The association between improved standard of living and paediatric burns.

INTRODUCTION: In the "Children's Hospital Zagreb Referral Centre for Paediatric Trauma of the Ministry of Health Republic of Croatia (MHC)" we observed a significant decline in the number of both hospitalised and ambulatory treated paediatric patients with burn injuries in the period from 2011 to 2018. Our hypothesis is that this decline could be either due to the decline of the paediatric population of Croatia or due to the economic growth and the improvement in the standard of living that Croatians have enjoyed in the past decade. MATERIALS AND METHODS: In this observational study, we analysed data on the numbers of patients treated due to burn injuries from January 2011 to December 2018 in the Children's Hospital Zagreb Hospital. Indicators of standard of living and population size estimates were obtained from Eurostat and the Croatian Bureau of Statistics. Associations between the proportion of people with poor standard of living and the number of treated patients were analysed with logistic regression models. RESULTS: Percentage of the population with low housing standards, percentage of Croatians with low level of education, percentage of children that live in jobless households, and percentage of children at risk of poverty and social exclusion were predictors of the rate of hospital admissions, ambulatory treated patients and total number of treatments. The slight decrease in the rate of treated patients was interrupted with notable decline in 2014 followed by the slight increase in 2015. Over following years, the rate did not change remarkably. CONCLUSION: Apart from the decline of the paediatric population of Croatia, it is reasonable to assume that the improvement in the standard of housing, level of education and employment rate as well as the reduction in the risk of poverty and social exclusion in children had a notable contribution to the decline in the rate of paediatric burns in the observed period.

Massive Dog Bite Injury of the Scalp in One-year Old Boy.

A one-year-old boy was referred to our Department of Pediatric Surgery with extensive scalp injury. He was bitten by a neighbour's mixed-breed dog. The wound of the forehead is primary closed while scalp is reimplanted. Due to non-acceptance on the eighth day a necrectomy of devitalized tissue was done. Before applying Integra®, for 2 days, the wound was treated with a V.A.C.® system. After 14 days, Integra® was accepted and split-thickness skin graft (STSG) was transplanted from left upper leg. After 3 months the local status is satisfactory. A hair transplant is planned in the future.

The patterns of phalangeal fractures in children and adolescents: a review of 512 cases.

INTRODUCTION: Fractures of the phalanges in children can often be underappreciated by the physician of first contact. Therefore it is necessary to point out which of these fractures, because of the risk of possible future complications, need special mention. MATERIALS AND METHODS: A retrospective review of 512 fractures of the phalanges in children and adolescents during an one year period. Fractures were subdivided into the following categories - physeal fractures, intraarticular (phalangeal neck and condylar) fractures, shaft fractures, tuft fractures, "mallet finger" fractures, volar plate avulsion injuries and collateral ligament avulsion injuries. Main outcome measures was the necessity for operation while the average age at which the injury has occured, the cause of the injury, the frequency of injury of each finger, the necessity for reduction, and the duration of splinting were the secondary outcome measures. RESULTS: Collateral ligament avulsion injuries and intraarticular (phalangeal neck and condylar) fractures were injuries which most often necessitated operative treatment. Physeal injuries were the most common injuires with avulsions of the volar plate being the second most common. Accidents during sport was by far the most common cause of injuires in all categories apart from tuft injuries. CONCLUSION: The findings regarding the incidence and the cause of these injuries in this study support the already published dana in the literature. The physician of first contact has to be capable to recognise the problematic fractures - intraarticular (phalangeal neck and condylar), significantly displaced Salter-Harris type III and IV fractures and collateral ligament avulsion injuries and Seymour fractures.

Treating Giant Congenital Nevus With Integra Dermal Regeneration Template in a 9-Year-Old Girl.

Integra dermal regeneration template has been well established in treating deep extensive burns, but there are very few cases reported of treating large full-thickness skin defects such as giant nevi. Apart from psychological and cosmetic burdens, the giant congenital nevus carries increased risk of malignant alteration. We present the case of a 9-year-old girl with a giant congenital nevus on her left lower leg. A total excision was done and she was successfully treated with Integra (LifeSciences Corp, Plainsboro, NJ). Three weeks later, a thin split-skin graft was applied over the neodermal skin layer. The takeoff was 91%. Protected with the silver wound dressing, the rest of the wound healed. A donor site morbidity was minimal, and the final result was excellent both in aesthetic and functional aspects.

[THE SCALP AS A SPLIT-THICKNESS GRAFT DONOR IN THE TREATMENT OF A MASSIVE THERMAL INJURY]. / VLASISTE KAO DONOR TRANSPLANTATA DJELOMICNE DEBLJINE KOZE U LIJECENJU MASIVNE TERMALNE OZLJEDE.

