Evaluation of EpiProtect® microbial cellulose burns dressings in young children.

INTRODUCTION: EpiProtect® is a biosynthetic cellulose dressing indicated for the treatment of superficial burns and the dressing of deep burns. Prior to this study the youngest reported patient treated with EpiProtect® was aged 13 years. METHOD: Data were collected prospectively for patients aged < 5 years, presenting to the Children's Burns Unit with ⩾ 2% total body surface area (TBSA) burns sustained by any mechanism. RESULTS: Thirty children were treated (median age = 17 months, age range = 1-61 months). Thirty-six burn depths were documented: superficial partial thickness (SPT) in 53% (n=19); mid-partial thickness (MPT) in 33% (n=12); deep partial thickness (DPT) in 11% (n=4); and full thickness (FT) in 3% (n=1). Median burn size was 4.5% TBSA (range = 2%-12%). EpiProtect® was applied under general anaesthesia in all cases. The median length of stay (LOS) was two days (range = 0-6 days). EpiProtect® was tolerated well and provided effective analgesia for subsequent dressing changes. Median healing time was 13 days (SPT burns), 14 days (MPT) and 24 days (DPT burns). Three patients required split skin grafting. Hypertrophic scarring arose in one patient. DISCUSSION: This case series represents the youngest published patient group to have been treated with EpiProtect®. Authors conclude that EpiProtect® provides a safe, reliable and well-tolerated dressing option for all burn depths in young children. Importantly, EpiProtect® is culturally neutral and may be used in situations which, for cultural reasons, may preclude the use of animal-derived products. Further studies are warranted to evaluate pain scores, burn depth, size and LOS correlation, and comparative analysis between dressing types. LAY SUMMARY: Burn injuries in the paediatric population are common and often require multiple dressing changes. Dressing changes can be painful and distressing to both children and their care givers. This article describes the experience of using a synthetically derived burns dressing, called EpiProtect®, in children aged ⩽ 5 years. Thirty patients were recruited with varying depths of scald burns and all underwent application of EpiProtect® dressing. The results suggested that EpiProtect® was a user-friendly dressing that can be used to treat partial-thickness burns and to dress full-thickness (FT) burns. It was well-tolerated and provided effective analgesia at the time of dressing changes. There was no incidence of increased burn wound infection rates and all wounds healed. In addition, as EpiProtect® is a synthetic product, it has the benefit of being culturally neutral, which is advantageous in a culturally diverse population. Further studies are warranted to evaluate the effectiveness of this dressing and to compare it to similar dressings that are available.

Successful treatment of mixed depth flame burns using enzymatic debridement with Nexobrid™ in a patient with aggressive systemic sclerosis (scleroderma).

INTRODUCTION: Enzymatic debridement for mixed depth and full thickness burns is gaining recognition as an important technique available to the burns surgeon. Reductions in blood loss, the need for autologous skin grafting and the number of wounds requiring surgical excision are among the benefits of this evolving treatment modality. We present a case of successful treatment using enzymatic debridement of mixed depth flame burns in a young patient with systemic sclerosis (scleroderma). METHODS: A 24-year-old man with rapidly progressive limited cutaneous systemic sclerosis suffered approximately 6% mixed depth flame burns to the right leg including areas of likely deep partial thickness burn totalling approximately 2% total body surface area (TBSA). Enzymatic debridement using Nexobrid™ was performed under spinal anaesthesia in accordance with unit protocol. Pain was well controlled and at 4 h the Nexobrid™ was removed and replaced with saline-soaked gauze initially then simple dressings. After liaison with Rheumatology, he was also started on iloprost infusions over five days. He was discharged home on day 9 and completely healed by day 31. Scarring was minimal, the skin was soft and full, and pain-free range of movement of the right knee was maintained. DISCUSSION AND CONCLUSION: This case demonstrates the safety and effectiveness of enzymatic debridement of mixed depth burns in a patient with very compromised wound healing. Enzymatic debridement combined with iloprost infusion provided maximum preservation of viable dermis. The authors recommend that this treatment strategy is considered in similar cases.

