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1.  A Computer Program to Evaluate Experimental Therapies for Treating Burned Patients 
Determining the worth of new therapies for burn patients has been difficult because of the rarity of the burn injury and the disparate survival chances associated with different sizes of burns. Recently a burn survival model has been developed that estimates the risk of death from a burn as a function of the patient's age, sex, area of full thickness (third degree) burn, area of partial thickness burn, involvement of the perineum, and time from burn to admission. An alternative risk model uses the total area burned in place of the areas of partial thickness burn and full thickness burn, and is appropriate if the amount of full thickness burn is not determined accurately. This paper describes a program that uses these risk models to correct or standardize for demographic and severity factors, then, after that adjustment, tests whether a group of burn patients who received a new or experimental therapy shows a significantly better survival rate than that predicted by a baseline model. The program is a simple one written in Fortran for easy adaptation to other computer systems.
PMCID: PMC2203672
2.  The domestic iron. A danger to young children 
Objectives—To study the epidemiology of thermal injury caused by the domestic iron in children 5 years old or less.
Methods—Retrospective review of case notes held in the accident and emergency (A&E) department of a large teaching hospital over a 36 month period. Data regarding demographics, site and extent of injury, mechanism of injury and outcome were retrieved.
Results—62 thermal injuries were identified in 59 patients. Of these, 60 were contact burns and two were scalds. The male to female ratio was 2:1. The mean age was 24 months. Fifty five per cent were aged between 1 and 2 years old. The hand was the commonest site of injury (63%) and, of these, two thirds were on the palm. Interestingly 10% occurred on the face. Iron contact burns accounted for 23.5% of all contact burns in this age group over this period. The majority of contact burns were partial thickness and most were less than 1% body surface area. Inadequate supervision is a recurring theme in many of these cases. A suspicion of non-accidental injury was raised in 10 cases and confirmed in nine of these.
Conclusions—Iron burns are common in young children, particularly boys aged between 1 and 2 years old. Most can be treated in the A&E clinic. The potential for serious injury does exist. Non-accidental injury always needs to be considered. Efforts at prevention and increasing public awareness are needed.
doi:10.1136/emj.17.3.199
PMCID: PMC1725390  PMID: 10819384
3.  Acute Dorsal Hand Burns in Children 
Summary
Hand burns in children, whether isolated or part of massive burns, require special attention. A crucial element in this respect is the preservation and full restoration of hand function. Most cases of severe sequelae after burns are associated with hand burns. From January 2002 to November 2004, 125 children with hand burns and other body burns were treated at the Centre of Burns and Plastic Surgery in Sofia, Bulgaria. This review presents our experience with 71 children with 89 burned hands in the region of the dorsal surface of the hand. Forty-nine hands had isolated dorsal surface burns, and 40 had combined burns, i.e. both dorsal and volar. Of all the hands treated, 69 had superficial burns, which epithelialized spontaneously. Twenty hands with deep dermal and full-thickness burns were subjected to sheet autografting. The review includes many details of the systematic approach to this type of burns. Optimal recovery of hand function can be achieved by accurate planning of treatment. Tracking of long-term results is also included in the general plan of behaviour in this type of burn. Our approach is conservative for superficial burns and active - with early excision and prompt closure with sheet autograft or, in extensive burns, allografting followed by covering with an autograft.
PMCID: PMC3188013  PMID: 21991015
ACUTE; DORSAL; HAND; BURNS; CHILDREN
4.  Hair bleaching and skin burning 
Summary
Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.
PMCID: PMC3664529  PMID: 23766754
deep dermal burns; hair bleaching
5.  Preventable Wheelchair-related Thermal Injury 
Background/Objective:
Wheelchair-related injuries are common, and with proper reporting of injuries, advanced technologic support may offer new ways to prevent those injuries.
Method:
Case Report and Findings: A man with tetraplegia who retains only minimal use of his right hand experienced a right-sided armrest malfunction of his wheelchair resulting in his wheelchair controls being out of reach. This left him stranded in the sun for almost 2 hours in 86°F weather. During that time, he developed full thickness sunburns of his left forearm and deep partial thickness burns of the left fingertips where they were in contact with the left armrest.
