PURPOSE:Ventral hernia repair (VHR) with mesh is the gold standard; however, the risks associated with mesh may have significant consequences for immunocompromised patients. This study seeks to evaluate outcomes of VHR in transplant recipients with and without biological mesh. METHODS:A retrospective review of all VHRs for liver transplant recipients from 2016 to 2024 was conducted. Baseline characteristics, operative details, and postoperative outcomes were compared between patients undergoing VHR with and without biological mesh. RESULTS:Thirty-six patients were included; 20 (55.6%) underwent repair without mesh and 16 (44.4%) with biological mesh. Hernia size was larger in the mesh cohort (11.3±5.5 vs. 7.8±4.2 cm, P =0.034). The majority underwent anterior component separation, 19.4% unilateral and 38.9% bilateral. Meshes used were Ovitex (50%), Strattice (37.5%), and FlexHD (12.5%). Placement was primarily retrorectus (50%) or intraperitoneal (37.5%). Length of stay was shorter without mesh (3.5 vs. 5 d, P =0.008). Follow-up trended toward longer in the mesh cohort. Complication rates were comparable with a trend toward fewer postoperative infections without mesh (5.0% vs. 25.0%, P =0.085). All mesh infections required reoperation, and 1 patient died from complications. Recurrence rates were comparable (no mesh 10.0% vs. mesh 12.5%, P =0.813). CONCLUSION:VHR can be safely performed without mesh in select liver transplant patients, reducing the likelihood of potentially life-threatening postoperative infections without a significant increase in recurrence rates.

BACKGROUND:Skin cell suspension autograft (SCSA) is a point-of-care approach to wound management facilitating epithelialization while reducing burden associated with conventional autografting. Despite growing clinical use of SCSA across diverse wound etiologies, the global clinical evidence describing its use has not yet been comprehensively synthesized. METHODS:A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines to identify studies between January 2000 and December 2024 reporting clinical use of SCSA for wound closure. Data on patient demographics, wound characteristics, and treatment methods were extracted. Clinical, safety, and health economic outcomes were extracted for comparative studies evaluating SCSA against control treatments. RESULTS:Ninety-nine studies across 13 countries were included. Across the overall dataset, SCSA was used alone or in combination with autografting for burns, surgical wounds, traumatic injuries, inflammatory conditions, and chronic wounds. Among comparative studies (n=27), SCSA consistently reduced donor skin, and healing outcomes favored SCSA in 61%, while 39% reported equivalent outcomes. Pain and esthetic outcomes more frequently favored SCSA, while safety outcomes were generally similar, with some studies favoring comparators. Health-economic outcomes suggested potential reductions in length of stay and resource utilization, although findings were variable across studies. CONCLUSION:The available global evidence supports SCSA as a versatile modality for supporting epidermal coverage across wound types and clinical contexts. However, the findings should be interpreted in the context of the limitations of this review, which include heterogenous study designs, variable outcome reporting, predominance of non-randomized data, and the absence of a formal quantitative analysis. Nevertheless, the demonstrated clinical and economic benefits in comparative studies reinforce the role of SCSA as an evidence-based innovation for burn and wound treatment.