Y-Peg-in-a-Round-Hole Closure for Immediate Periareolar Mastectomy Expander Reconstruction.

INTRODUCTION: Mastectomies closed with a linear scar can distort the resulting shape of the breast. We present our novel Y-peg-in-a-round-hole closure method of the mastectomy scar, which improves the shape of the reconstructed breast while maintaining reliable healing, implant coverage, and minimum scar size for covering by tattoo. MATERIALS AND METHODS: A retrospective review of all breast reconstruction cases performed by the senior surgeon during the period from January 2010 to January 2017 was undertaken. Data were analyzed for wound healing problems, infection rates and mastectomy skin flap necrosis. RESULTS: Data were extracted for 126 consecutive patients with 154 breast reconstructions. Twelve breasts (7.7%) experienced wound healing problems, for which 7 (4.5%) required revisionary surgery. Eighteen breasts (11.7%) developed an infection requiring antibiotics, of which 8 (5.2%) needed a further operation. Four breasts (2.6%) needed removal of the implant. No patients were lost to follow-up. CONCLUSION: After nipple resecting mastectomy, the Y-peg-in-a-round-hole scar minimizes radial size and contour deformity but allows for reliable wound healing.

Chemical burns: Diphoterine untangled.

OBJECTIVE: Diphoterine is a hypertonic, amphoteric, polyvalent and chelating decontamination solution used in the treatment of cutaneous and ocular chemical burns. Due to infrequent use by emergency physicians along with the small number of available studies, its debate in the literature as to its efficacy and safety remains inconclusive. METHODS: A structured literature search was performed in MEDLINE, EMBASE BIOLOGICAL ABSTRACTS and TOXNET to June 2016 for original English-language studies reporting on the safety and effectiveness of Diphoterine. Methodological and reporting quality of pre-clinical animal studies was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk of bias tool and Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. Clinical studies were assessed using Chambers' criteria. RESULTS: 13 studies (seven in the pre-clinical, five in the clinical setting and one mixed) met the study inclusion criteria. Pre-clinical studies showed a faster resolution of pH and reduced tissue necrosis with Diphoterine. Clinical studies showed reduced tissue necrosis/severity of symptoms, faster pH resolution and a reduction in pain when using Diphoterine. No adverse events were attributable to Diphoterine. Reporting and methodology of the studies was poor or showed a high risk of bias. CONCLUSIONS: Diphoterine appears to be safe to use and is probably superior to other rinsing solutions. However, immediate decontamination is imperative and if Diphoterine is not available a different rinsing solution should be used. The methodology of the published literature for Diphoterine is generally poor and future publications should use the frameworks given as templates.

A morphometric study of the human ear.

AIMS: We examined variations in the shape of the human ear according to age, sex and ethnic group with particular attention to ear prominence. METHODS: 420 volunteers were recruited. Measurements included; head height and length, ear height and axis, antihelix taken off angle, earlobe length and width, ear width at the helical root and tragus. Prominence was measured at the helical root and tragus (conchomastoid angle, conchal bowl depth and helical-mastoid distance). RESULTS: Good symmetry was shown for all measurements. Ethnically Indian volunteers had the largest ears (both length and width), followed by Caucasians, and Afro-Caribbeans. This trend was significant in males (p<0.001), but not significant in females (p=0.087). Ears increased in size throughout life. Subjectively, only 2% of volunteers felt their ears were prominent compared to 10% in the opinion of the principal investigator. No objective measurements were identified that accurately predicted subjective perceptions of prominence. CONCLUSIONS: We found consistent trends in ear morphology depending on ethnic group, age and sex. Our study was unable to define an objective method for assessing ear prominence. Decisions about what constitutes a prominent ear should be left to personal and aesthetic choice.