Conclusion:
This patient's full thickness burns could have been prevented if his motorized wheelchair had back-up communication in the event of a malfunction. Technology developers must realize the need for such systems. Health care professionals must advocate for a higher standard of safety and report injuries related to wheelchair malfunction.
PMCID: PMC1864799  PMID: 16739559
Tetraplegia; Thermal injury, burns; Wheelchair safety; Wheelchair-related injuries; MedWatch; Communication technology
6.  Bubble Hair and Other Acquired Hair Shaft Anomalies due to Hot Ironing on Wet Hair 
Bubble hair is an acquired hair shaft abnormality characterized by multiple airfilled spaces within the hair shaft. It is a result of thermal injury. We report a classic case of 22-year-old female who complained of dry brittle hair of two-week duration. Patient had used hot iron on wet hair twice to straighten hair. Hair microscopy was diagnostic and showed multiple air-filled spaces within the hair shaft.
doi:10.4103/0974-7753.90832
PMCID: PMC3250009  PMID: 22223976
Bubble hair; hair ironing; thermal injury
7.  Medical Treatment for Burn Patients with Eating Disorders: A Case Report 
Plastic Surgery International  2011;2011:370981.
There have been many cases of burn patients who also suffer from psychiatric problems, including eating disorders. We present a case of a 38-year-old female with an eating disorder and depression who became light-headed and fell, spilling boiling water from a kettle on herself at home sustaining partial thickness and full thickness burns over 5% of her total body surface area: left buttock and right thigh and calf. Eating disorders (in the present case, anorexia nervosa) cause emaciation and malnutrition, and consent for hospitalization from the patient and/or family is often difficult. During the medical treatment of burns for these patients, consideration not only of physical symptoms caused by malnutrition but also the psychiatric issues is required. Therefore, multifaceted and complex care must be given to burn patients with eating disorders.
doi:10.1155/2011/370981
PMCID: PMC3335636  PMID: 22567240
8.  Epilepsy and Full-Thickness Burns 
Summary
This paper presents various aspects of severe burns involving epileptic patients, who may suffer dramatic accidents during seizure attacks. Epileptics may fall onto an open fire or hot surface (e.g. a kitchen range) and they may upset containers full of boiling liquids, suffering deep burns and scalds. In our experience in this field, the most commonly affected body areas are the face and hands, the trunk, and the lower limbs. All such injuries are full-thickness burns, owing to the very long contact of the skin surface with the lesional agent. Three cases are presented of epileptics with severe burns who were admitted to the Burn Unit of Targu Mures Teaching Hospital, Romania, where they were hospitalized; conservative debridement using polyurethanefoam (PUR-foam) dressings was the standard procedure, which all the patients received. Split-thickness skin grafting was the final method for closing the granulating bed resulting from the conservative debridement. We have found that conservative debridement using PUR-foam dressings is a cheaper and more reliable alternative than sharp debridement (which may remove healthy tissue at the same time as burn eschars).
PMCID: PMC3188250  PMID: 21991200
epilepsy; major seizure attacks; full-thickness burns; conservative debridement; PUR-foam dressings; split-thickness skin grafts
9.  Reduction of Burn Progression with Topical Delivery of (Anti-Tumor Necrosis Factor-α)-Hyaluronic Acid Conjugates 
Wound Repair and Regeneration  2012;20(4):563-572.
In this study, we explored whether topical application of antibodies targeting tumor necrosis factor-α (TNF-α) or interleukin-6 (IL-6) conjugated to hyaluronic acid (HA) could reduce the extension of necrosis by modulating inflammation locally in a partial-thickness rat burn model. Partial-thickness to deep partial-thickness burn injuries present significant challenges in healing, as these burns often progress following the initial thermal insult, resulting in necrotic expansion and increased likelihood of secondary complications. Necrotic expansion is driven by a microenvironment with elevated levels of pro-inflammatory mediators, and local neutralization of these using antibody conjugates could reduce burn progression. Trichrome-stained tissue sections indicated the least necrotic tissue in (anti-TNF-α)-HA treated sites, while (anti-IL-6)-HA treated sites displayed similar outcomes to saline controls. This was confirmed by vimentin immunostaining, which demonstrated that HA treatment alone reduced burn progression by nearly 30%, but (anti-TNF-α)-HA reduced it by approximately 70%. At all time points, (anti-TNF-α)-HA treated sites showed reduced tissue levels of IL-1β compared to controls, suggesting inhibition of a downstream mediator of inflammation. Decreased macrophage infiltration in (anti-TNF-α)-HA-treated sites compared to controls was elucidated by immunohistochemical staining of macrophages, suggesting a reduction in overall inflammation in all time points. These results suggest that local targeting of TNF-α may be an effective strategy for preventing progression of partial-thickness burns.