BackgroundPolylactic acid membrane (PLAM) is a one-time application alloplastic skin substitute that has been utilized as an adjunct for pediatric burns for a multitude of indications. Literature has established its utility in mixed superficial and deep dermal burns, with advantages related to decreased need for procedures requiring general anesthesia and decreased overall healthcare cost (Eur Burn J 2021;3(1):1-9). Additionally, its application has been comparable in wound healing outcomes to established standard of care practices (Burns 2023;49(7):1585-1591, Wound Repair Regen 2006;14(3):321-4). Our study analyzes the impact of integrating PLAM into pediatric burn management at a single burn center. We hypothesize that the integration of PLAM into our practice would result in improved outcomes related to wound care needs, surgical efficiency, hospital length of stay, and overall wound healing. MethodsWe conducted a retrospective study of all pediatric (<18 years of age) patients with second- and third-degree burns treated at a single American Burn Association (ABA)-verified pediatric burn center from December 2019 to April 2024. All burn etiologies were included, and isolated first-degree burns were excluded. Our retrospective cohort was separated into two distinct treatment periods (pretherapy Era 1 and posttherapy Era 2) based on time before and after the introduction of PLAM at our institution (March 1, 2022). Data on patient demographics, burn characteristics, hospitalization treatments, operative details, surgical outcomes, and time to wound healing were analyzed. ResultsA total of 331 pediatric patients met the inclusion criteria. A total of 155 patients were included in our pretherapy Era 1 and 176 patients in our posttherapy Era 2. The average age was 5.6 years old, and the majority of patients were male (62.2%) and White (55.0%). Baseline characteristics between our two cohorts were comparable across age, gender, race, ethnicity, BMI, mechanism of burn, and total body surface area (TBSA) burned. The need for sedated burn care significantly decreased after the introduction of PLAM (72.9% vs 59.4%, P = 0.010), and the average number of days of sedation decreased as well (3.7 vs 2.1 days, P < 0.001). Forty-one percent of all patients underwent surgical intervention for their burns with a significant increase in the number of patients receiving surgery in the posttherapy era (32.9% vs 48.3%, P < 0.001). Additionally, time from burn to surgery shortened in Era 2 (9.1 vs 7.2 days, P < 0.001). There was a statistically significant reduction in median procedure time in Era 2 (26 vs 13 minutes, P < 0.001). Finally, we observed significant reductions in median length of hospital stay (5 vs 4 days, P = 0.004), postoperative length of stay (1 vs 0 days, P = 0.017), the need for sedated postoperative dressing changes (54.9% vs 18.8%, P < 0.001), and need for home nursing visits (51.0% vs 17.1%, P < 0.001) in Era 2. ConclusionsThe integration of PLAMs into pediatric burn management provides significant benefits. Our study highlights the decreased need for sedated burn care, improved operative efficiency, decreased time to surgical intervention, shortened hospital stays, the decreasing demand for home nursing visits, and minimized need for additional surgeries, with healing outcomes comparable to current standard of care practices. These findings suggest potential cost savings for healthcare systems, improved healthcare efficiency, and increased patient satisfaction.

BACKGROUND:The importance of adaptable and up-to-date plastic surgery graduate medical education (GME) has taken on new meaning amidst accelerating surgical innovation and increasing calls for competency-based training standards. We aimed to examine the extent to which the procedures plastic surgery residents perform, as represented in case log data, align with 2 core standardized components of plastic surgery GME: ACGME (Accreditation Council for Graduate Medical Education) minimum procedure count requirements and the PSITE (Plastic Surgery In-Service Training Examination). We also examined their alignment with procedural representation at 2 major plastic surgery meetings. METHODS:Nine categories of reconstructive and aesthetic procedures were identified. Three-year averages for the number of procedures completed in each category by residents graduating in 2019-2021 were calculated from ACGME national case log data reports. The ACGME procedure count minimum requirements were also ascertained. The titles and durations of medical programming sessions scheduled for Plastic Surgery The Meeting (PSTM) 2022 and the Plastic Surgery Research Council (PSRC) Annual Meeting 2022 were retrieved from online data. Finally, test items from the 2020 to 2022 administrations of the PSITE were retrieved. Conference sessions and test items were assigned to a single procedure category when possible. Percent differences were calculated for comparison. RESULTS:The distribution of procedures on plastic surgery resident case logs differs from those of the major mechanisms of standardization in plastic surgery GME, in-service examination content more so than ACGME requirements. Meeting content at PSTM and PSRC had the largest percent differences with case log data, with PSTM being skewed toward aesthetics and PSRC toward reconstructive head and neck surgery. DISCUSSION:The criteria and standards by which plastic surgery residents are evaluated and content at national meetings differ from the procedures they actually complete during their training. Although largely reflecting heterogeneity of the specialty, following these comparisons will likely prove useful in the continual evaluation of plastic surgery residency training, especially in the preparation of residents for the variety of training and practice settings they pursue.

