Burn-Induced Acute Kidney Injury-Two-Lane Road: From Molecular to Clinical Aspects.

Severe burn injuries lead to acute kidney injury (AKI) development, increasing the mortality risk up to 28-100%. In addition, there is an increase in hospitalization days and complications appearance. Various factors are responsible for acute or late AKI debut, like hypovolemia, important inflammatory response, excessive load of denatured proteins, sepsis, and severe organic dysfunction. The main measure to improve the prognosis of these patients is rapidly recognizing this condition and reversing the underlying events. For this reason, different renal biomarkers have been studied over the years for early identification of burn-induced AKI, like neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase-2 (TIMP-2), interleukin-18 (IL-18), and insulin-like growth factor-binding protein 7 (IGFBP7). The fundamental purpose of these studies is to find a way to recognize and prevent acute renal injury progression early in order to decrease the risk of mortality and chronic kidney disease (CKD) onset.

Unusual pattern of partial failure of preexpanded free parascapular flap for neck reconstruction.

The present article focuses on a relatively rare condition of a partial necrosis of free microvascular flap in a patient with severe postburn contracture of the neck region, subjected to reconstructive microsurgery. Reconstructive microsurgical staged procedure was undertaken to correct the scar contracture and restore the aesthetic unit. Substantial partial flap necrosis, requiring secondary surgery, was observed in the early postoperative period. Surprisingly only the distal 1/3 of the skin island of the parascapular flap survived. Final reconstruction of the neck reconstruction was accomplished by means of full thickness skin graft over the area of partially necrotic flap. Good final result was achieved. Overall treatment course is discussed in the light of the current trends.