[Lyell's disease--a case report]. / Lyelluv syndrom.

Lyell's disease is a rare, life-threatening, acute dermatologic disease. The mucous membranes are also often involved. Nearly all cases are induced by medications. There is currently no specific treatment and interdisciplinary cooperation is very important. The authors present a case report of a 15 year old boy with the ocular manifestations of Lyell's disease, triggered by lamotrigine. He was admitted to the burn unit with involvement of 85% of his body surface area. Ocular manifestations documented during hospitalization were classified as mild (lid edema, conjunctival injection) and later severe (multiple symblepharons). The patient was treated with antibiotic eyedrops/ointment, corticosteroid eyedrops/ointment, topical lubricants and a glass rod was used to lyse the symblepharons. At 23 months of follow-up our patient had a symblepharon which blocked the superior and inferior punctum in both eyes, without conjunctival fornix foreshortening or corneal abnormalities, minimal ocular discomfort.

Our first experience with Integra.

The advantages of Integra have lead to an increase in its use after extensive burn injuries, in reconstructive surgery after burns, and abroad in general reconstructive surgery as well. At the Burn Center of FNsP Hospital in Ostrava Integra was used for the first time in March 2003. Since then, seven patients have undergone operations, involving the use of Integra in 14 body areas. In four of the patients scars after burns were corrected--on the neck, axilla, two on the trunk, two in the popliteal area and one between the toes. In three patients the artificial skin was applied after necronectomy. In a 7-month-old baby and in a 2-year-old child with burn injuries exceeding 25% of the body surface it was applied twice on the trunk, once on the upper extremity and once on the lower extremity. In an adult female Integra was applied on her neck and axilla after burns to a lesser extent. We have evaluated the scars one year after surgery in two patients. Cosmetic appearance was good in both of them. We have noted good functional result after the reconstruction of axilla. After reconstruction in the neck area and reconstruction of the necrectomy in the neck area and axilla, the functional results were average. The average functional results in both patients are probably due to poor compliance with the immobilization and following rehabilitation program.

Surgical treatment of electrical burns by local flap plastic surgery.

Electrical burns are a serious problem within burn medicine even though they are relatively uncommon. The size of the burn is small, but the wound is often deep, and frequently the patient has systemic complications as well. In the majority of patients with such injuries immediate surgical intervention is essential, consisting of escharotomy, fasciotomy, and debridement of the devitalized tissues, necrectomy of the burn area, and closure of the defect by a direct suture, a dermo-epidermal graft, or local flap. Our report consists of three case studies. The patients underwent local flap plastic surgery after a full thickness soft tissue loss. All three patients healed primarily and did not require further correction of flaps. Final functional and aesthetic results are very good if the local flap is used appropriately.

Burn injury in children.

The authors have analyzed the data files of 580 child patients up to 15 years of age who were hospitalized at the Burn Center of the FNsP Hospital in Ostrava in the years 1999 - 2003. The authors focused on mechanisms of burn injury in relation to the age of a child as well as extent, depth, localization, and local treatment of the injury. The data file was divided to four age groups: up to two years of age, 2 - 5 years of age, 5 - 10 years of age, and 10 - 15 years of age. As regards the mechanisms of injury, the authors have analyzed scalding by hot liquids, burns due to contact with a hot object, burns due to electric current, explosion, and injury caused by burning clothing. Injury by scalding prevails to a very significant degree in the youngest children. In the second age group the incidence of burn following contact with hot objects increases, as does the percentage of children injured by burning of clothing in children aged 5 - 10. The older children have increased prevalence of injuries caused by explosions. The greatest average extent of an injury is from burning of clothing. Most of the areas are burned deeply, localized in more areas of the body, and almost half of the cases required surgical intervention. Scalding comes second in terms of average extent of an injury. More than half of the injured areas are superficial, and areas of injury are different in the individual age groups. We addressed about a fifth of the cases surgically. The explosion of combustible materials caused a smaller extent of injury, on average, taking third place. The injuries were predominantly superficial, most commonly involving the head, trunk, and upper extremities. In none of the cases it was necessary for us to operate. Burn injuries caused by contact with hot objects are of a smaller extent. More than half of the burned areas are deep, localized most commonly in the upper extremities. Surgical intervention was necessary in more than half the cases. In terms of average extent of an injury, the smallest burn injuries are caused by electric current. However, these injuries are deep, and surgical intervention was necessary in all cases.

Critical and severe burn injury in children.

The authors present a data file of 279 children with severe and critical burn injury, hospitalized in the Intensive Care Unit or the Pediatric Resuscitation Unit of the FNsP Hospital in Ostrava in the years 1999 - 2003. The severity of the burn trauma in children is determined by age, extent, depth, localization, circumstances of the injury, its mechanism, and by other serious illnesses of a child. The authors have divided the data file into two groups, severe and critical, using classification of a burn injury in children according to the extent of injury as well as localization and other circumstances (1). Complex therapy of extensive burn injuries in children is based on adequate fluid resuscitation, treatment of burned areas, algosedation, and appropriate antibiotic therapy. The authors have unequivocally confirmed that in the group of children with diagnosis of critical burns complications occur more often, while the overall course of illness is serious and requires more therapeutical interventions than in the group of children with severe burns.

First experience with the use of vacuum assisted closure in the treatment of skin defects at the burn center.

Morykwas and Argenta developed Vacuum Assisted Closure (VAC) in the early 90s for the treatment of tissue defects. In 2004, for the first time at our workplace, we used this method in the treatment of six patients between 54 and 91 years of age. Two of the patients were treated for a varicose ulcer on a lower extremity, two patients for loss of skin after an inflammation secondary to infection, one high-risk patient for deep burns, and one patient for a deep defect caused by an inappropriate medical care. We observed blood circulation improvement in all patients, which permitted an early dermo-epidermal graft.