Hydroxocobalamin is used for cyanide toxicity after smoke inhalation, but diagnosis is challenging. Retrospective studies have associated hydroxocobalamin with acute kidney injury (AKI). This is a retrospective analysis of patients receiving hydroxocobalamin for suspected cyanide toxicity. The primary outcome was the proportion of patients meeting predefined appropriate use criteria defined as ≥1 of the following: serum lactate ≥8 mmol/L, systolic blood pressure (SBP) <90 mmHg, new-onset seizure, cardiac arrest, or respiratory arrest. Secondary outcomes included incidence of AKI, pneumonia, resolution of initial neurologic symptoms, and in-hospital mortality. Forty-six patients were included; 35 (76%) met the primary outcome. All met appropriate use criteria due to respiratory arrest, 15 (43%) for lactate, 14 (40%) for SBP, 12 (34%) for cardiac arrest. AKI, pneumonia, and resolution of neurologic symptoms occurred in 30%, 21%, and 49% of patients, respectively. In-hospital mortality was higher in patients meeting criteria, 49% vs. 9% (95% CI 0.16, 0.64). When appropriate use criteria were modified to exclude respiratory arrest in a post-hoc analysis, differences were maintained, suggesting respiratory arrest alone is not a critical component to determine hydroxocobalamin administration. Predefined appropriate use criteria identify severely ill smoke inhalation victims and provides hydroxocobalamin treatment guidance.

Traditional measures of scholarly impact (ie, impact factor, citation rate) do not account for the role of social media in knowledge dissemination. The Altmetric Attention Score (AAS) tracks the online sharing activity of articles on platforms such as Twitter and Facebook. All 285 original scientific articles published in Journal of Burn Care & Research and Burns from January to December 2017 were obtained from official journal websites. Article characteristics extracted include AAS; number of Twitter, Facebook, and news outlet mentions; subject of study and study design; number of citations; number of authors and academic institutions; and others. The average AAS for all articles was 6.1 (SD: 48; range: 0 to 611) in which 156 (55%) of those had Twitter mentions. The mean AAS for Journal of Burn Care & Research and Burns were 7.7 (SD: 54; range: 0 to 536) and 5.3 (SD: 45; range: 0 to 611), respectively. There was a weak, positive correlation between AAS and citation count for all articles (ρ = 0.12; P = .049), and this finding was consistent for Journal of Burn Care & Research (ρ = 0.21; P = .039) and Burns (ρ = 0.15; P = .038) individually. The weak correlation between the two metrics supports that AAS and citation count capture the attention of different audiences. In addition, studies discussing skin grafting were associated with higher average AAS (β: 29 [95% CI: 4.2 to 54]; P = .022). Overall, our findings support using both AAS and traditional bibliometrics to assess article impact.

Introduction Thermal injury due to contact with engine exhaust systems represents a distinct subgroup of acute contact burns. Temperatures generated by motor vehicle, radiator, and lawn mower engines can exceed 250℃, at which point relatively deep tissue loss occurs with less than 0.06 seconds of cutaneous exposure. While prior studies have helped elucidate the demographic characteristics of exhaust pipe contact burns, our analysis was aimed at both demographics and burn severity, as indicated by rate of full-thickness injury and requirement for tangential excision and skin grafting. Methods Data were obtained from a retrospective review of admissions at a regional burn center between 1 July 2012 and 30 August 2016. Patients of all ages with muffler, exhaust, motorcycle, lawn mower, and radiator burn injuries were included. Extensive demographic information, percent total body surface area burned (TBSA), burn etiology and location, third-degree and fourth-degree burn percentage, and subsequent operative information were analyzed for patients who sustained exhaust pipe contact burns. These data were then compared with all contact burn injuries from the same time period, matched for %TBSA range, using Fisher exact and unpaired t-tests. Results A total of 110 patients suffered exhaust pipe contact burns during the study period; 65 (59%) were males, and mean age was 30. Nearly two thirds of the muffler burns were sustained from motorcycles with TBSA ranging from 0.05% to 3.14%; at least 61% had some third-degree burn. The average number of operating room visits per patient was 0.54, though this varied significantly, with 38 patients (35%) requiring 59 total surgeries (range 1–6). Muffler burn patients were older than the matched control group. The most common location of burn injury was the lower leg with no difference between adults and children. Pediatric patients understandably had smaller burn surface area but similar TBSA compared to adults. The majority of injuries occurred in May, June, and July. Conclusions Exhaust pipe contact burns comprise a specific subset of low %TBSA contact burns with relatively high morbidity, evidenced by a significantly higher proportion of full-thickness tissue loss and eventual need for skin grafting when compared with nonexhaust burn controls. Awareness of the increased severity of exhaust pipe contact burns may lead to more expedient surgical intervention as well as further education regarding preventative measures.

