The periareolar excision technique for improved scars in breast burns

Regardless of size or severity, post-burn breast scars can be traumatic for patients. There are various approaches to post-burn scar management, but herein we present the results of a novel approach in which we tried to remove the scars in an early stage of treatment. Breast burn patients, whose wound area included the nipple-areolar complex, were treated using a periareolar incision design similar to that of periareolar reduction mammoplasty. The remnant scar was located only along the periareolar complex. As a result, more cosmetically satisfactory results were achieved compared to skin grafting or local flap procedures.

Curative effect of autologous blister skin grafting on cicatricial depigmentation caused by deep burn / 局解手术学杂志

Objective To compare the treatment effect of autologous blister skin grafting with ReCell autologous chromocyte grafting on cicatricial depigmentation caused by deep burn.Methods Thirty-four patients with cicatricial depigmentation caused by deep burn who were admitted into hospital from May 2012 to February 2015 were included in this study.The total 61 depigmentation areas were randomly divided into two groups;32 areas from 18 patients were treated with autologous blister skin grafting,and the other 29 areas from 16 patients were trea-ted with ReCell autologous chromocyte grafting.In the autologous blister skin grafting treated group,epidermis from the depigmentation area was removed by grinding with a BY-II AM type epidermal graft vitiligo treatment equipment.Then the autologous blister skin was harvested with the suction blistering method and grafted onto the wound of depigmentation area.In the ReCell autologous chromocyte grafting treated group,split-thickness skin flap was harvested by electric dermatome.Then the donor skin was processed into chromocyte suspension with the ReCell assay kit and evenly sprayed onto the depigmentation areas.The wound healing time and the pigment recovery 3 months after surgery were observed.Results The wound healing time of autologous blister skin grafting treated group was significantly shorter than that of ReCell autologous chromocyte grafting treated group (P <0.05 ).The effective rate of pigment recovery 3 months after surgery in autologous blister skin grafting treated group was markedly higher than that of ReCell autologous chromocyte grafting treated group(P <0.05 ). Conclusion The autologous epidermal grafting treatment using grinding and suction blistering method is simple and easy to perform,marked-ly effective,with no suture scar and low surgical risk,thus serving as a promising and ideal therapeutic method for burn scar depigmentation.

Comparison of effectiveness between micro-plasma technology and 2940 nm Er ∶ YAG laser in treatment of burn scar / 中华医学美学美容杂志

Objective To compare the effectiveness,indications and side effect between microplasma technology (MPT) and 2940 nm Er ∶ YAG laser for treatment of burn scar.Methods 265 patients with hypertrophic scar were treated with MPT (MPT group,N=136) and Er ∶ YAG laser (Er ∶ YAG laser group,N=129).The patients were treated 2-6 times.Results The significant response rate was 73.52 ％ and 44.95 ％ in MPT group and Er ∶ YAG laser group; the cure rate was 28.67 ％ and 15.50 ％ in MPT group and Er ∶ YAG group,respectively.There was no statistically significant difference between two groups (P＞0.05).For moderate burn scar patients (93 cases),the significant response rate was 62.79 ％ and 10.00 ％ in MPT group and Er ∶ YAG laser group,respectively.There was significant difference between two groups (P＜0.05).Conclusions MPT and Er ∶ YAG laser has been proven to be effective and safe for the treatment of burn scar.The effectiveness of MPT is superior to Er ∶ YAG laser in treatment of moderate burn scar.

An implant-supported removable partial denture for a patient with post-inflammatory scar contracture caused by burn complications: a clinical report

The scars and contracture around the oral-facial region may cause difficulty in prosthodontic treatment to restore esthetics and function for the patients, who suffered severe burns. This article presents a technique that uses a fixed partial denture prepared with a conventional milling technique and an attachment to support anterior cantilever removable partial denture, thereby providing a more esthetically acceptable and functional result.

An implant-supported removable partial denture for a patient with post-inflammatory scar contracture caused by burn complications: a clinical report

The scars and contracture around the oral-facial region may cause difficulty in prosthodontic treatment to restore esthetics and function for the patients, who suffered severe burns. This article presents a technique that uses a fixed partial denture prepared with a conventional milling technique and an attachment to support anterior cantilever removable partial denture, thereby providing a more esthetically acceptable and functional result.