doi:10.1111/j.1524-475X.2012.00813.x
PMCID: PMC3389270  PMID: 22712482
10.  Epidermal growth factor receptor distribution in burn wounds. Implications for growth factor-mediated repair. 
Journal of Clinical Investigation  1992;90(6):2392-2401.
Epidermal growth factor (EGF) along with several related peptide growth factors has been shown both in vivo and in vitro to accelerate events associated with epidermal wound repair. EGF and transforming growth factor alpha act by binding to a common EGF receptor tyrosine kinase thereby initiating a series of events which ultimately regulate cell proliferation. This study examined the immunohistochemical localization of EGF receptor (EGF-R) in burn wound margins, adjacent proliferating epithelium, and closely associated sweat ducts, sebaceous glands, and hair follicles. Tissue specimens removed during surgical debridement were obtained from full and partial thickness burn wounds in 32 patients with total body surface area burns ranging from 2 to 88%. In the early postburn period (days 2-4), prominent staining for EGF-R was found in undifferentiated, marginal keratinocytes, adjacent proliferating, hypertrophic epithelium, and both marginal and nonmarginal hair follicles, sweat ducts, and sebaceous glands. During the late postburn period (days 5-16), EGF-R was depleted along leading epithelial margins; however, immunoreactive EGF-R remained intensely positive in the hypertrophic epithelium and all skin appendages. Increased detection of immunoreactive EGF-R and the presence of [125I]EGF binding in the hypertrophic epithelium correlated positively with proliferating cell nuclear antigen distributions. Thus, the presence of EGF-R in the appropriate keratinocyte populations suggests a functional role for this receptor during wound repair. Dynamic modulation in EGF receptor distribution during the temporal sequence of repair provides further evidence that an EGF/transforming growth factor alpha/EGF-R-mediated pathway is activated during human wound repair.
Images
PMCID: PMC443395  PMID: 1361495
11.  Home safety measures and the risk of unintentional injury among young children: a multicentre case–control study 
Background
Young children may sustain injuries when exposed to certain hazards in the home. To better understand the relation between several childproofing strategies and the risk of injuries to children in the home, we undertook a multicentre case–control study in which we compared hazards in the homes of children with and without injuries.
Methods
We conducted this case-control study using records from 5 pediatric hospital emergency departments for the 2-year period 1995–1996. The 351 case subjects were children aged 7 years and less who presented with injuries from falls, burns or scalds, ingestions or choking. The matched control subjects were children who presented during the same period with acute non-injury-related conditions. A home visitor, blinded to case-control status, assessed 19 injury hazards at the children's homes.
Results
Hazards found in the homes included baby walkers (21% of homes with infants), no functioning smoke alarm (17% of homes) and no fire extinguisher (51% of homes). Cases did not differ from controls in the mean proportion of home hazards. After controlling for siblings, maternal education and employment, we found that cases differed from controls for 5 hazards: the presence of a baby walker (odds ratio [OR] 9.0, 95% confidence interval [CI] 1.1–71.0), the presence of choking hazards within a child's reach (OR 2.0, 95% CI 1.0–3.7), no child-resistant lids in bathroom (OR 1.6, 95% CI 1.0–2.5), no smoke alarm (OR 3.2, 95% CI 1.4–7.7) and no functioning smoke alarm (OR 1.7, 95% CI 1.0–2.8).