Thousands of people are injured in motor vehicle collisions daily and the mandated installation of airbags protects passengers but can also cause injuries from deployment including cutaneous burns. We sought to characterize the patterns and outcomes of burns resulting from airbag deployment by performing a retrospective review of all patients evaluated by the burn service from May 1, 2015 to April 30, 2019. Inclusion criteria were patients of all ages with burn injuries related to airbag deployment. Demographic data, burn characteristics, and outcomes were reviewed. Seventeen patients met the inclusion criteria: 82.4% female and 17.6% male. The average age was 40.4 years. Fifteen patients had second-degree and two had third-degree burns. The average TBSA was 0.45%. The hands or upper extremity (88%) were most often injured, but there were two chest, one neck, and one anterior thigh burns. Eight patients suffered multiple burns. Burn etiology (chemical vs thermal) was often not specified. No patients required hospitalization or surgical intervention, and all wounds healed with wound care. The average time to re-epithelialization was 11 days. Although airbags prevent mortality and serious injury, the exothermic chemical reaction that inflates the airbag is responsible for deployment-related burns. Since there is a chemical and thermal component, all airbag-related burns should undergo chemical decontamination on the initial presentation. Burns related to airbag deployment tend to be small and do not require grafting; however, patients suffer from associated pain, scarring, and burn management can be a financial and time burden to the patient.

BACKGROUND:Thermal burn scars can have catastrophic impact on the quality of life and personal image, and over time can lead to profound physical and psychological debilitation. There are no established treatments to significantly improve burn scars.OBJECTIVE:To demonstrate the safety, efficacy, and tolerability of fractionally ablative Er:YAG resurfacing of mature burn scars.METHODS:Sixteen subjects were enrolled and received 3 treatments of fractionally ablative Er:YAG resurfacing at monthly intervals. Twelve completed the study. Scars were scored with the Vancouver Scar Scale (VSS) by the patient and physician before and after treatment. Blinded photographic analysis (Visual Analog Scale [VAS]) and blinded histologic analysis of tissue before and after treatment was also performed.RESULTS:Significant Improvement in VSS scores were seen in all 12 patients, reported by patients and the evaluating physician alike. Photographic analysis demonstrated subjective improvement in all 12 patients. Histologically, there was significant improvement in collagen architecture and the number of vessels per high-power field. The treatments were tolerated well by patients, and 1 superficial skin infection occurred.CONCLUSION:Fractionally ablative Er:YAG laser resurfacing is a safe and effective modality in the treatment of thermal burn scars with subjective and objective improvement as seen from the patient and physician.

