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Burns are a major cause of morbidity and mortality worldwide. Vulnerable people such as children, the frail and elderly, and the socially deprived are at particular risk. Most burns are caused by thermal injury to the skin, but electrical and chemical burns can be very severe. Fortunately, most burns are minor and superficial and can be managed by primary healthcare professionals. However, major and severe burns require in-hospital management from a team of surgeons and other specialists. Life-threatening conditions such as smoke inhalation airway damage and severe fluid loss should be addressed during the initial resuscitation. Prevention of further thermal damage by cooling is important along with prevention of secondary infection of burn injuries. A wide variety of dressings is available for the management of burns and expert nursing care is vital. Surgical intervention may be urgently required for fasciotomy or escharotomy in cases of compartment syndrome or circumferential burns, respectively. Debridement, skin grafting and reconstructive procedures will be required over the medium or long term for patients with severe or complex burns and should be planned with appropriate multidisciplinary expertise. The functional and psychological impact of major burn injury should not be underestimated. [ABSTRACT FROM AUTHOR]

Reconstructive surgeons often use a free radial forearm flap for nasal reconstruction when a forehead flap is not an option, but this flap has drawbacks. This article presents a series of patients with complex defects who underwent reconstruction with an anterolateral thigh (ALT) flap. Severe burns and cancer resection may lead to the loss of multiple anatomical units, including the entire nose and nearby structures. Multiple materials are required for reconstruction in those with complex total nasal defects involving adjacent areas. In this series of patients, a chimeric ALT flap was harvested and thinned to recreate the three-dimensional nasal structure and cover the adjacent area. Cartilage and alloplastic materials were used as the nasal framework, and the skin flap was folded for the mucosal lining. The results were good with an excellent contour, and no complications or airway obstruction were observed during follow-up. By thinning the ALT flap, this flap can be an alternative for complex reconstructions that require a facial or three-dimensional nasal structure., Competing Interests: Competing interests None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: One of the primary causes of heat-induced compartment syndrome is the loss of elasticity of the body surface eschar itself, we have recently replaced escharotomy with conservative tangential excision in the treatment of compartment syndrome caused by heat and achieved good results., Methods: Since 2019, our burn center has applied conservative tangential excision and heterogeneous dermal coverage technology for decompression treatment of 16 patients with thermal-induced compartment syndrome, involving 19 parts of the limbs and 5 parts of the chest and abdomen. All cases were treated with decompression under general anesthesia within 12-48 h after burn., Results: All patients were treated with conservative tangential excision for decompression. After limb decompression, the peripheral blood supply was restored, and the obvious pulse could be touched. No further fasciotomy was performed, and no secondary damage of deep muscle, nerve and vascular tissue was found in the follow-up treatment; After thoracic and abdominal decompression, there was no respiratory restriction and circulatory disorder., Conclusion: Conservative tangential excision represents an effective method for both the prevention and treatment of heat-induced compartment syndrome, it can be used as an alternative method for escharotomy., Competing Interests: Declaration of competing interest The authors declares no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Adults living with head and neck burn injuries experience psychosocial consequences due to scarring as well as functional disabilities. However, the impact of head and neck burns on long-term self-reported psychosocial outcomes, return to work, and need for reconstructive surgery has not been well described. This study investigates the unique longitudinal problems in psychosocial and functional recovery faced by adults with head and neck burn injuries., Methods: Utilizing the multicenter Burn Model System (BMS) National Database, long-term psychosocial and functional outcomes as well as postdischarge reconstructive surgery rates between adult participants with and without head and neck burns injured after 2014 were compared., Results: Of 1247 participants, 579 had head and neck burns and 668 had non-head and neck burns. Head and neck burn was a significant predictor of worse anxiety (β = 1.63, P = 0.049) and body image (β = -0.30, P = 0.011) at 6 months post burn; worse anxiety (β = 2.68, P = 0.004), depression (β = 2.14, P = 0.021), and body image (β = -0.41, P = 0.001) at 12 months post burn; and worse life satisfaction (β = -1.64, P = 0.036) at 24 months post burn. Head and neck burn participants reported significantly worse anxiety ( P = 0.001), depression ( P = 0.0026), and life satisfaction ( P < 0.001) at 12 months post burn and worse body image at 6 ( P < 0.001), 12 ( P < 0.001), and 24 ( P < 0.001) months post burn. The head-and-neck group had a significantly greater proportion of participants who had undergone contracture surgery at 12 months post burn ( P < 0.001) and a smaller proportion who had returned to work by 6 ( P < 0.001) and 12 ( P < 0.001) months post burn., Conclusions: This study suggests that adults with head and neck burns might strongly benefit from additional counseling, psychotherapy, and greater aftercare., Competing Interests: Conflicts of interest and sources of funding: The contents of this manuscript were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DPBU0007, 90DPGE0004, 90DPBU0005, and 90DPBU0008). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Blood loss during burn surgery significantly contributes to morbidity and mortality. Tranexamic acid (TXA), an antifibrinolytic agent, is hypothesized to reduce intraoperative bleeding. This double-blinded, randomized clinical trial aimed to assess the efficacy of systemic TXA in severe burn patients (total body surface area [TBSA] > 20 %) undergoing surgery. The study evaluated the impact of TXA on surgical bleeding, operating room (OR) time, intravenous (IV) fluid requirements, length of hospital stay (LOS), and overall patient outcomes. A total of 94 patients, with equal distribution in age, sex, and TBSA, were randomly assigned into two groups (47 each). We administered TXA as a 10 mg/kg loading dose followed by a 1 mg/kg/h infusion during surgery. Results demonstrated significant reductions in blood loss (P = 0.043), total IV fluid volume (P = 0.021), OR time (P = 0.002), LOS (P = 0.0001), and transfusions (P = 0.024) in the TXA group. Notably, women and patients without inhalation injuries exhibited better responses to TXA treatment, and graft survival was lower in the TXA group. The study concludes that IV TXA administration during burn surgery can reduce bleeding, minimize IV fluid and blood transfusion needs, and shorten surgery duration, enhancing overall surgical outcomes., Competing Interests: Declaration of Competing Interest The authors of this study have no potential conflict of interest. Conflict of interest The authors of this study have no potential conflict of interest., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Introduction: Ablative fractional carbon dioxide laser (AFCO2L) is widely used as a treatment for hypertrophic burn scars. This study aimed to evaluate clinician and patient-reported outcomes after AFCO2L treatment, safety, and identify factors influencing outcomes., Methods: This longitudinal study recruited adult patients with hypertrophic burn scars treated with AFCO2L at a single Australian burn unit. Patients received up to four AFCO2L treatments over approximately 12 months. Outcomes were ultrasound scar thickness, the Patient and Observer Scar Assessment Scale (POSAS), and the Brisbane Burn Scar Impact Scale (BBSIP), measured at baseline and 3, 6, and 12 months after the first AFCO2L treatment. Analysis used mixed effects linear models., Results: 47 patients were included with median age 32 years (IQR: 24, 53) and median burn TBSA of 35 % (IQR: 7.5 %, 48 %). Statistically significant improvements between baseline and 12-month follow-up occurred in scar thickness, and all POSAS and BBSIP subscores. Most improvements remained when accounting for TBSA, Fitzpatrick skin type, scar maturity, and body area treated. Patients reported transient symptoms after 61 of 89 (69 %) AFCO2L treatments, but infection or delayed wound healing occurred after only 4 of 89 (4 %) treatments., Conclusion: This study supports safety and improved clinician and patient-reported outcomes in patients undergoing AFCO2L for hypertrophic burn scars., Competing Interests: Declaration of Competing Interest none., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Management of the extensive soft tissue injuries remains a significant challenge in orthopedic and plastic reconstructive surgery. Since the thumb is responsible for 40% of the functions of the hand, saving and reconstructing a mangled thumb is essential for the patient's future., Case Presentation: This case report describes the management of a severe occupational thumb injury in a 25-year-old white Persian male who sustained an occupational injury to his left thumb, resulting in extensive burn, crush injury to the distal and proximal phalanx, and severe soft tissue damage to the first metacarpal, thenar, and palmar areas. Necrosis necessitated amputation through the first metacarpophalangeal joint. Postdebridement observation revealed a viable first metacarpal bone but was exposed due to a lack of soft tissue. Given the wound contamination and infection risk, the first metacarpal bone was banked in the distal forearm. After a 4 week period of antibiotics, irrigation, debridement, and vacuum dressing, the thumb and soft tissue reconstruction were performed, retrieving the viable first metacarpal. The first metacarpophalangeal joint fusion was achieved with an intramedullary screw and two K-wires. A reverse adipofascial radial artery forearm flap and skin grafts from the left thigh were used for soft tissue reconstruction., Conclusion: This case highlights the importance of a flexible, staged approach to hand trauma, emphasizing the utility of ectopic banking and reconstructive techniques in managing complex hand injuries. This report contributes to the ongoing dialogue on optimal strategies for hand reconstruction, particularly in cases where traditional immediate reconstruction is not feasible., Competing Interests: Declarations. Ethics approval and consent to participate: This work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Written informed consent was obtained from the study subject to publish case details including the injury, treatment, and radiographs. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Burn injuries often result in severe hand complications, including joint contractures and nerve damage, sometimes leading to amputation. Despite early treatment, hypertrophic scarring frequently hampers hand function recovery, and the thick raised scar blocks electromyography (EMG) sensing. A promising solution involves motion-mimicking robotic finger prostheses tailored to individual patient requirements. By using the versatility of motion-capturing technology on a sound finger, a robotic finger prosthesis can mimic the movement of a sound finger simultaneously with less latency than EMG-based sensory mechanisms through hypertrophic scars. This case study evaluated the clinical efficacy of a customized three-dimensional printed robotic finger prosthesis in a 24-year-old man who sustained left second finger loss due to electrical burns. Despite undergoing reconstructive surgery, the patient struggled with manual dexterity. Following the adoption of a personalized robotic finger prosthesis with a finger motion-capturing device, significant improvements in grip strength and daily task performance were observed. This innovative approach has advantages such as customization, reduced latency time for finger movements, and affordability from low-cost manufacturing, suggesting its potential for broader adoption among burn-induced amputees., (Published by Oxford University Press on behalf of the American Burn Association 2024.)

