Wound contracture of the lips is difficult to treat due to both cosmetic and functional problems. Flap reconstruction has problems with flap thickness and donor site aesthetics; thus, skin grafts are still useful for extensive lip skin reconstruction. We experienced a case of artificial dermis transplantation using external wire frame fixation before and after skin grafting to prevent contracture of the lips.
　A 39-year-old man suffered a burn on his face and the contracture gradually progressed on his upper and lower lips. Artificial dermis transplantation using wire frames was performed, and 17 days after that full-thickness skin grafting using wire frames was performed. One year after the operation, skin contracture was not observed and good aesthetic results were obtained. Postoperative skin contraction could be prevented by fixing artificial dermis with a wire frame and forming granulation tissue over a wide area before skin grafting.

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　Lime sulfur, a strong alkali, is a pesticide used as an insecticide and fungicide for fruit trees. We experienced three cases of chemical burns caused by lime sulfur. In all cases, the lime sulfur adhered to the limbs during agricultural work, and skin necrosis with a milky white eschar developed within a few hours. It was difficult to remove and early surgical debridement was performed. It became a deep ulcer and required split-thickness skin grafting.
　In chemical burns caused by lime sulfur, a peculiar milky white eschar is formed 2 to 3 hours after the injury, and it is difficult to determine the depth of invasion externally. Furthermore, when mechanical stimulus or friction is applied to sections of the lime sulfur adhesion, it tends to develop an ulcer that reaches deeper tissues. It is important to debride the milky white eschar as soon as possible as it can damage the tissue and deepen the ulcer for as long as it remains. In addition, it is important to educate users about the dangers of lime sulfur, and encourage protection, washing after injury, and early medical consultation. Medical staff should also raise awareness of this chemical burn.

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　Acalculous cholecystitis is a known complication of severe burn injuries. Cholecystectomy performed through a burn wound has not been previously reported.
　We present a case of an 89-year-old woman with severe burns to the face, neck, chest, abdomen, and arms, which comprised 29% of her total body surface area. On the 2nd day, we performed escharotomy on right arm to avoid compartment syndrome. On the 3rd day, the patient had compartment syndrome on the chest, we performed escharotomy and debridement. After debridement was completed, the patient developed acalculous cholecystitis. Open cholecystectomy was performed through the burn wound. Having observed no signs of infection after 3 days, we performed a split-thickness skin graft that included the surgical site. After surgery, the graft remained mostly intact and wound epithelialization was observed.
　Burn patients who develop gastrointestinal complications may require surgery. Surgical incisions through a burn wound generally increase the risk of infection; however, this method may be unavoidable in patients with severe burns. The procedure was performed in the present patient along with debridement and skin grafting. No wound infection was observed, which allowed burn treatment to continue. Laparotomy through a burn wound may also be an option in well-managed burn cases.

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　This study aimed to elucidate nursing care for and difficulties in treating severe burn patients, as understood by nurses in an advanced critical care and emergency center. We conducted a focus group study by selecting a sample of six nurses working in a hospital advanced critical care and emergency center. The data obtained from this sample were analyzed via a text mining method and hierarchical cluster analysis from a text about nursing care and its difficulties.
　The most frequent word used in this data was “patient”. Hierarchical cluster analysis results for nursing care were: “using experience to suggest dressing methods to doctors,” “anticipating abnormalities in burn locations based on changes in burn wounds and scope of pain,” “determining appropriate rehabilitation and rest levels, and discerning the need for care,” and “dealing with patients’ families considering burn location and overall condition”. The results for difficulties were: “timing when to let patients see their bodies,” “insufficient management of line securement,” “caring for families during the acute phase, when patients’ conditions may be unstable,” and “difficulty handling gauze fecal contamination”.
　These findings suggest the need to accumulate research and experiential knowledge, including the recovery processes of burn patients, and nursing care and development based on burn treatment guidelines. Creating educational programs incorporating problem-solving resources, cooperation with other healthcare professionals, and other resources may be an effective strategy.

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