The use of home oxygen (O2) can be imperative for patients suffering from cardiopulmonary diseases; however, patients are at risk for burn injury if they continue smoking while on O2. Published data varies on patient age, TBSA, burn depth, and disposition. A 2016 study reported an inhalation injury rate of 33%, and 0.76 injuries per month. Our study aims to add additional patients to the existing literature; we postulate a higher number of injuries per month and a higher rate of inhalation injury. Though exact causes are unknown, we consider our geographic location as a contributing factor. Retrospective chart review was done at an ABA verified burn center for injuries resulting from smoking while using home O2. Included subjects were at least age 18 and had any TBSA burn. Outpatient-only individuals were excluded. Ten patients over a nine-month period were reviewed. The group was 80% male and 90% Caucasian. Average age was 64.1 years. All were accidental with 60% also suffering inhalation injuries; one of these patients suffered inhalation injury without any cutaneous burn injury. Average hospital length of stay was 8.2 days (range 1–34 days). Two patients had one day ICU stays. Mortality was 10% (1 patient), secondary to pulmonary complications and inhalation injury (TBSA was 1.46% 3rd degree burn). Overall cohort’s average 2nd degree burn TBSA was 0.549%, and average 3rd degree burn TBSA across 3 patients was 0.7%. One patient was taken to the OR for chest burn excision. There exists tremendous variability in the circumstances around smoking-related burn injuries while using home O2. Our population had a higher number of burn injuries per month (1.11 patients/month) than previously described in the literature. Given that our institution is in a colder climate, individuals may be less likely to leave their homes to smoke, possibly resulting in ignition of their clothing, homes, and/or self. Two patients fell asleep at night while smoking inside their homes. Our inhalation injury rate was higher than previously reported. Specifically, three patients had their nasal cannula catch on fire. The literature describes limited interventions, though there is a need for further investment, as all injuries in this study were preventable. While education around smoking cessation is always a must, there may be a role for monitored smoking (i.e. stopping supplemental O2 to smoke) or further injury prevention education.

In the United States, scald burns are a major source of morbidity for pediatric patients less than sixteen years of age, based on national and regional data. Kitchen-related scalds are a contributor to these rates, with use of appliances allowing for easy creation or access to high-temperature liquids and foods. Common quick sources of nourishment are instant-noodle containers. Cheap and relatively simple to prepare with access to a microwave or source of boiling water, they are a source of potential scalding. We wished to evaluate the trends and aspects associated with instant noodle scald burns among our pediatric patient population. We obtained records of all pediatric patients less than 16 years old seen at our institution from 2010 to 2018 for scald injuries. This study was approved by the UR IRB. Data related to baseline, burn, management, and outcome characteristics were isolated. We evaluated the role of burn mechanism, height and mobility on burn distribution. We distinguished between instant noodle burns and other noodle burns. We used Chi-square, Fischer exact, Wilcoxon, univariate and multivariate analyses as appropriate. A total of 1,020 patients with scald burns were identified and reviewed. 153 patients (15%) received burns from instant noodles. Hospitalization rates were not significantly different between patients with burns from other etiologies versus instant noodles (32% versus 25%, p=0.11). The overall increase in annual patient numbers was significant (p<0.001), hospitalization rates were not (p<0.11), and the annual frequency of ramen burns remained stable at 10 to 24% without significant trend. Median instant noodle-noodle associated burns of hospitalized patients was 2.36% total body surface area (TBSA, IQR 3.2%), 2.36% partial thickness (IQR 3.0%), 0% full thickness (IQR 0%), which was significantly different than medians for other scald burns (3.78%, IQR 3.98%; 3.44%, IQR 4.15%; 0.0%, IQR 0.1%, p<0.05). Median length of stay was not different (p=0.1). The most common reason for in-patient care was pain control (84%). There was no difference in operative intervention at 7.7% (p=0.12). Modelling for burn region as a function of height for independently ambulatory patients, higher distributions of burns were inversely related to height, which was significant (p<0.001), though linear model fit was poor (R-square = 0.4). In conclusion, instant noodle burns represent a persistent aspect of pediatric burn care. Intervention is required at a public health level to minimize risks of accidental injury. Epidemiologic description and risk analysis of a source of burns among pediatric patients.