Biodegradable Temporizing Matrix (BTM) is a synthetic dermal template recently developed to reconstruct complex wounds. Current literature describes BTM outcomes in the presence of infection and other comorbidities but is limited by small sample sizes. The purpose of this systemic review and meta-analysis was to determine the current breadth and success of BTM use for complex wound closure. Databases were searched to identify previously published studies describing BTM use in human wounds. Studies were excluded if conducted in vitro, using nonhuman animals, or for procedures irrelevant to wound care. A total of 24 studies met the inclusion criteria, representing 202 patients. The most common injury treated with BTM was burns (68 cases, 33.7%) followed by acute surgical wounds (59 cases, 29.2%). The large majority of patients did not experience any postoperative infections (76.6%). Infected wounds were associated with a 7.5-day delay from BTM to grafting. Univariate regression analyses showed a negative association between time to BTM implantation and age, exposed muscle, and exposed tendon (p < 0.001). In total 92% of patients received BTM implantation less than 2 weeks from admission. A total of 84% of patients had a greater than 95% BTM take. The median time to split-thickness skin graft (STSG) was 34 days, and 92% of patients experienced a greater than 95% STSG survival. To our knowledge, this is the first reported systemic review on the application of BTM for wound reconstruction. According to the published data, BTM is a versatile dermal template for complex wounds coverage with a low risk of infection, high template take rate, and excellent autograft survival., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

In modern burn care, the focus extends beyond mere patient survival to encompass long-term functional and cosmetic outcomes. Research suggests that the technique and manner of suturing during skin grafting play a significant role in scar formation. This study aimed to explore the effectiveness of wound edge approximation with skin grafting compared to the conventional approach, where the graft edge exclusively interacts with the wound edge, in reducing hypertrophic scar development. Seventy-four burn unit patients eligible for grafting were randomly allocated into 2 groups: those receiving grafts with overlapping edges (Group A) and those receiving grafts with edges tailored to the burn wound (Group B). Evaluation of graft sites occurred immediately post-surgery and at 1 and 6 months post-operatively using the standardized Vancouver Scar Scale (VSS) administered by trained surgeons. The findings of this study revealed that there was no statistically significant difference between the 2 examined groups regarding the average duration of hospitalization and the mean thickness of wounds (P > 0.05). Similarly, the mean scores for pain, vascular index, and pigmentation index immediately post-surgery, at 1 month, and 6 months later, as well as the scar height index and flexibility immediately and at 1-month post-surgery, and the VSS index at the study's conclusion, showed no significant variation between the 2 groups (P > 0.05). However, at the 6-month follow-up, the mean scar height score (P = 0.004) in the overlapping group and the mean flexibility score (P = 0.017) in the non-overlapping group were significantly lower compared to the respective alternative group. This indicates a notable improvement in scar height and wound flexibility in the overlapping group over the non-overlapping group after 6 months., (Published by Oxford University Press on behalf of the American Burn Association 2024.)

Small burn injuries are extremely prevalent in the pediatric population and continue to pose a challenge for clinicians. Despite their high incidence, a standardized algorithm for treating small burns does not currently exist, and care is often guided by clinical judgement and resource availability. The aim of this study was to explore the utility of a two-stage grafting technique, involving allograft and autograft, for treating small burns (≤10% total body surface area) in pediatric patients. A retrospective review of patients aged 0-18 years who had a small burn and underwent a two-stage grafting procedure between September 1, 2018 and September 1, 2022 was conducted. One hundred and seventy-five patients with 220 wounds met the inclusion criteria for this study. The mean time from presentation to allograft surgery was 11.4 days (SD 5.2) followed by autograft surgery approximately one week later. Most patients were discharged within 24 hours following allograft surgery (87.4%) and autograft surgery (81.1%). Mean autograft take was 97.7% (SD 11.8) with only four patients experiencing significant graft loss requiring subsequent re-grafting. These positive outcomes demonstrate that the two-stage technique can be successfully utilized for treating smaller pediatric burns. Moreover, these findings help to address the significant knowledge gap regarding the optimal approach to treating small burn wounds. Further research is warranted to learn more about aesthetic outcomes following two-stage grafting and determine how it compares to other techniques for treating small burns., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Burn trauma is one of the most common causes of inpatient treatment in children and is associated with severe physical and psychological consequences. Synthetic skin substitutes are designed to reduce the risk of infection, minimize wound pain, and reduce the frequency of dressing changes. However, data regarding premature detachment of these materials is scarce. The aim of this study was to identify factors associated with early detachment and subsequent consequences for surgical treatment. A retrospective analysis of 392 children with superficial and deep partial thickness burns undergoing inpatient treatment with the application of a skin substitute (Suprathel) was performed. Patient age, wound localization and progression, as well as burned total body surface area (TBSA%) were investigated as possible risk factors for early detachment of wound dressings and surgical intervention. Premature material detachment was significantly associated with burn localization (P < .001) and correlated with burn depth progression (r = 0.23, <0.001) and patient age (r = 0.22, <0.001). Surgical revision after material detachment was required in 13% of patients. Patient age and burn localization seem to increase the risk of premature material detachment. In addition, we observed increased premature detachment of Suprathel® in areas that elicited higher wound progression rates. Identifying these areas might prove pivotal in the improvement of pediatric burn trauma management., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Effective burn surgery is based on two fundamental principles: prompt excision of necrotic tissue and definitive coverage, preserving functional dermis and body contour. There is often compromise, either prioritizing the urgency of excision or opting for patient stability and optimal conditions prior to autografting. We propose a surgical concept that addresses this critical treatment gap. In 2022, we implemented a new three-phase protocol, EDM: (Excision phase, E) Immediate excision of the burn wound preserving body contour; (Dermis phase, D) definitive temporization of the wound bed, using biodegradable temporizing matrix, to prepare it for successful grafting. Upon complete dermal temporization, full autologous coverage in a single micrografting procedure is achieved (Meek phase, M). We performed a retrospective single-center cohort study to characterize the EDM protocol compared to the prior standard of care (>40% TBSA, n = 5 in EDM vs n = 10 matched controls). Primary outcomes were total surgeries required, total surgeries to achieve>90% healing, uninterrupted recovery time without surgery, and time on mechanical ventilation. The EDM group required fewer surgeries in total (5 vs 9.5; P = .01) and to achieve>90% healing (3 vs 6.5; P = .001). EDM patients experienced longer uninterrupted recovery (25 vs 13 days, P = .001). Additionally, EDM patients spent less time on mechanical ventilation (210 vs 1136 h, P = .005). The EDM protocol could improve surgical efficiency, ultimately having the potential to expedite rehabilitation for severely burned patients. The study underscores the potential of combining the fundamentals of burn surgery, with innovative surgical techniques and materials, in order to bridge the gap between excision and grafting., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: This study aimed to evaluate the therapeutic efficacy of minimally invasive dermabrasion for deep second-degree facial burn wounds during the early postburn phase., Methods: A total of 35 patients with deep second-degree facial burns underwent minimally invasive debridement using a hydrosurgery system within 2-4 days post-injury. Subsequently, the wounds were covered with human biological dressings. The wound infection rate, healing time, and overall healing quality following debridement were monitored., Result: In this cohort of 35 patients, no infections were reported after debridement. The average healing time for these wounds was significantly shorter than that of those treated with standard surgical excision. Clinical observations indicated that minimally invasive dermabrasion was associated with a lower infection rate and reduced healing time. After 6 months, scar assessment using the Vancouver Scar Scale showed that the average score for wounds treated with minimally invasive techniques was lower than those treated with standard surgical excisional technique., Conclusions: This research indicates that minimally invasive debridement during the early postburn stage can effectively reduce wound infection rates, shorten healing times, and minimize the occurrence of scar hyperplasia and contracture deformities. Therefore, minimally invasive dermabrasion is valuable in treating deep second-degree facial burn wounds., Competing Interests: Declarations. Ethics approval and consent to participate: This study received approval from the Affiliated Hospital of Nantong University’s Ethics Committee (Ethics:2019-K059). Informed consent was obtained from all participants, and for those under 16 years, consent was provided by parents or legal guardians. Consent for publication: Written informed consent for the publication of identifiable images or personal clinical details was obtained from all participants or legal guardians for minors under 18 years. Conflicts of interest: The authors declare that they have no conflicts of interest to disclose., (© 2024. The Author(s).)

