Management of Burn Wounds

Abstract

Small and moderate scalds in toddlers are still the most frequent thermal injuries the pediatric surgeons have to face today. Over the last years, surgical treatment of these patients has changed in many aspects. Due to new dressing materials and new surgical treatment strategies that are particularly suitable for children, today, far better functional and aesthetic long-term results are possible. While small and moderate thermal injuries can be treated in most European pediatric surgical departments, the severely burned child must be transferred to a specialized, ideally pediatric, burn center, where a well-trained multidisciplinary team under the leadership of a (ideally pediatric) burn surgeon cares for these highly demanding patients. In future, tissue engineered full thickness skin analogues will most likely play an important role, in pediatric burn as well as postburn reconstructive surgery.

Keywords

burns - scalds - child - toxic shock syndrome - tissue engineering

• References

• 1 Yates J, McKay M, Nicholson AJ. Patterns of scald injuries in children—has anything changed?. Ir Med J 2011; 104 (9) 263-265
• 2 Shah M, Orton E, Tata LJ, Gomes C, Kendrick D. Risk factors for scald injury in children under 5 years of age: A case-control study using routinely collected data. Burns 2013; (e-pub ahead of print). doi:10.1016/j.burns.2013.03.022
• 3 Zhou B, Zhou X, Ouyang LZ , et al. An epidemiological analysis of paediatric burns in urban and rural areas in south central China. Burns 2013; (e-pub ahead of print). doi:10.1016/j.burns.2013.04.020
• 4 Brusselaers N, Monstrey S, Vogelaers D, Hoste E, Blot S. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Crit Care 2010; 14 (5) R188
• 5 Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J. Hypertrophic burn scars: analysis of variables. J Trauma 1983; 23 (10) 895-898
• 6 Frame JD, Eve MD, Hackett ME , et al. The toxic shock syndrome in burned children. Burns 1985; 11 (4) 234-241
• 7 Burd A. Toxic shock syndrome in paediatric burns: a peculiarly British malady or a malady of peculiar British?. Burns 2005; 31 (7) 937-938
• 8 Vloemans AF, Gorissen KJ. Non-existence of toxic shock syndrome in Dutch Burns Centres. Burns 2006; 32 (4) 522-523
• 9 Deitch EA, Rutan RL. The challenges of children: the first 48 hours. J Burn Care Rehabil 2000; 21 (5) 424-430 , quiz 431, discussion 423
• 10 Trupkovic T, Giessler G. Burn trauma. Part 1: pathophysiology, preclinical care and emergency room management [in German]. Anaesthesist 2008; 57 (9) 898-907
• 11 Ashworth HL, Cubison TC, Gilbert PM, Sim KM. Treatment before transfer: the patient with burns. Emerg Med J 2001; 18 (5) 349-351
• 12 Trop M, Schiestl C. Primary care and initial intensive therapy for burns in children. Notfall Rettungsmed 2007; 10 (2) 94-98
• 13 Meuli M, Lochbühler H. Current concepts in pediatric burn care: general management of severe burns. Eur J Pediatr Surg 1992; 2 (4) 195-200
• 14 Graf A, Schiestl C, Landolt MA. Posttraumatic stress and behavior problems in infants and toddlers with burns. J Pediatr Psychol 2011; 36 (8) 923-931
• 15 Landolt MA, Buehlmann C, Maag T, Schiestl C. Brief report: quality of life is impaired in pediatric burn survivors with posttraumatic stress disorder. J Pediatr Psychol 2009; 34 (1) 14-21
• 16 Monstrey SM, Hoeksema H, Baker RD , et al. Burn wound healing time assessed by laser Doppler imaging. Part 2: validation of a dedicated colour code for image interpretation. Burns 2011; 37 (2) 249-256