Despite their difference in etiology, friction injuries and thermal burns share a similarity in treatment mechanism regarding both operative and non-operative interventions. No study to date compares these two cohorts in regard to potential differences in rates of operative requirement albeit their similarities in wound appearance and treatment modality. The primary objective of this study was to analyze and compare the operative rates of third degree friction injuries with third degree thermal burns and further explore characteristics of each injury type in relation to required treatment. A retrospective chart review was performed for all patients who sustained burn or friction injuries evaluated by our team from July 2010 to March 2017. Patients included in the study were those with third degree or full thickness injuries of known mechanism. The thermal burn group was further split into three smaller cohorts based on burn mechanism and categorized as either contact, scald, or flame related in nature. Pertinent data collected included mechanism of injury, total body surface area (TBSA) of full thickness burn, date of injury, date of presentation, and date of operative intervention if applicable. 1,658 patients met inclusion criteria with a breakdown of 82.3% thermal burns and 17.7% friction injuries. Rate of operative intervention revealed 46.5% of patients who sustained third degree thermal burns required surgical treatment which proved significantly greater than that of the friction injury group whose surgical rate was 35.9% (p= .005). Additionally, there were higher operative rates of scald, contact, and flame burns when individually compared to friction injuries, p vales equaling .02, .0001, and .0001 respectively. Further analysis of TBSA revealed no size difference between thermal and non-thermal injuries (p=.112). Our study demonstrates that third degree friction wounds appear to require operative intervention less frequently than third degree thermal burns despite identical wound care regimens and no significant difference in TBSA. Although there are many similarities between these two patient populations our findings may suggest differences in wound characteristics or healing properties of non-thermal injuries. This is the most comprehensive review of friction injuries in the literature to our knowledge. This study leads us to examine this population more closely as it appears that the rate of healing with wound care alone may be higher than expected when compared to similar thermal wounds. With this information, we are better able to predict healing patterns of friction wounds, potentially sparing patients unnecessary risks associated with surgical intervention.

In the US, the incidence of burn injury is > 2 million cases/year. A significant amount of burn related morbidity and mortality is due in part to immune dysfunction and wound healing complications which leads to increased risks of infection, coagulopathy, multi-organ failure, and sepsis. We conducted a prospective observational study of burn patients (≥18y). Citrated samples were collected at patient presentation. Whole blood aggregation (WBAgg) studies were performed immediately. TEGs were ordered as clinically indicated. Additional samples were collected at days 3, 7, 10, 14, 21, and 28, processed immediately, and plasma was kept frozen at -80oC until analysis. Samples were studied for microRNA, cytokines/chemokines, coagulation factors, and microparticles (MPs) concentration and identity. 57 patients have been enrolled in this study. The majority of patients had burns caused by flame exposure. The mean (± SD) age of patients was 47±16 and 70% were male. The mean total body surface area (TBSA) burn was 9.7±9.5% (range 0.3-76.0%). Most patients had abnormal WBAgg in response to ADP, collagen, and arachidonic acid. This was very obvious even in patients with as little as 1% TBSA. Significant increase in platelet counts were detected over the 28 days follow up. Most TEG tracings were normal or had shortened R times indicating hypercoagulable state. Higher TBSA% were associated with increased MP concentrations. Decreased IL-1α and IL-7 and increased IL-10, MCP-1 and IL-1RA levels at presentation were also seen with higher TBSA% (p<0.05). IL-8 levels were increased for up to 14 days in higher TBSA%. Interestingly, xenografting was associated with decreased levels of IP-10, MDC, IL-10, and MCP-1. Lastly, subjects who developed infections were found to have higher levels of IL-1RA and IL-8 for up to 14 days (p<0.05). This is one of the first prospective burn studies evaluating coagulopathy and platelet function at time of presentation. The reason for decreased platelet activity in burn patients is unclear and further studies are ongoing. One theory is that the platelets may degranulate as a response to the acute phase reaction. This may produce higher percentage of platelet microparticles, which contribute to the hypercoagulable state that has been observed by others and by our TEG studies. Further analysis is undergoing to identifying MPs type. The levels of chemokines and cytokines changes is consistent with published data. Early xenografting was associated with reduced inflammation. Finally, levels of certain cytokines may predict or herald subsequent development of infection. To better understand the immune dysfunction that occurs in burn patients and to reduce the concomitant morbidity and mortality.