C-arm Guided Surgical Excision of Heterotopic Calcification

PURPOSE: Heterotopic calcification is the abnormal deposition of calcium salts in tissues other than bone and enamel, and it occurs in the form of dystrophic calcification or metastatic calcification. This deposition can occur under many conditions, but in some rare cases, it may develop in burns and nonhealed scars. It is difficult to treat the combination of heterotopic calcification and ulceration in scar tissues by using conservative therapy and to determine the margin of excision in such cases. Our study proposes the use of intraoperative C-arm-guided mapping of lesions with heterotopic calcification, and adequate excision of ulcers in chronic scars where heterotopic calcification is also observed. METHODS: This study included 2 patients and was conducted from January 2010 to July 2010. The first patient was a 63-year-old woman who presented with atypical calcium deposits and chronic ulceration in the lower one-third region of the right leg. The second patient was a 38-year-old man who presented with a nonhealing ulcer that had developed on the right leg 3 months earlier he had a history of 40% scalding burns on the entire body. Surgery is the most reliable method for treating heterotopic calcification therefore, both patients were treated using intraoperative C-arm-guided marginal mapping of heterotopic calcification, followed by release of contracture, and eventually split-thickness skin grafting. RESULTS: Plain radiographs of the leg showed spotty radiopaque areas in the hard part of the scar well superficial to the underlying bones. Histopathological analysis revealed multiple foci of calcified deposits, increased fibrosis, and inflammation in the scar tissue. Surgery-related complications were not observed. CONCLUSION: C-arm guided excision of calcified scars and the release of contracture can cure nonhealing ulcers and may therefore prevent recalcification.

Effectiveness of Thick Acellular Dermal Matrix (Allocover(R)) in Burn and Burn Scar Contracture

PURPOSE: To treat burn and burn scar contracture, many types of dermal substitutes have been manufactured and used recently. Allogenic dermis is known to have best cellular affinity to the host, but it is the thinnest product among artificial dermis. Processed thick allogenic dermis (Allocover(R)) has been developed and applied to overcome the problems of preexisting materials as a permanent dermal substitute. METHODS: From June 2007 to May 2009, we have grafted thick acellular human dermal allograft with thin split-thickness skin graft on burn wound and burn scar contracture of feet and legs in 14 patients who had hypertrophic scar, joint contracture and various skin defect areas. Intraoperatively, we fixed spilt thickness skin graft to artificial dermis with suture fixation for avoiding the mobilization between them. RESULTS: Thirteen patients out of 14 patients had no problem. One patient underwent partial skin loss and secondary healing process. During the 18 months of follow up period, no contracture recurrence or skin loss was observed. CONCLUSION: The thick acellular human dermal allograft (Allocover(R)) could be very useful in the management of skin loss and burn scar contractures. Its vascularization has occurred fast enough that wounds can be covered in an adequate layer of dermal augmentation with minimal contracture and good cosmetic results.

Reconstruction of Burn Scar Contracture with Split-Thickness Skin Graft Taken from the Scalp and Alloderm(R): Case Report

A 13 year old male patient had limitation of foot motion due to burn scar contracture on right ankle area. The scar contracture was released and Alloderm(R) was applied over the raw surface. Split thickness skin was harvested from the scalp and harvested skin was applied over Alloderm(R). Epithelialization of donor site began from the post-op 5th day. Graft was well taken without any problem. There was no complications during 6 months of follow-up period.

Island scapular flap based on transverse branch of circumflex scapular artery for axillary burn scar contracture / 中华医学美学美容杂志

Objective Island scapular flap (ISF) based on transverse branch of circumflex scapular artery is less reported than ISF based on ascending or descending branch. This article presented authors' experiences in correction of severe axillary burn scar contracture with ISF based transverse branch of circumflex scapular artery. Methods ISFs based transverse branch was harvested in 12 patients with 15 severe axillary burn scar contracture, rotating an arc of about 180°. Flap size was between 12 cm× 5cm to 20 cm × 10 cm. The donor site was closed primarily. Results All 15 flaps survived completely and axillary burn scar contracture was corrected successfully. 8 patients were satisfied with both the functional and aesthetic results after 1-3 years' follow-up. Conclusion ISF based transverse branch of circumflex scapular artery is a good choice for reconstruction of severe axillary burn scar contracture, especially for female patients or ones whose ISF based on ascending or descending branch could not be harvested because of formation of hypertrophic scar in donor site.