Interpretation
Homes of children with injuries differed from those of children without injuries in the proportions of specific hazards for falls, choking, poisoning and burns, with a striking difference noted for the presence of a baby walker. In addition to counselling parents about specific hazards, clinicians should consider that the presence of some hazards may indicate an increased risk for home injuries beyond those directly related to the hazard found. Families with any home hazard may be candidates for interventions to childproof against other types of home hazards.
doi:10.1503/cmaj.050592
PMCID: PMC1586091  PMID: 16998079
12.  Adherence to Referral Criteria for Burns in the Emergency Department 
Eplasty  2008;8:e26.
Objective: To audit the referral patterns of burns in an emergency department compared with national referral guidelines. Methods: A retrospective case note audit of patients attending an emergency department with a diagnosis of “burn” in a 1-year period. Results: Only one quarter of the patients were managed according to the suggested national referral criteria for burns. Large and full thickness burns were managed appropriately but those at important anatomical sites and in patients at the extremes of age were managed less well. Conclusion: Increased awareness of the national referral guidelines, along with further education of staff within this department, may improve management of burn injuries. It is likely that referral patterns are similar in other emergency departments and may be improved by training staff in the assessment and management of burns. Increased adherence to the guidelines is likely to improve patient outcome at the expense of increased patient numbers and workloads in regional burns units that have implications for funding and service provision.
PMCID: PMC2380084  PMID: 18536778
13.  Burn Injuries in Enugu, Nigeria - Aetiology and Prevention. A Six-year Retrospective Review (January 2000 - December 2005) 
Summary
Background.Burn injuries frequently occur in our homes and workplaces and during travels. They are a common presentation at the National Orthopaedic Hospital, Enugu, Nigeria, which is a regional centre for burns care and for plastic surgery, orthopaedic surgery, and trauma patients. Most burn injuries are preventable, and campaigns to arouse greater awareness are necessary to reduce the number of occurrences. Objectives.The objectives of this study are to highlight the causes of burn injuries and to characterize age and sex incidences, as also the severity of burn injuries. It is hoped that formidable preventive measures will be suggested to aid public enlightenment campaigns in fighting the scourge of burn injuries. Materials and method. A retrospective review of patient's folders from Jan. 2000 to Dec. 2005 showed that 414 cases of burn-injured patients were treated at the emergency unit of the National Orthopaedic Hospital, Enugu. Results. Flame burns accounted for 48.3% of burn injuries followed by scalds with 40.6%; chemical burns accounted for 6.3%, while electrical and friction burns accounted for 4.6% and 1.0% respectively. Males made up 60.4% of the cases and females 39.6% (ratio, 1.5:1). The age group most commonly affected was that of children aged between 0 and 10 yr, accounting for 37.2% of cases, followed by the 21-30 yr age group with 22.7%. Altogether, 95.0% of the patients were aged less than 50 yr. With regard to flame burns, 51.5% were due to petrol flames (premium motor spirit), while 33.0% were due to kerosene. Cooking gas explosions accounted for 7.5% of the cases and diesel (automotive gas oil) 1.0%. Of the scalds, hot water accounted for 89.3% and hot oil 7.7%. As to chemical burns, 84.6% were due to acids, with alkalis, corrosive creams, and others making up the rest. With regard to electrical injury, current passage accounted for 63.2% of cases and flash burns for 36.8%.
PMCID: PMC3188203  PMID: 21991150
BURN INJURIES; ENUGU; NIGERIA; AETIOLOGY; PREVENTION; RETROSPECTIVE; REVIEW
14.  Efficiency of Microbial Cellulose Dressing in Partial-Thickness Burn Wounds 
Microbial cellulose is a natural polymer that can hold a quantity of water without any disconformities. Therefore, it is proposed for use as wound dressing material. We report a case of 28% total body surface area partial-thickness flame burn: approximately 4.5% superficial partial-thickness burns on anterior face and 23.5% combined superficial and deep partial-thickness burns on both upper arms and anterior trunk. A microbial cellulose dressing, Nanocell (Thai Nano Cellulose Co Ltd, Bangkok, Thailand), was applied to the face wound only once, without any further dressing change. Progress of healing, until full epithelialization on the face, was observed for 2 weeks. During the treatment period, the patient did not show any irritation or allergic reaction to this new dressing, and wound swab culture showed no evidence of bacteria presence. This innovative material can be an alternative dressing for superficial partial-thickness burn wounds.
doi:10.1016/j.jcws.2011.04.001
PMCID: PMC3601851  PMID: 24527162
Burn; Microbial cellulose; Partial-thickness wound
15.  A retrospective analysis of ambulatory burn patients: focus on wound dressings and healing times 
INTRODUCTION
In this study, we retrospectively analysed healing times of ambulatory burn patients after silver-based dressings were introduced in late December 2005, and compared the results with those obtained before.