Negative pressure wound therapy (NPWT) over complex wounds can control exudate, decrease infections, and improve revascularization. Previous studies have already shown NPWT is safe, efficacious, and cost-effective in the burn surgery population. However, no study specifically addresses differences in outcomes between meshed and non-meshed skin grafts dressed with NPWT. Our study aims to characterize patient outcomes with respect to two groups: meshed and non-meshed autologous skin grafts. Patients undergoing autologous skin grafting with or without a NPWT dressing for any burn injury over a nine-month period were included. Xenografts and Allografts were excluded. Through retrospective chart review, the following were assessed: burn etiology, use of NPWT, graft take and size, meshed or non-meshed, seroma incidence, and length of hospital. Our study included 122 patients (who underwent 324 split thickness skin grafts) and consisted of 57% males, 57% Caucasian, and an average age of 41. Burn injury etiologies consisted of scald (55%), chemical (25%), flame (15%), and contact (5%). Average 2nd degree TBSA in our cohort was 2.34%, 3rd degree TBSA 4.50%, and total TBSA 5.35%. 100% patients received a split-thickness skin graft (STSG), with an average graft size of 120.5 cm2. There was 100% graft take and 0% seroma formation in all patients. Of STSGs, 38% received a NPWT dressing. Those with the dressing had an average LOS of 14.8 days, whereas those without the NPWT dressing had an average LOS of 13.8 days. Of those with a STSG, 66.7% were non-meshed and these patients had an average LOS of 11.7 days versus 33.3% meshed with an average LOS of 13.8 days. There were no significant differences in LOS when stratified by TBSA and graft size. There exist many options for dressings after repair of burn injuries, each with its own unique advantages. Using a NPWT over a STSG, and using a meshed graft resulted in a slightly longer LOS than their respective counterparts in our study. There were, however, no differences in graft take in using a NPWT dressing. Some surgeons may be hesitant in using a NPWT dressing over a non-meshed graft because it may be more difficult to extract any residual fluid, but our data shows that there is no increased seroma rate by this method.

Split-thickness skin-grafts are a mainstay of burn management. Studies suggest no benefit to using thick (0.025 inch) over standard (0.012-0.020 inch) grafts, and some support the use of thin (0.008 inch) over standard thickness. Data on the use of even thinner grafts is scarce. This study reviewed outcomes of burn patients treated with thin (0.008-0.011 inch) and ultra-thin (<= 0.007 inch) grafts. Retrospective review of records from July 2012 to June 2016 included patients who sustained operative burns treated by a single surgeon. Patients were excluded for nonoperative injuries, inhalational injuries, or prolonged hospitalizations. Outcome measures were compared between thin and ultra-thin groups. One-hundred twenty-eight patients met inclusion criteria; 35 received thin split-thickness skin-grafts while 93 received ultra-thin. Cohort analysis demonstrated equivalent graft-take, time to reepithelialization, and functional outcomes. Time to donor-site healing was significantly faster in the ultra-thin cohort (P = .04). Of those with functional outcomes recorded, 88.1% had good-excellent function and 11.9% retained a limitation in function as designated in physical therapy notes. There were fewer complications overall (P = .004) and a lower incidence of hypertrophic scarring (P .025) in the ultra-thin cohort. This study presents a single-surgeon experience with thin and ultra-thin split-thickness skin-grafts. These grafts are exhibit excellent graft-take and few complications. There was no correlation between thickness and functional outcome at the time of physical therapy discharge. Donor-site reepithelialization was faster with ultra-thin grafts, which may be important in patients with large burns and limited donor sites.

