% superficial dermal burn injury on her lower abdomen due to microwave-heated hair removal wax. Upon arrival, she was treated using fluid therapy, and was discharged after 8 days as the wound was epithelialized. There are three causes of the burn in this case: 1) application of high-temperature wax, 2) insufficient stirring after heating the hair removal wax, and 3) adhesion of the hair removal wax to areas not coated with any moisturizer to protect the skin such as oil. Burns caused by hair removal wax rarely occur under proper use. As hair removal wax is becoming easier to use at home, it is necessary to state the possible risk of burn injury and appropriate first aid instructions (Cool the wax and lower the temperature and for oil-based wax, remove using the oil or cream containing oil, etc.) for caution along with the usage method. In addition, it is recommended for medical workers to understand the characteristics of hair removal wax and treatment.
Many commercially available spray-can products (aerosol products), such as deodorant spray, hair spray, waterproof spray, and insecticide spray, are being used daily for various purposes. Most people are not aware that many of these products contain flammable gases and that there are many accidents caused by fires or explosions due to the flammable gases.
In the past 10 years, among the burn patients treated at our department, 5 patients were burned due to fires or explosions from overheating of home appliances caused by the spray from spray-can products. The home appliance was a water heater in 4 of these 5 burn cases.
All the patients treated at our department had mild to moderate burns, but there have been reports of patients with severe burns and patients who died from burns caused by fires or explosions when using spray-can products. Large explosions caused by aerosol products that had been disposed of in rubbish have recently been occurring in Japan. People must be made aware of the risks of fires and explosions caused by flammable gases in spray-can products.
The patient was a 45-year-old male. He was transferred to the emergency room after losing consciousness while using a dichloromethane-based paint stripper in a poorly ventilated room. At the time of transport, in addition to impaired consciousness, 7% of the total burn area was found to be partial thickness burns (left elbow 2%, abdomen 2%, right forearm 1%, left thigh 2%) . An elevated blood carboxyhemoglobin level was also observed. He was diagnosed with acute poisoning with chemical burns caused by dichloromethane. Decontamination was performed immediately, and high-concentration oxygen administration was continued after hospitalization, but the blood carboxyhemoglobin level in the blood increased, and the disturbance of consciousness was prolonged. Hyperbaric oxygen therapy was started the day after the injury, and the blood carboxyhemoglobin level promptly decreased and the disturbance in consciousness improved. The burn wound did not deepen and healed within 3 weeks after the injury with topical medication application. Dichloromethane can cause chemical injury due to its local irritant and degreasing effects, as well as impaired consciousness on its own and due to carbon monoxide produced by its metabolism. Early decontamination and hyperbaric oxygen therapy were useful in this case.
The patient was a 76-year-old female who was found lying unconscious on the floor in front of a heater in her house. She had a 14x11cm deep burn on the left side of her head. On post-burn day 2, we performed debridement of the necrotic soft tissue to the cranial bone, which was partially exposed, and full-thickness scalp defects were then covered with artificial dermis. However, sufficient granulation was not achieved, and the surrounding preserved galea and periosteum became necrotic. On post-burn day 17, we excised the outer layer of the cranial bone to the level of bleeding, and applied a free latissimus dorsi muscle flap and split-thickness skin grafting to cover the defect. We consider covering the exposed cranial bone with a vascularized free flap at an early stage to be a useful reconstructive method to control the progression of necrosis and infection of the exposed bone.