The usefulness of immediate excision has been long reported and it is a common practice. Excisional debridement is currently the most common therapy for burns; however, it has a high patient burden due to its invasiveness. KMW-1, a novel enzymatic debridement agent, has been reported in overseas clinical trials to be minimally invasive and to immediately remove eschar without harming viable tissues.
　We conducted a phaseⅢclinical trial to confirm the efficacy and safety of KMW-1 in Japanese patients with deep dermal burns（DDB）and deep burns（DB）.
　The percentage of patients with complete removal of the eschar was 88.6%（95%CI［74.05, 95.46］）. The mean removed percentage of the eschar was 96.2% per patient and 97.1% per target wound. The median times to complete removal of the eschar were 1.0 and 3.0 days from the time of enrollment and injury, respectively. All side effects were mild to moderate. No adverse events requiring dose reduction, dose interruption, or dose discontinuation were reported.
　This study demonstrated that KMW-1 can be applied early, effectively, and selectively to remove eschar safely in Japanese patients with DDB and DB. Moreover, this agent may be an alternative method to immediate excision with excisional debridement.

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　Although prone therapy is recommended to improve the mortality of patients with acute respiratory distress syndrome（ARDS）, it is often impossible to perform in burn patients due to positional limitations.
　We report a patient who attempted self-immolation with 21.5% total body surface area burns on the front side of the body and ARDS due to inhalation injury in whom prone therapy was not an option due to positional limitations. We placed him in the sitting position to improve oxygenation by increasing the functional residual capacity, but postural maintenance was difficult due to burns and muscle weakness. Oxygenation was unable to be improved due to the short time in the upright position. The patient was weaned off the ventilator after 60 minutes in an upright position with multidisciplinary cooperation of nurses. A prolonged upright position may be effective as an alternative position for ARDS patients with positional limitation when prone therapy cannot be performed.

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　We report a case of a full-thickness necrosis of the anterior skin of the patella while harvesting bone-patellar tendon-bone（BTB）with the KOH BTB Harvester（KOH device）.
　A 20-year-old male underwent reconstructive surgery of the anterior cruciate ligament of the right knee at the orthopedic surgery department of our hospital. After the operation, the patient was referred to our department because whitening of the anterior skin of the right patella was noted.
　The patient was initially followed up with conservative management. However, as necrosis progressed, debridement was performed 14 days after the surgery. On the 27th day after the surgery, a skin flap was applied from the right lateral thigh. Postoperatively, there was no motor function deficit.
　To date, there have been no reports of burns caused by the use of a KOH device. As the KOH device is used for osteotomy of the patella subcutaneously, frictional heat is generated subcutaneously during osteotomy. In the present case, due to equipment issues, osteotomy required three-times as long as normal, leading to the burn. Therefore, when using the KOH device, it is necessary to take measures to shorten the contact time with the heat source.

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　We report a burn patient who received five split-thickness skin grafts （STSG） after sustaining a superficial dermal burn on her leg and thigh subsequent to a 60% total surface area burn. The leg was the original donor site of the grafts. The STSG-reconstructed region of the previous burn area exhibited slow epithelization, but epithelization of the donor site for the original graft （leg） was normal. Faster epithelization was noted at the area of the donor site for the previous graft than at the area of the previous STSG. This difference was attributed to the growth of keratinocytes preserved in the epithelium.

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　Introduction: In patients with a wide range of severe burns, the fingers and hands are often amputated to preserve life.
　However, in younger patients, recovery of finger function should be considered in the chronic phase in order to improve the quality of rehabilitation after lifesaving. We report our concept and concrete surgical method of reconstructive treatment when the fingers are lost.
　Case: We report two young patients with severe burns who have been treated at our hospital since their first presentation.
　The first case was a 2-year-old girl who underwent first-finger reconstruction and thumb separation two years after injury. The second was a 23-year-old woman who underwent thumb reconstruction with a pedunculated abdominal wall flap and free iliac transplantation two years after injury.
　Discussion: There are few reports of functional reconstruction for burn patients with total loss of the fingers from Japan or overseas. We thus investigated an approach similar to that for severe finger trauma and congenital finger defects. In general, priority is given to rebuilding the pinch function between the thumb and one of the opposing fingers or the opposing surface. Adductor pollicis function and interosseous muscle function are often preserved even in cases of burns in which the fingers are lost, and the issue is how to connect these residual functions to restore effective functions.
　Summary: We reported a method unique to our hospital for functional reconstruction of the hand with a finger defect after severe general burns.
　Even if it is a widespread burn, it must be properly managed from the acute stage, and even if the function of the fingers is lost in the chronic stage, it can be restored in a case-by-case basis using limited grafts. Reconstruction considering the function of the internal muscles of the hand is important.

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