Burn injuries are at high risk for infection due to increased length-of-stay (LOS), immunocompromisation from injury, and use of broad-spectrum antibiotics. Burn wound infection (BWI) is a leading complication with rates of 2–39%, and infection is the principle cause of death and morbidity after injury. Our study aims to demonstrate the nosocomial BWI rate at a major verified burn center and describe the attendant wound care protocol. Retrospective review of patients admitted to the burn inpatient service from 7/1/2015–6/30/2017. Nosocomial BWI was defined as cellulitis, impetigo, invasive infection, or surgical site infection after hospitalization for ≥ 48 hours. Patients admitted < 48 hours or without burn injury were excluded. All BWI were diagnosed clinically by an attending burn surgeon. Wound care was consistent amongst all burn patients. At presentation all burn wounds received washing with chlorhexidine and mechanical and/or sharp debridement to remove nonviable tissue and unroof blisters. The burn was then rinsed with sterile saline, patted dry, covered with bacitracin/polymyxin B and Xeroform, and dressed. Facial burns were covered with petroleum jelly and left undressed. This protocol was followed daily with emphasis on biofilm removal during chlorhexidine wash and mechanical debridement as needed. A total of 507 patients met inclusion criteria - 36.7% female, 63.3% male. Average age at admission was of 32.17 ± 23.67 years. Majority of patients identified as Caucasian (70.6%) or Black (21.3%). Comorbidities were noted in 168 patients. Most common: smoking (122); hypertension requiring medication (41); respiratory disease (32); diabetes mellitus (32); and drug dependence (33). Average LOS was 8.60 ± 10.28 days. Sixty-four patients were admitted to the ICU for an average LOS 7.75 ± 9.44 days and 24 were intubated. Eight patients died in the hospital. Thermal (81.1%) and friction (14.0%) burns were most common. Second-degree burns were noted on 461 patients with average TBSA 4.48% ± 6.05%; 267 patients had 3rd-degree burns with average TBSA 2.61% ± 8.24%; and 46 patients had inhalation injury. Average combined TBSA was 5.67% ± 9.09%. A total of 727 procedures were performed on 159 patients in 306 trips to the OR. Zero BWI were diagnosed. There were 8 UTIs, 4 pneumonias, 2 catheter-related bloodstream infections, and 1 C. Diff. colitis. BWI after injury remains a common and potentially devastating complication. However, through the employment of daily wound care - with special emphasis on removal of biofilms and nonviable tissue - nosocomial BWI can be eliminated. Nosocomial BWI is a preventable complication and our study demonstrates that with our daily wound care protocol this complication can be eradicated.

Objective: The objective was to study and describe the presenting patient characteristics for those with chemical burns acquired from hair removal beauty products. Methods: Retrospective single-center chart review was done to identify all burn injuries caused by the use of depilatory cream use. Results: A total of seven patients who acquired burn injuries due to depilatory cream use were identified. Six were female and one was male. Patients' age ranged from 3 to 43 years, with a mean age of 27.2 years. Total body surface area of the burns ranged from 0.18% to 0.79% including first- and second-degree burns; none of the patients acquired third-degree burns. Most of the injuries involved groin and pubic area. All patients were treated with wound care, and none required inpatient care. All of the patients who presented to follow-up visits showed re-epithelialization and good healing. Conclusion: Depilatory cream is a corrosive chemical hair removal agent that can lead to unintended chemical burns if used improperly. Burn-care provider, as well as other health-care providers, should be aware of this unusual cause of chemical burn and educate their patients appropriately.

Ceramic and metal hair straightening and curling irons are common household items which reach up to 450°F in as little as five seconds. Of particular concern is the threat these devices pose to children. Our objective is to characterize and bring attention to this preventable injury in the pediatric population. Retrospective records from a high-volume level I trauma center and regional burn center from 2011-2015 were analyzed. Inclusion criteria were defined as patients <11 years of age, as those presenting with burns above this age were more likely to be utilizing the tools for hair styling. A total of 59 patients were identified with an average age of 2.4 years. The average burn size was 0.30%, with an average 0.24% 2nd degree TBSA. The etiology of the burns included touching a hair iron that was within reach (61%), pulling a hair iron's power cord (15%), stepping/rolling/jumping onto a hair iron left on the ground (17%), and hair irons falling (7%). The majority of households were comprised of unemployed (64%), single (60%) parents. CPS consult was required for 20% of patients. Grafting and excision was necessary for 20% of patients The pediatric population is at risk for accidental burns with household hair irons. These burns typically have a small TBSA, but may require excision and grafting and extended follow-up.