Reconstruction of the chin region represents a technical challenge due to its three-dimensional configuration and its location close to the mouth. It requires both a functional approach by restoring mobility and an aesthetic approach by restoring the perioral furrows. For men who want to wear a beard, it becomes more difficult to choose the donor site for hairy skin. In that case, strategies of full thickness skin graft or pre-expanded loco-regional flaps are unusable. We propose here a functional, aesthetic and hairy reconstruction by performing a pre-expanded temporal free flap which allowed to resolve the problem of adjacent cervical contractures and to restore an integrated the bearded chin subunit., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Deep burns to the upper abdomen that involve the submammary fold can lead to downward contracture and may cause significant asymmetry in a single breast, which can cause serious aesthetic and psychological problems, especially when they occur during childhood or before puberty. The objective of this study was to establish a practical treatment approach for postburn unilateral breast reconstruction after downward contracture., Method: We conducted this retrospective review of patients with postburn unilateral breast deformity who underwent reconstruction using the expanded lateral thoracic flap and torso advancement flap from 2016 through 2021. We collected data on various characteristics, including patient information, surgical procedure details, number of expanders used, reconstruction effectiveness, and postoperative breast development., Results: A total of 25 patients were included in the study, and all flaps survived. A total of seven complications related to the expander were recorded, including one hematoma, three port and tube issues, two cases of skin ischemia, and one instance of expander exposure. All complications were effectively managed through appropriate interventions. Breast position deviations were corrected, resulting in breast symmetry with the opposite side., Conclusions: The results of this study indicate that the expanded lateral thoracic flap and torso advancement flap procedure can effectively and safely restore the position of postburn breasts and promote symmetrical breast development. This procedure may be one of the options for reconstruction of postburn unilateral breast deformity., Competing Interests: Conflicts of interest and sources of funding: This research was supported by the following two funding sources: 1, Beijing Nature Science Foundation, no. 7242076; 2, Beijing Natural Science Foundation — Changping Innovation Joint Fund Project, no. L234067., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Postburn axillary contracture is a common complication that leads to functional impairment and unsatisfactory aesthetic outcomes. The authors present their experience with axillary contracture reconstruction using preexpanded brachial artery perforator propeller (BAPP) flaps and provide a systematic review of other regional or free flaps., Methods: This retrospective study included patients who underwent postburn axillary contracture reconstruction using preexpanded BAPP flaps from 2015 to 2022. Data on the flap characteristics and function of the affected shoulders were recorded. A systematic review was conducted by retrieving studies that assessed the outcomes of regional or free cutaneous/fasciocutaneous flaps for treating axillary contracture from PubMed, Web of Science, Embase, and Scopus published before October 1, 2023., Results: Twelve preexpanded BAPP flaps measuring up to 26 × 11 cm (mean, 116.9 cm 2 ) survived completely with no major complications, and the donor sites were closed primarily. The average range of shoulder abduction increased from 77.9 to 141.7 degrees ( P = 0.002). The systematic review included 34 articles, reporting 12 regional and 3 free flaps. The most commonly reported flaps were the thoracodorsal artery perforator flap, scapular flap, and parascapular flap. The overall complication rate ranged from 0 to 25%, and the average change in shoulder abduction ranged from 72.5 to 99.4 degrees., Conclusions: Preexpanded BAPP flaps can be used effectively for reconstructing postburn anterior axillary fold contracture. Donor-site availability and the specific axillary contracture type should be considered when selecting a regional or free flap., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: To determine if face, head, or neck burns increases risk of persistent sleep disordered breathing (SDB) or obstructive sleep apnea (OSA) after adenotonsillectomy., Methods: The TriNetX database was used to gather data for patients who had face, head, or neck burn including mouth and pharynx and history of sleep study with adenotonsillectomy. A comparison of persistent SDB or OSA was done between cohort 1, a group with sleep study and adenotonsillectomy after burn injury, and cohort 2, a group with treatment before a burn. Risk of persistence was evaluated as relative risk (RR) with 95 % confidence interval (CI)., Results: Eighty-three pediatric patients were included. Fifty-one patients were in cohort 1, and 32 in cohort 2. Forty-three patients in cohort 1 had persistent SDB or OSA as compared to 11 in cohort 2, which was statistically significant (RR: 2.45; 95 % CI: 1.50-4.02; p-value <0.0001). After propensity score matching, both groups had 23 patients, and 19 had persistent SDB or OSA in cohort 2, while cohort 1 had 10 patients. The difference in persistence was significant (RR 1.9; 95 % CI: 1.15-3.14; p-value equals 0.006)., Conclusions: Pediatric patients with a face, head, or neck burn had a higher rate of persistent SDB or OSA after adenotonsillectomy compared to patients who had surgery prior to thermal injury., Competing Interests: Declaration of competing interest There are no outside sources of funding and no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

We aimed to compare the scar quality and recovery rate of joint activity for patients with joint-involved burn injuries receiving either artificial dermis (AD) with split-thickness skin graft (STSG) or full-thickness skin graft (FTSG) for reconstruction. The primary outcomes were %skin graft (SG) take. Secondary outcomes included complications such as the infection rate and donor site morbidity, 12-month scar quality evaluated using the Vancouver scar scale (VSS), recovery rate of joint activity and incidence of scar contracture requiring further revision. Twenty-eight patients between 1 August 2021, and 1 August 2023, were enrolled. Twelve patients received AD-STSG while the other 16 patients underwent FTSG for reconstruction. The median %SG take was 95.0% (interquartile range [IQR] 6.3%) and 96.0% (IQR 10.0%) for the AD-STSG and FTSG groups (p = 0.71). The FTSG group had significantly better 12-month scar quality (median VSS 4.0 [IQR 1.3] vs. 6.0 [IQR1.5], p < 0.01) and recovery rate of joint activity (median 82.5% [IQT 15.0%] vs. 70.0% [IQR 7.5%], p < 0.01) compared with AD-STSG group. However, two patients in the FTSG group (12.5%) suffered partial wound dehiscence of the donor site, whereas no patients experienced donor site morbidity in the AD-STSG group (p = 0.49). The incidence of scar contracture requiring further revision was 25.0% (3/12) in the AD-STSG group and 12.5% (2/16) in the FTSG group (p = 0.62). In conclusion, AD-STSG could be an alternative treatment over FTSG for larger joint-involved burn wounds (>200 cm 2 ) owing to lesser donor site morbidity with admissible cosmetic outcomes and functional recovery., (© 2025 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