PATIENTS AND METHODS
Data were collected in November–December 2005 and in January–February 2006. We excluded from the study: (i) admitted patients; (ii) patients with mixed superficial partial thickness and deep partial thickness burns; (iii) patients with full-thickness burns; and (iv) operated patients that came for follow-up. We recorded the age, sex, cause (flame vs scald), burn depth, dressings used and healing times.
RESULTS
We selected 347 patients corresponding to 455 burned areas (64.4% superficial and 35.6% deep; 47.7% treated in 2005 and 52.3% in 2006). During the years 2005 and 2006, there was an increase in the use of silver-based dressings (2005, 9.7%; 2006, 38.7%; chi-squared test, P < 0.001) and a decrease in the use of paraffin gauzes (2005, 66.4%; 2006, 40.3%; chi-squared test, P < 0.001). The healing time of overall burns and of superficial burns showed no significant differences between 2005 and 2006. However, in deep partial thickness burns, a significant reduction was present (2006, 19; 2005, 29 days; Student's t-test, P < 0.01). Among all dressings, paraffin gauzes had the shortest healing times in superficial burns (5 days); with silver-based dressings in deep burns, the healing times were nanocrystalline silver (16 days) and silver carboxymethylcellulose (21 days).
CONCLUSIONS
Results of our retrospective study would suggest that paraffin gauzes are a valuable option in superficial burns, while silver-based dressings are preferable in deep burns.
doi:10.1308/003588410X12518836439001
PMCID: PMC3025243  PMID: 19995488
Burn dressings; Ambulatory burns; Healing times
16.  Biologic and synthetic skin substitutes: An overview 
The current trend of burn wound care has shifted to more holistic approach of improvement in the long-term form and function of the healed burn wounds and quality of life. This has demanded the emergence of various skin substitutes in the management of acute burn injury as well as post burn reconstructions. Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various aetiologies. At present, there is no ideal substitute in the market. Skin substitutes can be divided into two main classes, namely, biological and synthetic substitutes. The biological skin substitutes have a more intact extracellular matrix structure, while the synthetic skin substitutes can be synthesised on demand and can be modulated for specific purposes. Each class has its advantages and disadvantages. The biological skin substitutes may allow the construction of a more natural new dermis and allow excellent re-epithelialisation characteristics due to the presence of a basement membrane. Synthetic skin substitutes demonstrate the advantages of increase control over scaffold composition. The ultimate goal is to achieve an ideal skin substitute that provides an effective and scar-free wound healing.
doi:10.4103/0970-0358.70712
PMCID: PMC3038402  PMID: 21321652
Skin substitute; burn; biological dressing
17.  The Introduction of a Protocol for the Use of Biobrane for Facial Burns in Children 
Plastic Surgery International  2011;2011:858093.
Biobrane has become an indispensible dressing with three established indications in acute burns care at our institution: (1) as the definitive dressing of superficial partial thickness facial burns, (2) after tangential excision of deep burns when autograft or cadaver skin is unavailable, and (3) for graft reduction. This paper details our initial experience of Biobrane for the management of superficial partial thickness facial burns in children and the protocol that was compiled for its optimal use. A retrospective analysis of theatre records, case notes and photographs was performed to evaluate our experience with Biobrane over a one-year period. Endpoints included length of stay, analgesic requirements, time to application of Biobrane, healing times, and aesthetic results. Historical controls were used to compare the results with our previous standard of care. 87 patients with superficial partial thickness burns of the face had Biobrane applied during this period. By adhering to the protocol we were able to demonstrate significant reductions in hospital stay, healing time, analgesic requirements, nursing care, with excellent cosmetic results. The protocol is widely accepted by all involved in the optimal management of these patients, including parents, anaesthetists, and nursing staff.