Treatment of Heterotopic Calcification with Ulceration in Burn Scar

PURPOSE: Heterotopic calcification is a pathological event in which deposits of calcium salts build up, usually in the joint area or soft tissues. It can occur under many conditions and in some rare cases may develop in burn scars. In particular, ulcerations in burn scars accompanied by heterotopic calcification are difficult to treat through conservative treatment. This study reports methods for accurate diagnosis and adequate treatment of ulceration in burn scars accompanied by heterotopic calcification. METHODS: Fourteen patients who visited our hospital from March 2008 to January 2010 were subjected to this study. Their sex, age, modes of burn, degree, TBSA(%), ulcerated area, the time of occurrence of the ulcerations in the burn scars were investigated. In addition, radiological examination and biopsy was performed to diagnose heterotopic calcification. RESULTS: Among the 14 cases, 6 were male and 8 were female. The average age of the patients was 48.2(27-69 yrs). As for the mode of burn, 11 were flame burns and 3 were scalding burns. The average time of occurrence of the ulcerations in the burn scars was 4.5 months. The ulcerated areas were situated in the legs in 12 cases, arms in 1 case, and torso in 1 case. The diagnosis was confirmed through X-ray and biopsy, and skin graft was performed after wide excision. CONCLUSION: Diagnosis of the ulceration in burn scars accompanied by heterotopic calcification is possible through radiological and pathologic studies. Surgical treatment is the most reliable method of treatment, and we chose to perform skin graft after wide excision. Also, we learned that the complete removal of the calcified tissue and the inflammatory fibrotic tissues is crucial in preventing recurrence. Also, in contrast to Marjolin's ulcer, heterotopic calcification had a small size, little or no granulation tissue, and lacked fungating type ulceration. Therefore, favorable prognosis could be achieved through adequate treatment.

Acceleration of Integra Incorporation in Reconstruction of Burn Scar Contracture with the Vacuum-Assisted Closure(VAC)

PURPOSE: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study is to evaluate usefulness of the VAC(Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra(R) in reconstruction of burn scar contracture. METHODS: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The patient's ages ranged from 5 to 27 with an average of 19.7 years. The surface area ranged from 24 to 1,600cm2 with an average of 785cm2. The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra(R) was sutured in place with skin staple and Steri-strip(R). Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra(R). Negative-Pressure ranging from 100 to 125mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP-site(R). The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra(R) deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006-0.008 inches) was performed after silicone sheet removal. RESULT: The mean time for clinically assessed incorporation of Integra(R) was 10.00 days(range 9-12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra(R) had successful incorporation in tissue without serious complications. CONCLUSION: Integra(R) in combination with Vacuum- Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.

The Facial Tissue Expansion to Achieve the Natural Cervicomental Angle

PURPOSE: Wide scars occurring on the lower face and neck cause both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. METHODS: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil(R) tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule formed by the tissue expander was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst(R) facial garment in order to stabilize the operation site at least twelve months. RESULTS: The most prevalent location of the scar was the cheek(15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was 55.7+/- 39.4cm2. CONCLUSION: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

Dermatofibrosarcoma Protuberans Arising froma Burn Scar

Malignant neoplasms arising in burn scars are well known. In previous literature, 25 cases of burn scar sarcomas were reported. However, dermatofibrosarcoma protuberans is very rare and only two cases have been reported. A 43-year-old Korean man presented with multiple erythematous clustered plaques and nodules and a skin-colored subcutaneous mass on the chest after a severe burn injury at the age of 8 years. A biopsy specimen revealed dermatofibrosarcoma protuberans. The tumor was excised widely to include the surrounding burn scar. Herein, we report this third case of dermatofibrosarcoma protuberans arising from a burn scar.

Múltiplos melanomas malignos em área de cicatriz de queimadura: relato de caso e revisão da literatura / Multiple malignant melanomas at burn scar: case report and review of the literature'

Alterações neoplásicas malignas podem ocorrer em aproximadamente 2 por cento dos casos de cicatrizes de queimaduras. As lesões neoplásicas se apresentam mais freqüentemente como carcinoma espinocelular. Neste artigo descreve-se o caso de uma paciente do sexo feminino, na sexta década de vida, com melanomas malignos múltiplos que se desenvolveram em uma antiga área de cicatriz de queimadura no tronco. Melanomas malignos múltiplos que se desenvolvem em região de cicatriz de queimadura são extremamente raros, e apenas quatro casos foram descritos na literatura até o presente momento.