The hair-bearing superficial temporal artery flap is one of the traditional options for total eyebrow reconstruction. The anatomical variation of the superficial temporal artery has been well discussed; however, the anatomy of the superficial temporal vein is highly diverse. The authors report the use of preoperative computed tomography (CT) angiography in a 27-year-old man with a total eyebrow defect caused by thermal burn injury. The authors harvested a 6×1.5-cm pedicled hair-bearing superficial temporal artery flap from the area where the parietal branches of the superficial temporal artery and vein were running in close proximity, according to the CT angiography findings. Postoperatively, the flap survived completely without any vascular compromise. The authors believe that preoperative visualization of the superficial temporal vessels with CT angiography is highly beneficial in performing safe eyebrow reconstruction with a hair-bearing superficial temporal artery flap., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Deep dermal and full-thickness burns often result in scar sequelae such as contractures, hypertrophy, pain and itching following split-thickness skin grafting. Dermal substitutes are currently employed alongside split-thickness skin grafting to enhance clinical outcomes, though their indications remain a subject of ongoing debate. This systematic review aims to clarify the indications for the application of dermal substitutes in burn patients, in both acute and reconstructive settings. A comprehensive search across various databases was conducted. Studies (n = 190) assessing the indications and outcomes of dermal substitutes in acute burn patients and those requiring reconstructive surgery were included. Data extraction included the applied dermal substitute, age, total body surface area, wound depth, burn aetiology, anatomical site and exclusion criteria. The indications were derived from predetermined indications, i.e. inclusion and exclusion criteria and patient characteristics. The depth of the wound emerged as the primary indication for dermal substitute use. A one-stage approach is recommended for deep dermal to full-thickness wounds larger than 10 cm 2 , while a two-stage approach is advised for wounds of this depth with limited donor sites or exposed bone or tendon. No definitive age or burn/scar location thresholds were identified, and careful consideration is advised for electrical and chemical burns. Contraindications include wound infections and allergies to matrix components. Limited data exist on use in patients with diabetes mellitus, chronic vascular disease, or immunocompromised status. This is the first review to address the indications for dermal substitutes in burn patients, providing valuable insights for the development of international evidence-based treatment guidelines., (© 2024 The Author(s). Wound Repair and Regeneration published by Wiley Periodicals LLC on behalf of The Wound Healing Society.)

Early debridement of partial-thickness burns and coverage with skin substitutes is currently the standard of care in children, although there is currently no "gold standard" skin substitute. Our aim is to compare the effectiveness of three different skin substitutes, analyzing the medium- and long-term outcomes., Methods: A retrospective study was conducted on burn patients under 18 years admitted to our Burn Unit between 2015 and 2021, who were divided into 3 groups according to the type of skin substitute used (EZ-derm®, Biobrane®, and Suprathel®). Demographic and clinical data and short- and long-term outcomes were analyzed. Effectiveness was analyzed by escharectomy and grafting rate during acute management and long-term follow-up reintervention rate. A total of 378 patients were included (179 EZ-derm® group, 107 Biobrane® group, and 92 Suprathel® group). No differences in demographics or burn characteristics were observed between the groups. Patients treated with Suprathel® had a significantly shorter hospital stay (median 4 days (IQR 2-9)), a lower rate of escharectomy and grafting during acute management (21.1%), and a lower long-term follow-up reintervention rate (18.5%) when compared to the EZ-derm® group (median stay 9 days (IQR 6-13); escharectomy and graft 24.6% and reintervention 26.8%) and to the Biobrane® group (median stay 9 days (IQR 7-14); escharectomy and graft 32.1% and reintervention 26.2%)., Conclusion: Treatment of partial-thickness burns with Suprathel® is associated with a shorter hospital stay, lower need for escharectomy and grafting, and lower need for long-term reintervention. Therefore, it should be considered the treatment of choice for pediatric partial-thickness burns., What Is Known: • Different types of skin substitutes are available for the treatment of skin burns in paediatric patients., What Is New: • Suprathel® is linked to a reduction in hospital stays, a lower need for escharectomy and grafting, and a lower likelihood of requiring long-term re-interventions., Competing Interests: Declarations. Ethics approval: The protocol of the study obtained the approval of La Paz Hospital Institutional Review Board (IRB number PI-5041) and complied with the guidelines of the Declaration of Helsinki (as revised in 2013). Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: In resource-limited environments, it is critical to triage burn patients most likely to benefit from operative intervention. This study sought to identify patients with a more significant treatment effect after operative intervention following burn injury at a tertiary burn center in Lilongwe, Malawi., Methods: This is a retrospective analysis of burn patients presenting to Kamuzu Central Hospital from 2011 to November 2022. We compared patients based on whether they had scald or flame burns. Using logistic regression, we estimated the adjusted treatment effect of operative intervention on in-hospital mortality. Operative intervention was defined as burn excision and debridement with or without skin grafting., Results: We included 3266 patients. 2099 (64.7 %) patients had a scald burn, and 1144 (35.3 %) had a flame burn. 630 patients (19.3 %) underwent surgery. Crude mortality among all patients was 18.1 %, and for patients who underwent surgery, it was 9.7 %. When adjusted for total body surface area burned (TBSA) and age, the average treatment effect of surgery on mortality was - 0.07 (95 % CI - 0.11, - 0.033) for patients with scald burns and - 0.17 (95 % CI - 0.22, - 0.11) for patients with flame burns (Fig. 1). For patients with flame burns, the adjusted odds ratio of death associated with surgery was 0.26 (95 % CI 0.17, 0.39)., Conclusions: Operative intervention confers a survival advantage for patients with flame burns, and the average treatment effect was more significant compared to patients with scald burns. In general, in resource-limited environments flame burns should be prioritized for surgery over scald burns to improve patient outcomes., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to disclose. The authors have no financial relationships to disclose., (Copyright © 2024 Elsevier Ltd and ISBI. All rights reserved.)

Background: Opioid consumption for analgesia in burn patients is enormous. Non-opioid analgesics for burn pain management may result in opioid sparing, reducing opioid-related adverse reactions and drug tolerance or addiction., Methods: A dual-center, randomized controlled trial assessed Esketamine for the perioperative period in patients with severe [20-50 % total body surface area (TBSA)] and extensive (≥ 50 % TBSA) burns, comparing analgesia with standard anesthesia. Sixty patients were randomly allocated (1:1 ratio) to two arms. In the Treatment Arm, patients received intra-operative Esketamine and postoperative intravenous primary intelligent analgesia pump with Esketamine. Patients in the Control Arm received the same intervention as Treatment Arm without Esketamine. The primary endpoint was subjective analgesic efficacy (SAE) evaluated on Day 28 or the day before hospital discharge. Secondary outcomes included the postoperative Numeric Pain Rating (NPR) Scale at rest (NPRr) and during movement (NPRm) and opioid consumption. Gastrointestinal dysfunction Scores (GIDS) and serum markers of intestinal injury [intestinal fatty acid-binding protein 2 (iFabp2) and apolipoproteinA2 (ApoA2)] were measured in the 1st and 4th post-injury weeks. Depression and sleep quality were assessed by relevant questionnaires., Results: Fifty-five patients were included in the analysis. Esketamine-treated Arm recorded a better analgesic efficacy than the Control Arm (proportion of patients with Grade 1 or 2 SAE scores, 67.9 % vs. 40.7 %, p = 0.022). Esketamine-treated patients had lower NPRm values (p = 0.033) and lower daily opioid consumption (p = 0.033) when compared with Controls. Esketamine-treated patients showed comparable gastrointestinal recovery to those in the Control Arm. The overall sleep quality might be improved in the Treatment Arm., Conclusions: Esketamine use is safe for perioperative primary intelligent analgesia of severe burns, resulting in improved resting pain control and lower opioid requirements., Trial Registration: The trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn/) (ChiCTR2000034069)., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Advancements in resuscitative care and burn surgery have improved survival rates after extensive burn injuries, shifting focus to enhancing the quality of survival. Conventional treatment with split-thickness skin grafts (STSG) presents limitations such as donor-site morbidity, limited availability in extensive burn injuries, and hypertrophic scarring. Tissue engineering aims to address these drawbacks by developing optimal skin substitutes. This systematic review aims to provide an overview of the current applications of cultured cells in burn surgery, encompassing diverse approaches and addressing existing challenges to enhance burn wound management and improve patient outcomes., Methods: Following PRISMA guidelines, a comprehensive search was performed across three databases (PubMed, Embase, Cochrane Library) for articles on cultured cell use in burn treatment. Only clinical studies were included. Articles were screened by two independent reviewers. Quality assessment was performed., Results: The search yielded 167 articles, of which 14 met the eligibility criteria. The selection included 8 randomized controlled trials, 5 prospective cohort trials, and 1 retrospective cohort study. Various tissue-engineered skin substitutes, from cultured epidermal autografts to dermal regeneration templates seeded with cultured cells, showed promising outcomes. Several substitutes exhibited take rates comparable to STSG with improved scar quality., Conclusion: Results are promising, though standardization of cultured skin substitutes and robust clinical trials with larger populations and appropriate comparators are still lacking., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Early wound coverage is one of the most essential factors influencing the survival of extensively burned patients, especially those with a total body surface area (TBSA) burned greater than 50 %. In patients with limited donor sites available for autografting, techniques such as the Meek micrograft procedure or cultured epidermal allografts (CEA) have proven to be viable alternatives. In this systematic review and meta-analysis, we analyzed the outcomes of different wound coverage techniques in patients with massive burn injuries ≥ 50 % TBSA in the past 17 years., Methods: The EMBASE, PUBMED, Google Scholar and MEDLINE databases were searched from inception to December 2022 for studies investigating major burn reconstruction (>50 % TBSA) with the use of one of: a) autografts, b) allografts, c) cell-based therapies, and d) Meek micrografting. The review was conducted in accordance with the PRISMA guidelines. The outcomes evaluated were mortality, length of hospital stay, graft take and number of operations performed., Results: Following a two-stage review process, 30 studies with 1369 patients were identified for analysis. Methods of coverage comprised the original autografting, and the newer Meek micrografting, CEA autografting, and allografting. Pooled mean age of the entire cohort was 32.5 years ( ± SE 3.6) with mean burn size of 66.1 % ( ± 2.5). After pooling the data, advantages in terms of mortality rate, length of stay, graft take and number of required surgeries were seen for the Meek and CEA groups. Mortality was highest in patients treated with autografts (50 %) and lowest with cell-based therapy (11 %). Length of stay was longest with cell-based therapy (91 ± 16 days) and shortest with Meek micrografting (50 ± 24 days). Graft take was highest with autografts (96 ± 2 %) and lowest with cell-based therapy (72 ± 9 %). Average number of operations was highest with cell-based therapy (9 ± 4) and lowest with Meek micrografting (4 ± 2)., Conclusions: Comparison of the four techniques highlighted differences in terms of all outcomes assessed, and each technique was associated with different advantages. Interestingly autografting, the option with the highest graft take rate, was also associated with the highest mortality. This study not only serves to provide the first comparison of the most commonly used techniques in major burn reconstruction, but also highlights the need for prospective studies that directly compare the efficacy of the different techniques to ultimately establish whether a true superior option exists., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests. The authors declare that they have not received funding in any form for this work., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