doi:10.1155/2011/858093
PMCID: PMC3335537  PMID: 22567247
18.  Stevens-Johnson Syndrome: a Case Report 
Summary
The Stevens-Johnson syndrome has the appearance of a partial-thickness burn that may lead to a 100% loss of epidermis, requiring the same resuscitation as a severe burn. A 38-yr-old male patient was admitted to the neurosurgery department of the Evangelismos General Hospital in Athens, where immediately after administration of an antiepileptic drug he developed sloughing of total epidermis, high fever, and the clinical picture of a severe burn patient. He was treated as a burn patient with massive cutaneous injuries and the concomitant systemic effects. Fluid resuscitation was important and the Parkland formula was used, as in a burn patient. Steroid medications were initially administered. Systemic antibiotics were discontinued after signs of sepsis and documented infection had been overcome. Improved treatment techniques and critical burn care have decreased mortality and morbidity in cases of the Stevens-Johnson syndrome. Prompt recognition of the disease and cure of the patient by the appropriate staff of the burns centre contribute to the successful treatment of such patients.
PMCID: PMC3188138  PMID: 21991171
STEVENS-JOHNSON; SYNDROME; CASE REPORT
19.  Home Oxygen Therapy and Cigarette Smoking: a Dangerous Practice. 
Summary
Oxygen as a therapeutic agent is an important form of home therapy for hypoxic chronic obstructive pulmonary disease (COPD) and improved survival has been demonstrated in hypoxic COPD patients receiving continuous oxygen. However, some patients, despite dissuasion, continue to smoke and we describe the case of a patient on home oxygen who sustained a partial-thickness facial flash burn whilst engaged in this habit. A review is made of the literature, as also a comparison of all discovered cases of burns in home oxygen users, followed by a discussion of the implications of this potentially hazardous form of therapy.
PMCID: PMC3188038  PMID: 21991033
oxygen; therapy; cigarette; smoking; dangerous; practice
20.  A modified surgical technique in the management of eyelid burns: a case series 
Introduction
Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts.
Case presentation
We present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up.
Conclusions
This new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid.
doi:10.1186/1752-1947-5-373
PMCID: PMC3212825  PMID: 21843322
21.  Head and Neck Burns: Acute and Late Reconstruction.Data of Burn Injury Management in 2007 
Summary
Modern burn care is based on operative wound management. The evidence is clear that prompt excision and closure can be lifesaving for patients even with large burns. Facial burns that are full-thickness need grafting. Deep dermal facial burns need surgery in the third week post-burn. Deep burns to the eyelids should be excised and grafted early in order to prevent cicatricial ectropion and corneal exposure. Following healing from burns, the reconstruction of severe deformities and scars of the face, head, and neck confronts the surgeon with some of the most challenging problems in reconstructive surgery. Our purpose is to provide some retrospective data on acute and late reconstruction of head and neck burns in 2007. Eighty-one patients are considered who were operated on in the Burns and Plastic Surgery Service of the University Hospital Centre in Tirana, Albania, suffering from burns and also from burn deformities in the head and neck regions. A description is given of the different types of operative techniques used for head and neck reconstruction as also of developmental aspects of burned face deformities (physical and psychological) and of their correction. In all, 246 patients with burns and burn deformities were subjected to surgery in 2007. Of these we have extracted 81 cases in which the pathology concerned the head and the neck, including 13 cases of full-thickness facial burns needing excising and grafting. The other 68 cases were burn deformities. This last group of patients included 19 with facial deformities, 14 with perioral deformities, 12 with burn alopecia, ten with upper and lower eyelid deformities, nine with ear deformities, and four with cervical deformities. The operative techniques used were skin grafts (split-thickness or full-thickness), composite grafts, pedicle flaps, and tissue replacement. In burn alopecia cases, we used tissue expansion for the correction. Head and neck burns constitute some of the most challenging problems in acute wound care and in the subsequent rehabilitation and reconstruction.With knowledge of the reconstruction techniques available, plus an accurate diagnosis of tissue deficiency and secondary distortion, a carefully performed surgical plan is the first step for achieving improvements in a burn-deformed face.