Malignant changes in burn scars can develop in approximately 2 percent of patients. The majority of these lesions are squamous cell carcinomas. In this article we present the case of a female patient, in the sixth decade, with multiple melanomas arising in the setting of an extensive old truncal burn scar. Multiple malignant melanomas arising in a burn scar are extremely uncommon and only four previous cases have been described in literature.

A Case of Malignant Fibrous Histiocytoma Developing in a Burn Scar / 대한피부과학회지

Burn scar can give rise to different types of malignant tumors, and malignant fibrous histiocytoma (MFH) is very rare among these different tumors. We herein report on a rare case of MFH that developed on the burn scar. A 58-year-old male patient who had been scalded on the chest and abdomen at the age of 8 years was hospitalized with exudative ulcer in the scar area. He was diagnosed with MFH and then he underwent wide excision and flap coverage. No sign of metastatic recurrence was noted during the 6 month follow-up period.

Correction of Burn Scar Contracture: Indication and Choice of Free Flap

PURPOSE: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures METHODS: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. RESULTS: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. CONCLUSION: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.

Preserved Superficial Fat Skin Composite Graft for Correction of Burn Scar Contracture of Hand

PURPOSE: Split or full thickness skin graft is generally used to reconstruct the palmar skin and soft tissue defect after release of burn scar flexion contracture of hand. As a way to overcome and improve aesthetic and functional problems, the authors used the preserved superficial fat skin(PSFS) composite graft for correction of burn scar contracture of hand. METHODS: From December of 2001 to July of 2007, thirty patients with burn scar contracture of hand were corrected. The palmar skin and soft tissue defect after release of burn scar contracture was reconstructed with the PSFS composite graft harvested from medial foot or below lateral and medial malleolus, with a preserved superficial fat layer. To promote take of the PSFS composite graft, a foam and polyurethane film dressing was used to maintain the moisture environment and Kirschner wire was inserted for immobilization. Before and after the surgery, a range of motion was measured by graduator. Using a chromameter, skin color difference between the PSFS composite graft and surrounding normal skin was measured and compared with full thickness skin graft from groin. RESULTS: In all cases, the PSFS composite graft was well taken without necrosis, although the graft was as big as 330mm2(mean 150mm2). Contracture of hand was completely corrected without recurrence. The PSFS composite graft showed more correlations and harmonies with surrounding normal skin and less pigmentation than full thickness skin graft. Donor site scar was also obscure. CONCLUSION: The PSFS composite graft should be considered as a useful option for correction of burn scar flexion contracture of hand.

Management of the Hyperplastic Scar and Contracture after Burn(review) / 中国康复理论与实践

@#Hyperplastic scar and contracture are two mainly respects that contribute to poor functional recovery of the patients after burn.The principles of prevention and management of the scar were reviewed in the article and the methods in facilitating functional recovery were also discussed as well.

A Cases of Bowen's Disease Arising in an Old Burn Scar / 대한피부과학회지

It is known that Bowen's disease is a representative precancerous lesion of squamous cell carcinoma, along with actinic keratosis. Chronic sun-exposure and arsenism are main causes of Bowen's disease. Also trauma, radiation, and viral infection are associated. Up to now, it is not yet reported that burn scar can induce Bowen's disease. We report an unusual case of Bowen s disease, which arose in an old burn scar.

A Case of Dystrophic Calcinosis Cutis in a burn scar / 대한피부과학회지

Calcinosis cutis is the deposition of insoluble calcium salts in the skin. Dystrophic calcinosis cutis is diagnosed when calcium is deposited in the previous damaged tissue and the values of calcium and phosphorus levels are normal. We report a case of dystrophic calcinosis cutis in a 32-year-old man. He had experienced a burn accidentally on the left anterior thigh at 2 years old. About 1 year ago, an ulcer developed on the burn scar. He found the chalky material in an ulcer and removed it, then the ulcer healed. But, new ulcers developed in a linear pattern. Histopathologically, amorphous eosinophilic materials that were black with Von Kossa stain were deposited in the dermis.