This investigation delineates the evolution and prospective utilisation of an innovative two-blade dermatome, designed for the concurrent harvesting of a conventional split-thickness skin graft (STSG) and an additional dermal graft within the same surgical harvest. Historically, the extraction of dermal grafts has encountered substantial technical impediments, contributing to its limited acceptance and utilisation in clinical practice. The prototype dermatome, introduced in this technical note, offers a solution that could facilitate the more extensive adoption of dermal grafting techniques. The dermal segment of an STSG, obtained as a second graft, confers four notable advancements: First, employing solely the dermal component for grafting and repositioning the uppermost skin flap to the donor site, markedly diminishes donor site morbidity. Second, owing to its elasticity, the dermal graft reduces the need for meshing, thereby enhancing cosmetic outcomes. Third, utilising both the uppermost skin layer and a deeper dermal layer for the recipient site can reduce donor site areas. Fourth, the dermal segment of the graft can serve as a dermal matrix in reconstructive procedures, potentially reducing the need for an allogenic dermal matrix and obviating the subsequent STSG; the dermal graft may heal independently, eliminating the need for an additional conventional STSG. The findings of this study, predicated on the application of a first-generation two-blade dermatome on four cadavers, demonstrate the feasibility of extracting at least two distinct grafts with pre-determined thicknesses in a single, technically less challenging, surgical harvest procedure. In conclusion, this proof-of-concept research elucidates the feasibility of a two-blade dermatome, capable of simultaneously yielding at least one conventional STSG and one dermal graft, thereby simplifying skin graft harvesting. Although these preliminary investigations were conducted on human cadavers, the results hold promise for the development of two-blade dermatomes and represent a significant advancement in skin graft harvesting. Further research is imperative to refine the prototype and to broaden our comprehension of the potential applications of dermal grafting in various clinical scenarios., Competing Interests: Conflict of Interest The authors declare that there is no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Burn injuries pose significant challenges in healthcare, with Integra dermal regeneration template (DRT) emerging as a prominent solution to enhance wound healing and recovery. Although there is no clear consensus on its technical use and application. We convened a panel of 14 burn specialists aiming to provide consensus regarding the application and usage of Integra in managing burn wounds., Methods: Panelists employed a modified Delphi technique to assess agreement and provide feedback on 81 initial statements covering various aspects of Integra DRT application in burn wound care over three subsequent rounds. This study was endorsed by the Italian Society of Burn Surgery (SIUST)., Results: Fourteen heads of burn unit departments participated in the Delphi process. At the end of the third round and subsequent discussion on the final statement list, the panel achieved consensus on 24 statements shaping recommendations for Integra application across various aspects, including wound bed preparation, acellular dermal matrix application, definitive coverage, and complication management., Conclusion: The resultant 24 finalized statements from this Italian consensus offer a comprehensive and practical framework for employing Integra DRT in burn patient care. Reflective of specific Italian expertise and practice, these recommendations supplement and refine existing literature, serving as a dynamic guide subject to periodic updates aligned with evolving evidence and experience in the field of burn surgery., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest. The ethics committee of the lead institution confirmed that no ethical approval was required for this study., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Autologous fat grafting (AFG), mostly in combination with adhesiolysis, has become the workhorse for reconstructing a dysfunctional or absent subcutaneous layer. In a previous study we showed that fat grafts isolated by centrifuging led to more than 20 % improvement in scar pliability. Nevertheless, there is still debate on which technique should be used to process and purify fat grafts. Therefore, a cohort with matured scars was obtained using the same study protocol but with filtration as processing technique. Scar quality was evaluated by the Patient and Observer Scar Assessment Scale (POSAS version 2.0), the Cutometer (pliability) and the DSM II ColorMeter (erythema and melanin). Scar evaluation was performed pre-operatively (baseline) and at 3 and 12 months after AFG. Between 2014 and 2018, 46 patients were included. Mean scar age was 20 ± 17 years and the majority of scars was caused by burns. Compared with baseline, patients showed improvement in scar quality measured by POSAS items at 12 months follow-up. The item score of 'pliability' improved the most from 7.4 to 5.8 (p = 0.001). Item scores of 'pain', 'itch' and 'color' also improved significantly. Clinicians also scored 'pliability' as most improved, but this was not statistically significant (p = 0.111). Objectively measured pliability and erythema and melanin showed no statistically significant differences at 12 months follow-up. Patient-reported outcomes revealed a significant improvement in scar quality, especially scar pliability, after AFG processed by filtration in patients with adherent scars. However, no scar quality improvement was found when assessed with objective tools., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd and ISBI. All rights reserved.)

Objective: This article aimed to ascertain the application of problem-based learning (PBL) combined with micro-video teaching in burn surgery teaching and its impact on satisfaction with teaching., Methods: Fifty clinical medical students who were interns at our hospital from November 2022 to October 2023 were selected as the study subjects and randomly separated into the control group ( n  = 25) and the observation group ( n  = 25). The control group adopted traditional teaching methods. The observation group employed PBL combined with micro-video teaching mode. The scores of theory tests and skill tests, the critical thinking capability, the students' evaluation of teaching methods, the scores of teachers for teaching methods, and the scores of interns for teaching satisfaction were compared., Results: The observation group possessed higher scores on theory tests and skill tests, greater critical thinking ability after teaching, higher evaluation of teaching methods and more satisfaction with their internships versus the control group (all p  < 0.05)., Conclusion: The application of PBL combined with micro-video teaching in the teaching of burn surgery can improve students' thinking ability and their satisfaction with teaching.