• 17 Jeng JC, Bridgeman A, Shivnan L , et al. Laser Doppler imaging determines need for excision and grafting in advance of clinical judgment: a prospective blinded trial. Burns 2003; 29 (7) 665-670
• 18 Cho JK, Moon DJ, Kim SG, Lee HG, Chung SP, Yoon CJ. Relationship between healing time and mean perfusion units of laser Doppler imaging (LDI) in pediatric burns. Burns 2009; 35 (6) 818-823
• 19 Jenkins AT, Young A. Smart dressings for the prevention of infection in pediatric burns patients. Expert Rev Anti Infect Ther 2010; 8 (10) 1063-1065
• 20 Highton L, Wallace C, Shah M. Use of Suprathel® for partial thickness burns in children. Burns 2013; 39 (1) 136-141
• 21 Silverstein P, Heimbach D, Meites H , et al. An open, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream. J Burn Care Res 2011; 32 (6) 617-626
• 22 Patel PP, Vasquez SA, Granick MS, Rhee ST. Topical antimicrobials in pediatric burn wound management. J Craniofac Surg 2008; 19 (4) 913-922
• 23 Kamolz LP, Lumenta DB, Trop M. Is there still a need for silver sulfadiazine in small burns?. Burns 2013; 39 (3) 535-536
• 24 Schiestl C. Treatment of scald injuries in infants and toddlers: the Zurich concept [in German]. Handchir Mikrochir Plast Chir 2007; 39 (5) 356-359
• 25 Schiestl C, Beynon C, Balmer B. What are the differences? – Treatment of burns in children compared to treatment in adults. Osteo Trauma Care 2007; 15 (1) 26-28
• 26 Hazani R, Whitney R, Wilhelmi BJ. Optimizing aesthetic results in skin grafting. Am Surg 2012; 78 (2) 151-154
• 27 Mittermayr R, Wassermann E, Thurnher M, Simunek M, Redl H. Skin graft fixation by slow clotting fibrin sealant applied as a thin layer. Burns 2006; 32 (3) 305-311
• 28 Branski LK, Mittermayr R, Herndon DN , et al. Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model. Burns 2011; 37 (8) 1360-1366
• 29 Stiefel D, Schiestl CM, Meuli M. The positive effect of negative pressure: vacuum-assisted fixation of Integra artificial skin for reconstructive surgery. J Pediatr Surg 2009; 44 (3) 575-580
• 30 Petkar KS, Dhanraj P, Kingsly PM , et al. A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients. Burns 2011; 37 (6) 925-929
• 31 Martinot V, Mitchell V, Fevrier P, Duhamel A, Pellerin P. Comparative study of split thickness skin grafts taken from the scalp and thigh in children. Burns 1994; 20 (2) 146-150
• 32 Klöti J, Pochon JP. Split skin grafts from the scalp. Prog Pediatr Surg 1981; 14: 111-122
• 33 Cole RP, Shakespeare PG. Toxic shock syndrome in scalded children. Burns 1990; 16 (3) 221-224
• 34 Young AE, Thornton KL. Toxic shock syndrome in burns: diagnosis and management. Arch Dis Child Educ Pract Ed 2007; 92 (4) ep97-ep100
• 35 Janzekovic Z. A new concept in the early excision and immediate grafting of burns. J Trauma 1970; 10 (12) 1103-1108
• 36 Jackson DM. Second thoughts on the burn wound. J Trauma 1969; 9 (10) 839-862
• 37 Jackson DM, Stone PA. Tangential excision and grafting of burns. The method, and a report of 50 consecutive cases. Br J Plast Surg 1972; 25 (4) 416-426
• 38 Janzekovic Z. Once upon a time ... how west discovered east. J Plast Reconstr Aesthet Surg 2008; 61 (3) 240-244
• 39 Vloemans AF, Schreinemachers MC, Middelkoop E, Kreis RW. The use of glycerol-preserved allografts in the Beverwijk Burn Centre: a retrospective study. Burns 2002; 28 (Suppl. 01) S2-S9