PMCID: PMC3188193  PMID: 21991138
HEAD; NECK; BURNS; RECONSTRUCTION; MANAGEMENT
22.  Irritant contact dermatitis complicated by deep-seated staphylococcal infection caused by a hair relaxer. 
Chemical hair relaxers are used by many women to straighten their hair. We describe a case of a deep soft tissue staphylococcal abscess that complicated an irritant contact dermatitis from a hair relaxer treatment.
PMCID: PMC2594120  PMID: 11853045
23.  Airbag-related chest wall burn as a marker of underlying injury: a case report 
Introduction
This case of a man who sustained an airbag-induced thoracic injury and burn, highlights the potential harm that can be caused by airbags. It also serves to illustrate that a surface burn which looks small and benign can actually be a surface marker of a more serious injury. Staff working in emergency departments need to be aware of the risk of possible airbag-associated injuries.
Case presentation
A 65-year-old man was the driver in a frontal collision. He was wearing a seatbelt. The airbag was activated and caused a superficial chest wall burn. Initial chest x-rays were unremarkable but following deterioration in his condition, a computed tomography scan revealed a serious sternal fracture. The location of the fracture was marked on the surface by the burn.
Conclusion
Airbags can cause significant chest wall injuries and burns. Surface burns at the point of impact should not be dismissed as trivial as the forces involved can cause significant injury. We recommend that all people with chest wall injuries and/or burns due to airbags should have more detailed chest imaging as initial emergency radiographs can be falsely reassuring.
doi:10.1186/1752-1947-2-91
PMCID: PMC2330057  PMID: 18361799
24.  Straightening Caenorhabditis elegans images 
Bioinformatics  2007;24(2):234-242.
Motivation: Caenorhabditis elegans, a roundworm found in soil, is a widely studied model organism with about 1000 cells in the adult. Producing high-resolution fluorescence images of C.elegans to reveal biological insights is becoming routine, motivating the development of advanced computational tools for analyzing the resulting image stacks. For example, worm bodies usually curve significantly in images. Thus one must ‘straighten’ the worms if they are to be compared under a canonical coordinate system.
Results: We develop a worm straightening algorithm (WSA) that restacks cutting planes orthogonal to a ‘backbone’ that models the anterior–posterior axis of the worm. We formulate the backbone as a parametric cubic spline defined by a series of control points. We develop two methods for automatically determining the locations of the control points. Our experimental methods show that our approaches effectively straighten both 2D and 3D worm images.
Contact: pengh@janelia.hhmi.org
Supplementary information: The example data sets and programs are available upon request.
doi:10.1093/bioinformatics/btm569
PMCID: PMC2940239  PMID: 18025002
25.  Resolvin D2 prevents secondary thrombosis and necrosis in a mouse burn wound model 
Deep partial thickness burns are subject to delayed necrosis of initially viable tissues surrounding the primary zone of thermally induced coagulation, which results in an expansion of the burn wound, both in area and depth, within 48 hours postburn. Neutrophil sequestration and activation leading to microvascular damage is thought to mediate this secondary tissue damage. Resolvins, a class of endogenous mediators derived from omega-3 polyunsaturated fatty acids, have been shown to regulate the resolution of inflammation. We hypothesized that exogenous resolvins could mitigate the deleterious impact of the inflammatory response in burn wounds. Using two different mouse burn injury models involving significant partial thickness injuries, we found that a systemically administered single dose of resolvin D2 (RvD2) as low as 25 pg/g bw given within an interval of up to 4 hours postburn effectively prevented thrombosis of the deep dermal vascular network and subsequent dermal necrosis. By preserving the microvascular network, RvD2 enhanced neutrophil access to the dermis, but prevented neutrophil-mediated damage through other anti-inflammatory actions, including inhibition of tumor necrosis factor-α, interleukin-1β, and neutrophil platelet–endothelial cell adhesion molecule-1. In a clinical context, RvD2 may be therapeutically useful by reducing the need for surgical debridement and the area requiring skin grafting.
doi:10.1111/j.1524-475X.2012.00853.x
PMCID: PMC3746505  PMID: 23110665

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