Introduction: Despite the multitude of preventative methods, postburn hand contractures are poorly controlled and often require surgery. However, there is no consensus on which hand reconstruction technique is most efficacious. This systematic review aims to compare the efficacy of available postburn hand contracture reconstruction techniques over the long term and to evaluate the quality of current literature. Effectiveness is assessed with functional improvement, increase of skin surface area, and scar quality/enhanced cosmesis., Material and Methods: Four medical databases/registries were searched (PubMed/MEDLINE, Scopus, Cochrane, EMBASE) alongside grey literature sources from December 2012 to November 2022 for randomized controlled trials and observational studies with ≥ 15 participants and ≥ 3-month follow-up. Exclusion criteria were acute burn management, non-burn/non-hand contractures, non-surgical management, other burn sequelae, non-English studies, and outcomes reports, reviews, communications, editorials, letters, case reports, and non-human studies. Quality was assessed with the Joanna Briggs Institute checklist and GRADE., Results: Seven observational studies (1310 patients) were eligible; three with a pre-/post-operative design and four comparative cohorts. Functional and aesthetic/scar quality outcomes for skin grafting and random or defined-vascularization flaps, complication rates and rehabilitation modalities were reported. No studies on dermal substitutes or utilising skin surface area measurements were identified. Significant risk of bias, indirectness and imprecision were noted in all studies, deriving from absence of randomization, blinding, or independent control groups; confounding; missing data; and subpar reporting. Owing to heterogeneity in outcome measures, meta-analysis was not possible., Conclusions: No consensus remains on the superiority of a single reconstruction technique. Meticulous preoperative planning and intensive rehabilitation are vital. A stepwise approach, considering individual patient and contracture characteristics and the limitations of each technique, should be followed. Well-designed and conducted future studies, utilizing reliable and validated contracture description methods and outcome assessment, are now imperative., Competing Interests: Declaration of Competing Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 International Society of Burns Injuries. All rights reserved.)

Objective: This study aimed to examine the prevalence and predictors of reconstructive surgery among pediatric burn patients in the Netherlands., Methods: Pediatric burn patients were identified through the Dutch Burn Repository R3. Eligibility criteria included a burn requiring hospital admission or surgical treatment at one of the Dutch burn centers in 2009-2019. First, patient, burn, and treatment characteristics were summarized using descriptive statistics. Second, time to the first reconstructive surgery was modelled using Kaplan Meier curves. Third, a prediction model was developed using univariate and multivariate logistic regression. The model's performance was assessed using calibration, discrimination, and explained variance. Fourth, internal validation was performed using bootstrapping., Results: Approximately three percent (n = 84) of pediatric patients (n = 3072) required reconstructive surgery between the initial burn-related hospital admission and September 2021. Median time to the first reconstructive surgery was 1.2 (0.7-1.6) years. Most surgeries were performed on the face, arm, neck, hand, or anterior trunk, owing to contractures or hypertrophic scarring. Predictors of reconstruction included the etiology, anatomical site, extent of full-thickness burn, surgical treatment in the acute phase, and length of hospital stay., Conclusion: Our study provided an overview of the prevalence and independent predictors of reconstructive surgery in the pediatric burn population., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: While there is no consensus on the best surgical procedure for post-burn axillary contractures, it is crucial to consider the elongation rate along the scar axis as a useful measurement index for determining the optimal surgical approach. The square flap and five flap z-plasty techniques are commonly employed scar lengthening procedures to address scar contractures in the axilla. These approaches successfully disrupt the linear scar, leading to significant elongation while reducing transverse tension. Our study aims to compare the increase in band length and functional results of these two approaches for treating post-burn contractures in the axilla., Methods: A retrospective study was carried out utilizing data from 34 patients with mild-to-moderate band-like contractures located on the anterior or posterior axillary lines who underwent surgical correction through either the square flap method or five-flap z-plasty technique. The effectiveness of surgical methods was evaluated using two objective indices: improvement in contracture band length and improvement in abduction angle at the shoulder joint., Results: All patients achieved complete contracture release. There is no statistically significant difference between the two groups regarding the improvement in the degree of abduction postoperatively. Although there was a significant increase in the length of the contracture band postoperatively in both groups, the average increase in length for cases treated with a square flap was significantly greater than those managed with a five-flap Z-plasty (87.7 ± 44.8 % vs. 38.80 ± 11.119 %,) respectively., Conclusion: The square flap technique is considered a better alternative to the commonly used 5-flap Z-plasty method because it can achieve higher elongation in the contracture band, restore joint function, and create optimal shape when dealing with single linear band contractures over the axilla., Competing Interests: Declaration of Competing Interest Not declare., (Copyright © 2024 Elsevier Ltd and ISBI. All rights reserved.)

Background: The relative effectiveness of early excision and autografting (EG) for deep-partial thickness burns needs to be updated through comparison to initial non-operative (INO) treatment using modern interactive antimicrobial (IA) dressings in a South-Asian burn patient population., Objective: To compare the outcome of early tangential excision and autografting (EG) to initial non-operative (INO) treatment using interactive antimicrobial dressing., Methods: Records of 106 adult burn survivors with predominantly deep-partial thickness thermal burns of TBSA ≤ 30 % were retrospectively reviewed (53 patients each in EG-arm and INO-arm). EG-arm patients underwent excision and autografting within 7 days. INO-arm patients, who had opted against surgical excision, received interactive antimicrobial dressing (hydrofiber with ionic silver). Outcomes measured include percentage of wound healed on days 14 and 21, days to complete wound healing, duration of hospital stay, complications (on 12 months' follow-up) and patient satisfaction scores. Patients were analyzed as treated., Result: Patients in each arm had similar TBSA and demographic profiles. In EG-arm patients, 15-20 % of TBSA were grafted on 5.02 ± 0.71 post-burn day. Thirty percent of EG-arm patients required a second session of grafting for the remaining burn wound, which occurred on 6.873 ± 0.34 post-burn day. On the 21st post-burn day the EG-arm, compared to the INO-arm, had a higher percentage of wound epithelization (98.60 ± 4.03, versus 76.16 ± 7.02, P < 0.01), less days to complete healing (17.60 ± 5.83, versus 40.16 ± 9.09, P < 0.01), and shorter hospital stays (19.62 ± 6.85 days, versus 35.56 ± 7.77 days, P < 0.01). Twenty-five (47 %) INO-arm patients underwent delayed grafting on post-burn day 25.42 ± 0.49. The INO-arm suffered significantly more complications, such as hypertrophic scar, dyspigmentation and functional disability (P < 0.05). EG-arm patients were more satisfied than INO-arm patients (P < 0.01)., Conclusion: We report superior outcomes in the early tangential excision and autografting-arm as compared to the initial non-operative treatment arm. The dogma of early excision and autografting remains valid despite significant advances in wound dressing materials., Competing Interests: Conflict of interest statement All the authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Reports on treatment characteristics and long term outcomes for severe burns are scarce, while the need to compare outcomes of novel treatment modalities to standard of care is increasing. Our national database on burn treatment enabled analysis of patient as well as treatment characteristics during acute treatment and following reconstructive procedures. Furthermore, outcome data of longitudinal scar assessments were analysed from a single burn centre database. Acute and reconstructive data were analysed for patients admitted to the three Dutch burn centres with total body surface area burned of ≥ 20% TBSA. Long term outcome was analysed from a single centre scar database, both for a period of 2009-2019. Treatment characteristics from 396 surviving acute burn patients were analysed. Surgical treatment was required in 89.6% of these patients and 110 patients (27.8%) needed reconstructive surgery in the years after the burn incident, with a mean of 4.4 reconstructive procedures per patient. Main indications were contractures (70.5%) and arms (45.0%) and head and neck region (41.2%) were most frequently affected. Techniques used for reconstructive corrections were predominantly excision, release and flaps (54.7%), followed by skin transplants (32.4%). Scar quality was significantly worse in patients with more severe burns compared to those with TBSA < 20% during prolonged times. These data provide insight into health care utilization, treatment characteristics and outcomes in severely burned patients. These real-world data can guide future development of improved treatment strategies for at risk patients as well as anatomical locations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Smit et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Burn care continues to improve and larger total body surface area (TBSA) burn survival is increasing. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar-related complications. Prior work has shown low rates of follow-up for burn survivors linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow-up and reconstructive surgery rates in massively burned patients. Patients who survived to discharge with >50% TBSA burns and planned return to the treating institution were included in the study. Univariate and multivariate analyses were performed on the data collected. Sixty-five patients were included with an average TBSA of 63.1%. Fifty-three patients (81.5%) attended at least one follow-up appointment with median of 4 follow-up appointments. Younger patients (33 ± 9 vs 44 ± 11; P = .0006), patients with larger TBSA burns (65 ± 13 vs 55 ± 5%; P = .02), those with private insurance, and those without housing insecurity (1.8% vs 45.4%; P = .003) were more likely to follow up. On multivariate regression analysis, patients with housing insecurity were independently associated with lack of follow-up (OR: 0.009; CI: 0.00001-0.57). Thirty-five patients had at least one reconstructive surgery and 31 patients had reconstructive surgery after discharge. No patients with housing insecurity underwent reconstructive surgery. Follow-up rates in massive burns were higher than reported for smaller TBSA burns and more than half received reconstructive surgery. Housing-insecure patients should be targeted for improved follow-up and access to reconstructive surgery., (Published by Oxford University Press on behalf of the American Burn Association 2024.)