• 40 Rheinwald JG, Green H. Serial cultivation of strains of human epidermal keratinocytes: the formation of keratinizing colonies from single cells. Cell 1975; 6 (3) 331-343
• 41 Gallico III GG, O'Connor NE, Compton CC, Kehinde O, Green H. Permanent coverage of large burn wounds with autologous cultured human epithelium. N Engl J Med 1984; 311 (7) 448-451
• 42 Gobet R, Raghunath M, Altermatt S , et al. Efficacy of cultured epithelial autografts in pediatric burns and reconstructive surgery. Surgery 1997; 121 (6) 654-661
• 43 Wood FM, Kolybaba ML, Allen P. The use of cultured epithelial autograft in the treatment of major burn injuries: a critical review of the literature. Burns 2006; 32 (4) 395-401
• 44 Boyce ST, Kagan RJ, Meyer NA, Yakuboff KP, Warden GD. The 1999 clinical research award. Cultured skin substitutes combined with Integra Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns. J Burn Care Rehabil 1999; 20 (6) 453-461
• 45 Boyce ST, Kagan RJ, Greenhalgh DG , et al. Cultured skin substitutes reduce requirements for harvesting of skin autograft for closure of excised, full-thickness burns. J Trauma 2006; 60 (4) 821-829
• 46 Yannas IV, Burke JF. Design of an artificial skin. I. Basic design principles. J Biomed Mater Res 1980; 14 (1) 65-81
• 47 Burke JF, Yannas IV, Quinby Jr WC, Bondoc CC, Jung WK. Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury. Ann Surg 1981; 194 (4) 413-428
• 48 Moiemen NS, Vlachou E, Staiano JJ, Thawy Y, Frame JD. Reconstructive surgery with Integra dermal regeneration template: histologic study, clinical evaluation, and current practice. Plast Reconstr Surg 2006; 117 (7, Suppl): 160S-174S
• 49 Moiemen NS, Staiano JJ, Ojeh NO, Thway Y, Frame JD. Reconstructive surgery with a dermal regeneration template: clinical and histologic study. Plast Reconstr Surg 2001; 108 (1) 93-103
• 50 Stiefel D, Schiestl C, Meuli M. Integra Artificial Skin for burn scar revision in adolescents and children. Burns 2010; 36 (1) 114-120
• 51 Schiestl C, Stiefel D, Meuli M. Giant naevus, giant excision, eleg(i)ant closure? Reconstructive surgery with Integra Artificial Skin to treat giant congenital melanocytic naevi in children. J Plast Reconstr Aesthet Surg 2010; 63 (4) 610-615
• 52 Schiestl C, Neuhaus K, Biedermann T, Böttcher-Haberzeth S, Reichmann E, Meuli M. Novel treatment for massive lower extremity avulsion injuries in children: slow, but effective with good cosmesis. Eur J Pediatr Surg 2011; 21 (2) 106-110
• 53 Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38 (6) 563-576 , discussion 577
• 54 Braziulis E, Biedermann T, Hartmann-Fritsch F , et al. Skingineering I: engineering porcine dermo-epidermal skin analogues for autologous transplantation in a large animal model. Pediatr Surg Int 2011; 27 (3) 241-247
• 55 Schiestl C, Biedermann T, Braziulis E , et al. Skingineering II: transplantation of large-scale laboratory-grown skin analogues in a new pig model. Pediatr Surg Int 2011; 27 (3) 249-254
• 56 Hartmann-Fritsch F, Biedermann T, Braziulis E, Meuli M, Reichmann E. A new model for preclinical testing of dermal substitutes for human skin reconstruction. Pediatr Surg Int 2013; 29 (5) 479-488
• 57 Hartmann-Fritsch F, Biedermann T, Braziulis E , et al. Collagen hydrogels strengthened by biodegradable meshes are a basis for dermo-epidermal skin grafts intended to reconstitute human skin in a one-step surgical intervention. J Tissue Eng Regen Med 2012; (e-pub ahead of print). doi:10.1002/term.1665