We are presenting our initial experience with the utilization of the scalp as a donor for split thickness skin grafting in the treatment of massive thermal injuries. Rapid donor reepithelization, absence of hypertrophic scarring in the donor area, inconspicuous donor area and a large area for the procurement of grafts in the pediatric population are the advantages that are emphasized in the literature. The outcome in a 3-year-old boy who suffered a burn injury from an open fire in the family house on the 57% of his total body surface area (48% full thickness burn) showed that the "take rate", in the absence of a massive local infection, was around 80% and that the scalp can be utilized again as a donor area after a period of 14 days. Folliculitis and alopecia are complications that should be kept in mind when using this technique.

Fibrin gel as a scaffold for skin substitute ­ production and clinical experience.

The purpose of this study was to create a fibrin-based human skin substitute in vitro with epidermal and dermal component and to assess its healing potential in deep partial and full thickness burns. Fibrin scaffolds were prepared from commercial fibrin glue kits. Human fibroblasts were cultured in fibrin gel. Human keratinocytes were seeded on the top of the gel. Viability of cells was determined fluorimetrically. Scanning electron microscope and immunocytochemistry analysis of cultured cells were performed. After hydrosurgical preparation of deep burn necrotic tissue, wound bed was prepared for skin substitutes. Progress of healing was documented using visual estimation and photos. Scanning electron microscope images showed good cell attachment and colony spreading of keratinocytes and fibroblasts on fibrin scaff old. Immunofluorescent staining of cell cultures on fibrin scaffold showed expression of vimentin, a marker of fibroblast cells, cytokeratin 19, a marker of epithelial stem cells, as well as involucrin, a marker of differentiated keratinocytes. Clinical results clearly showed that appearance of the skin did not differ significantly from the areas of transplanted skin using split-thickness skin graft techniques. In conclusion, using these fibrin-cultured autografts on massive full-thickness burn resulted in good healing.

[INITIAL EXPERIENCE WITH TOPICAL NEGATIVE PRESSURE THERAPY IN THE TREATMENT OF PEDIATRIC BURNS].

We are presenting the experience of the Referral Centre for Pediatric Traumatism of the Croatian Ministry of Health in the usage of topical negative pressure therapy (TNP) method for the treatment of pediatric burns. In the period of 20 months we have used negative pressure wound therapy method in eight children aged between 1.5 and 10 years. Burn injuries total body surface area ranged between 3% and 30%. TNP was used either for the wound bed conditioning or for the fixation of skin grafts. Average skin graft "take" was 86% eight days after surgery according to the evaluation by the senior author. Based on our initial experience, we can confirm that TNP is a very useful tool which enables good wound bed conditioning as well as a good fixation tool for skin grafts if the burned area does not exceed 30% of total body surface area.

Pulsed dye laser treatment of vascular lesions in childhood.

Almost all congenital vascular abnormalities affect the skin and are evident from birth or become so during the first few weeks of life. The two most common types of vascular birthmarks, hemangiomas and vascular malformations, may appear to be very similar but their course and treatment are different. Hemangiomas appear in the first few weeks of life and usually regress spontaneously over time. Vascular malformations are always present from birth even though they might not be apparent, never disappear and often grow during the person's lifetime and may vary extremely from high blood flow lesions, sometimes located in critical sites that may be life-threatening to asymptomatic spots of mere aesthetic concern. Laser therapy nowadays has become indispensable in the management of pediatric vascular lesions. With a proper balance of wavelength, energy density and pulse duration, the laser energy of thermo coagulation could be molded to effectively manage different lesions. Both dermatology and plastic surgery have been transformed by understanding vascular lesions biology and modern laser technology. As a result, we can now provide an optimal selective treatment with minimal collateral damage. Although alternatives such as the potassium titanyl phosphate (KTP), red/infrared (IR), or intense pulsed light lasers are available, pulsed dye lasers continue to be the standard of care for the majority of pediatric vascular lesions.

Reversal of thrombocytopenia and bleeding tendency in a preterm neonate with recombinant activated factor VII: case report.

A male neonate, born at 26 weeks of postmenstrual age, with intracranial hemorrhage grade IV and thoracic drainage for artificial tension pneumothorax on day 6 of his life is presented. Despite prior transfusions, the preprocedural hemogram showed marked anemia and thrombocytopenia. To reverse thrombocytopenia and to avoid volume overload, the patient was administered 110 microg kg(-1) of recombinant activated factor VII (rFVIIa) and drainage of the pneumothorax was performed uneventfully.

Vaginal aplasia associated with anatomically and functionally normal uterus.

Maldevelopment of the vagina is usually combined with aplasia/hypoplasia of the uterus. Complete vaginal aplasia with a normally developed uterus and cervix is an extremely rare form of developmental failure. The accepted treatment for this kind of maldevelopment is hysterectomy plus creation of a neovagina. We present the case of 12-year-old girl with isolated complete vaginal aplasia. After the creation of a vagina during a first procedure and lysis of pericervical adhesions with implantation of skin graft in a second she now has regular menstrual bleeding.