Some severe burn injuries may warrant amputation; however, the physical and functional adjustments resulting from postburn amputation can have long-term consequences. This study investigates longitudinal functional and psychosocial outcomes among pediatric burn amputees. Pediatric participants enrolled in the Burn Model System national longitudinal, multicenter database between 2015 and 2023 with postburn amputations were included. Participants with amputations were matched using nearest-neighbor matching to those without amputations based on burn location, age, and % total burn surface area burn size. Primary outcomes were the Patient-Reported Outcomes Measurement Information System Pediatric-25 Profile v2.0 Physical Function and the Children Burn Outcomes Questionnaire: appearance subscore, both measured at 6-, 12-, and 24 months postburn. In this study, 17 participants had amputations, and 17 did not (matched participants). Pairwise analyses at each timepoint found those with amputations reported significantly lower physical function scores at 24 months postburn (54.9 ± 11.6 vs 66 ± 5, P = .013). No significant differences were found in appearance scores. This study suggests that pediatric burn amputees may potentially face greater physical impairment long-term, highlighting an important area of research that deserves further attention., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Autologous skin cell suspension (ASCS) is an adjunct to conventional split-thickness skin grafts (STSG) for acute burns, enhancing healing and reducing donor site requirements. This study validates ASCS's predictive benefits in hospital stay reduction and cost savings by analyzing outcomes and real-world charges post-ASCS implementation at a single institution. A retrospective study (2018-2022) included burn patients with ≥10% TBSA. The study population comprised 2 groups: burns treated either with a combination of ASCS ± STSG or with STSG alone. Outcomes included LOS, surgeries, infection, complications, days on antibiotics, and adjusted charge per TBSA. The ASCS ± STSG group demonstrated significantly shorter LOS (Mdn: 16.0 days, IQR: 10-26) than the STSG group (Mdn: 20.0 days, IQR: 14-36; P = .017), and fewer surgeries (Mdn: 1.0, IQR: 1-2) versus the STSG group (Mdn: 1.0, IQR: 1-4; P = .020). Postoperative complications were significantly lower in ASCS ± STSG (11% vs. 36%; P < .001). The STSG group had a longer distribution of antibiotic days (IQR: 0-7.0, min-max: 0-76) than the ASCS ± STSG group (IQR: 0-0, min-max: 0-37; P = .014). Wound infection incidence did not differ (P = .843). ASCS ± STSG showed a lower distribution of adjusted charge per TBSA (IQR: $10 788.5-$28 332.6) compared to the STSG group (IQR: $12 336.8-$29 507.3; P = .602) with a lower mean adjusted charge per TBSA ($20 995.0 vs. $24 882.3), although this was not statistically significant. ASCS ± STSG utilization demonstrated significant reductions in LOS, surgeries, postoperative complications, antibiotics, and potential cost savings. These findings underscore the practicality of integrating ASCS in burn management, offering substantial benefits to patients and healthcare institutions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Dermal substitutes have been introduced in burn care to improve wound healing outcomes; however, their use remains limited in standard treatments. This systematic review and meta-analysis aimed to evaluate the outcomes of dermal substitutes in patients with burns and patients requiring burn scar reconstruction and subsequently contribute to optimising the integration of dermal substitutes into clinical practice and reducing the knowledge gap. A comprehensive search across various databases included human studies from peer-reviewed journals on dermal substitutes for deep dermal and full-thickness burns, and scar reconstruction across all ages. Data from comparative trials were extracted, focusing on patient and wound characteristics, treatment specifics, and outcomes related to wound healing and scar quality. Meta-analysis was performed on trials reporting similar post-burn measures, with statistical heterogeneity assessed. Outcomes were presented using mean differences or odds ratios with 95% confidence intervals. A total of 31 comparative trials were included. The overall quality of the studies was considered moderate. The meta-analysis indicated delayed re-epithelialization 4-7 days after treatment with a collagen-elastin matrix compared to split-thickness skin graft in acute burns (-7.30%, p = 0.02). Significant improvement in subjective scar quality was observed with acellular dermal matrix compared to split-thickness skin graft in acute burn wounds 6 months post-operative (-1.95, p <0.01). While acknowledging the initially delayed wound healing, incorporating dermal substitutes into the surgical treatment of burn patients holds promise for enhancing scar quality. However, future research must prioritise outcome measure uniformity, address variations in dermal substitute application, and standardise indications for consistent and effective practices., (© 2024 The Author(s). Wound Repair and Regeneration published by Wiley Periodicals LLC on behalf of The Wound Healing Society.)

Severe burns on the forehead are rare; well-conducted initial surgical treatment also limits the occurrence of sequelae. Therefore, indications for repairing the forehead arise from complex burns often extending to adjacent units. Repair techniques depend on the location and size of the lesions, associated nearby damage, and the patient's ability to withstand the burden of treatment. Management at the acute stage determines the sequelae; excision-grafting is the standard treatment, but it yields good results only if the fundamental principles of repair are respected: intervention within the 10th and 15th days post-burn, graft harvesting from the cephalic extremity or the upper part of the thorax and arms, and respect for the frontal unit. Sequelae management follows the same imperatives and typically requires skin expansion: front expansion for skin flaps if enough frontal skin is still available, upper thorax expansion for full thickness skin grafts if the frontal scar is too extensive. However, the excellent results obtained should not conceal the significant constraints associated with skin expansion., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Aim: Genital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients., Materials and Methods: From 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called "reverse circumcision," which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months., Results: The reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery., Conclusions: Compared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

Background: Autologous skin grafting has been the popular method for reconstructing post-burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post-burn scar contracture in the lower and upper extremities and trunk., Method: Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree-linked flaps for the correction of post-burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self-report questionnaire for upper extremity reconstruction., Result: Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58., Conclusions: Three-dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post-burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction., (© 2024 Wiley Periodicals LLC.)

Background: Autologous fat transfer (AFT) has been proposed as a possible treatment for scar tissue and its associated symptoms. Its effectiveness's evidence is yet unidentified though. The aim of this meta-analysis is to evaluate the currently available evidence on the efficacy and safety of autologous fat transfer in treating post-burn and post-traumatic scars using a validated scar measurement tool., Methods: This study performed a systematic literature review in November 2023 using the following electronic databases: MEDLINE, SCOPUS, Directory of Open Access Journals (DOAJ), PUBMED, and Google Scholar. The following key terms were included: (Fat grafting OR Autologous fat transfer) AND (body scars OR body burns OR body wounds) AND (Efficacy OR Safety OR satisfaction). We evaluated articles according to predefined quality criteria. The following data were included during the extraction period: patient demographics, indications for AFT, the number of AFT sessions, follow-up periods, and changes in the Patient and Observer Scar Assessment Scale (POSAS) scores, which contain both the patient and observer components., Results: This study included 1326 patients and 23 published articles. A total of 14 prospective studies, 7 retrospective studies, and 2 Randomized clinical trials studies were evaluated. These 23 articles came from diverse global locations; the earliest was published in 1992, and the most recently published in 2022., Conclusion: Our findings demonstrated significant enhancements in scar characteristics from both patient and observer perspectives. Overall, AFT holds promise as a valuable treatment option for scar-related conditions as it enhances scar quality ,contributing to improved patient outcomes and satisfaction., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Burns of the hand are prevalent and must be managed aggressively in the acute phase to prevent deformity and disability. Proper early wound management, achieving durable soft tissue coverage, and appropriate positioning in the acute period offer substantial benefits to patients long-term. When contractures occur, secondary procedures are often indicated, and they range from laser therapy to local/regional flap coverage; rarely free flaps are used. Boutonniere deformities are common, and unfortunately, at times finger amputation renders the hand more functional than further efforts at reconstruction., Competing Interests: Disclosure The authors have no financial relationships to disclose., (Published by Elsevier Inc.)

Introduction: A common treatment for large deep-to-full-thickness burns is excision and grafting with a widely meshed split-thickness skin graft (mSTSG). Due to the differential healing of the interstices and adhered split-thickness skin graft, wound patterning and delayed wound healing are common outcomes of this treatment. Delayed healing may increase infection rates and wound care requirements, while wound patterning may be psychologically and aesthetically consequential for patients. Autologous skin cell suspension (ASCS) can be used to "over spray" a meshed autograft. It was hypothesized that the use of ASCS combined with mSTSG would increase the rate of wound healing and decrease patterning in healed burn wounds., Methods: Full-thickness burns or excisional wounds (n = 8 each) were created in red Duroc pigs and received 4:1 mSTSGs after wound bed preparation. Half of the wounds received ASCS and half did not at the time of grafting. Percent re-epithelialization, patterning, rete ridge ratio, cellularity, dermal and epidermal thickness, immunofluorescent S100β staining, and melanin index were assessed for each scar., Results: Wounds that received ASCS exhibited increased rates of re-epithelialization (burn +ACSC versus burn-ASCS; day 3 (53.9 ± 3.1 versus 34.3 ± 3.3, P = 0.009): day 5 (68.1 ± 1.6 versus 40.8 ± 3.2, P < 0.001)). Excision +ASCS versus excision-ASCS; day 7 (98.1 ± 1.2 versus 86.4 ± 2.0, day 7 P = 0.022) compared to wounds not treated with ASCS. There was no difference in rete ridge ratio, cellularity, dermal thickness, epidermal thickness, S100β staining, melanin index, or patterning was measured between wounds that received ASCS and those that did not., Conclusions: The addition of ASCS to 4:1 mSTSGs leads to increased rate of wound healing but does not impact the degree of patterning in this model, suggesting that ASCS application likely robustly transfers keratinocytes but not functioning melanocytes at acute timepoints., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to compare the improvement in abduction and change in web slope between 5-flap z-plasty and double z-plasty for post-burn or post-trauma interdigital pocket web contractures., Methods: We retrospectively reviewed 16 webs in 11 patients with post-burn or post-trauma interdigital pocket web contractures. Seven patients underwent 5-flap z-plasty and 4 double z-plasty. The abduction and slope angles of the affected fingers were measured before surgery and every 3 months after surgery., Results: The follow-up time ranged from 12 to 36 months. The postoperative abduction angle improved in both groups. There was an increase of 19° ± 4° in the mean abduction angle after surgery in the 5-flap z-plasty group compared with a mean of 12° ± 2° in the double z-plasty group; the postoperative decrease in the web slope angle was 30° ± 5° and 22° ± 2°, respectively. All patients were able to actively move the affected webs and fingers with no pain or other discomfort., Conclusions: Five-flap z-plasty can be considered a better alternative to double z-plasty for interdigital pocket web contractures based on the improvement in abduction angle and changes in the slope angle., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

The most common cited cause of split-thickness skin graft failure is infection and due to the association between bacterial findings in wound beds an attempt to decrease the bacterial burden before skin-grafting evolved. Thus, preoperative microbiology swabs of the wound bed became routine at some institutions prior to grafting. This is not standard practice in the Pietermaritzburg Burn Service. Emphasis is instead placed on a strict protocol of intraoperative wound bed preparation to promote adequate graft take. This pilot study aims to evaluate whether preoperative wound swabs are appropriate. We performed a prospective observational study to determine if positive wound cultures were associated with graft failure. All patients with a burn surface area of less than 10%, where delayed grafting (later than 28 days from the time of burn injury) was performed, from March to December 2021 were analyzed. Patient demographics, days from burn to graft, %TBSA burn, %TBSA grafted, whether sharp debridement prior to grafting in the same procedure was performed or not, use of topical gentamicin intraoperatively, graft outcome (% graft loss), need for regraft, and organism grown were recorded into an excel spreadsheet for analysis. The sample included 52 patients. Of these, 17 (31.5%) were female. The median %TBSA grafted was 8% (IQR 4%-13%) and similar in both groups. The median days from burn to grafting were 35 days. Thirty-nine patients (75%) had graft Take and 13 (25%) had graft Failure. In the failed group, the median % graft failure was 50% (30%-70%). Of the group with successful graft take, 90% were noted to have had a positive wound culture prior to grafting. A positive wound culture was not found to be a risk factor for graft failure (P = .993). Despite the positive wound cultures graft take was more than 90% in 75% of grafts performed and only 2/52 patients required supplementary grafting. We believe that this demonstrates that our local protocol is reasonable in this setting and that waiting for negative wound swabs prior to grafting should not be a reason to delay grafting., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

There is no consensus on the optimal management of diabetic foot burn injuries. Here, we systematically identify studies reporting on diabetic foot burns and evaluate outcomes among patients managed operatively vs nonoperatively. PubMed, Embase, and Web of Science were searched. Screening was performed by independent reviewers. Primary research studies with English full texts published between 1980 and 2023 that discussed outcomes of foot burns in adults with diabetes were included and critically appraised using validated tools. Results are presented using descriptive statistics of aggregated data. The search yielded 2402 nonduplicate papers, of which 35 met the inclusion criteria. Nine papers were included for meta-analysis, including 7 retrospective comparative analyses, 1 cross-sectional study, and 1 retrospective chart review. There were 1798 diabetic foot burn patients. The mean age was 58.2 years (SD 4.12), and 73.1% (n = 1314) were male. A total of 15.7% (n = 283) of patients were surgically managed, including debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). The secondary amputation rate, defined as amputation following initial surgery, was 4.9% (n = 14). The overall amputation rate was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). One study reported functional status at the last visit. Diabetic foot burns are highly morbid. The surgical management of these complex injuries is high risk, as amputation results in poorer quality of life and functional outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Postburn flexion contracture of the hand in children constitutes a significant proportion of postburn complications. We compared the early clinical outcomes of reconstruction of pediatric postburn flexion contracture of the digits of the hand using tourniquet or tumescent technique. A prospective randomized study of pediatric patients requiring contracture release and wound resurfacing with full-thickness skin graft between September 2020 and August 2021. Patients were randomized into groups of either tourniquet or tumescent technique for contracture release. The surface area of graft take and total active motion across joints were the outcome measures. Student t test and chi-square test were performed. Twenty-two patients were randomized into either group. The mean age of the participants was 6.09 ± 2.41 years, mostly males 31 (72.1%). A grade 3 flexion contracture was the most common (72.1%). Ninety-four digits and 178 joints were operated on, with the proximal interphalangeal joint being the most common (48.9%). The mean surface area of graft take on postoperative day 10 was significantly higher for the tumescent group than the tourniquet group, P = .001. The total active motion across the joints at 6 and 9 weeks postoperative showed a strong correlation between the total active motion across joints and the technique of release, P = .004 and .001, respectively. Tumescent technique is a feasible alternative to the tourniquet method for postburn flexion contracture release of the digits in the pediatric burned hand., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The management of acute burn pain poses significant challenges. Regional techniques have become increasingly popular in perioperative burn pain management. Continuous nerve block catheters are particularly useful for split-thickness skin grafts where donor site pain can exceed that of the burn-injured site. Donor skin is frequently harvested from the anterolateral thigh. The fascia iliaca (FI) compartment block provides blockade of both the lateral femoral cutaneous nerve and the femoral nerve, and thus, it is a useful modality for burn donor pain. Our institution initiated a protocol in which continuous FI catheters were placed in patients undergoing split-thickness skin grafting of the anterolateral thigh. This retrospective review seeks to assess the impact of this modality on postoperative pain scores and opioid requirements. Oral morphine equivalent (OME) administration was significantly lower in the FI group than the control group, starting with POD 0, which is the day of the FI catheter insertion (188 vs 327 mg, P < .001). Over the next 4 postoperative days (PODs), OME administration remained lower in the FI group compared to control patients, although not statistically significant on PODs 3-4. There was a significant difference in OME administered between the FI group and the control group on POD 5 (159.5 vs 209.2 mg, P < .05). Our retrospective study evaluating the role of FI catheters in burn patients undergoing split-thickness skin grafting surgery showed significantly lower opioid consumption on PODs 1-5 compared to patients without an FI catheter., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)