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Background: Starting infusion at a rate based on the Baxter formula is the global standard. However, with this infusion formula, an excessive amount of fluid may be stored inside the body (fluid creep), which may lead to severe respiratory disorders or abdominal compartment syndrome. The present study explored whether the Baxter formula or the Modified Brooke formula is more beneficial for resuscitation in extensively burned patients. Methods: The study design was a randomized controlled trial. One group received conventional intervention based on the Baxter formula, and the other received intervention using the infusion method by the Modified Brooke formula. Thirty-nine patients were enrolled in this study by admission to each hospital for 3 years. Of the 39 cases, 3 dropped out according to the study protocol, so 36 cases were analyzed, and 17 patients in the Modified Brooke formula group and 19 in the Baxter formula group were used for the analyses in this study. Results: There were no statistically significant differences between the 2 groups in the age, gender, body weight, burn severity, infusion volume required within 2 days after admission, serum creatinine, and acute kidney injury based on the KDIGO guideline within 48 h after arrival at the hospital, daily P/F ratio within 1 week after hospitalization, survival rate on the 28th day, and discharge survival rate. There were no cases of abdominal compartment syndrome during the observation period. The Modified Brooke formula group failed to achieve the target urine output corresponding to the infusion volume within 8 h after arrival, especially in ≥40% TBSA burn patients, but it did not become a clinical problem. Conclusion: We were unable to conclusively demonstrate that the Modified Brooke formula blocked the occurrence of “fluid creep” in extensively burned patients. However, it was suggested that starting the initial resuscitation at half the conventional volume might contribute to an improved physiological condition in the acute phase of major burns.

Summary: Background: Blepharoptosis operations are performed under local anaesthesia, and it is necessary to determine the location where the levator aponeurosis is fixed to the tarsus by checking opening and closing of the eyelids during surgery. Changes in posture during the operation affect the facial condition in various ways. This study was performed to clarify the differences in palpebral fissure height according to intraoperative head position. Methods: Sixty subjects (48 women and 12 men aged 20–76 years) were enrolled in the study. The palpebral fissure height of the dominant eye was measured in the head-neutral position and 30° head-down position. Results: The total fissure height in the 30° head-down position was lower than that in the head-neutral position. Conclusions: The head-down position affects the patient's fissure height and may mislead the operator. Blepharoptosis operation under local anaesthesia should be performed with the patient in the head-neutral position. Keywords: Blepharoptosis, Fissure height, Head position, Operation position

Summary: Background: Heterotopic ossification (HO) occurs frequently in the elbow in burn patients, and extends beyond the anatomical structure. HO of the elbow can cause joint contracture and adversely affect activities of daily living.Currently, there is no effective prophylaxis for HO as the precise underlying mechanism remains unknown. Therefore, there is no choice but to treat HO after it has developed. To date, however, no effective standard treatment has been reported, and therefore treatment methods vary between different facilities. Surgical resection is widely accepted as the only therapeutic option once HO limits functional mobility of the elbow. Purposes: Based on past reports, we examined our cases and recommend effective therapeutic strategies. We posed the following three questions: (1) Is the surgical intervention effective or detrimental for elbow ankylosis due to HO? (2) What is the best timing for the intervention? (3) What is the most effective postoperative rehabilitation plan? Methods: We treated three patients with complete ankylosis of the elbow due to HO after severe burn injury using different protocols. Results: Surgery was performed in two cases and rehabilitation therapy was commenced immediately from the first postoperative day. Both patients showed improvement in the active range of motion in their elbow joints. The other patient did not undergo surgery, and his elbows became fixed in the completely extension position. Conclusion: Surgical resection is beneficial for elbow ankylosis due to HO after burn injury. Although the exact surgical timing is still controversial, we recommend that surgery should be performed as soon as possible after improving the skin condition around the elbow and confirming the maturation of HO on radiographs. Early rehabilitation and pain control are also important after surgery. Keywords: Heterotopic ossification, Burn, Surgical resection, Elbow, Rehabilitation, Ectopic bone

Introduction: A number of issues, such as delayed epithelialization and ulcer outbreak, may occur after epithelialization, especially in patients with skin vulnerability. This case report examines whether our method involving small-slice thin-thickness skin harvesting in a net pattern can enhance stable epithelialization at skin graft donor sites without complications, even in patients with skin vulnerability. Patients and methods: The study population consisted of five patients with skin vulnerability. The causes of injury were trauma and peripheral arterial disease (PAD). The study population included no patients with burn injuries. We applied a new skin harvesting method in these patients from July 2011 to December 2016. Thin-thickness skin grafts as small slices were harvested from the lateral thigh using a small freehand dermatome. Intact skin gaps between the harvested areas were preserved in a net pattern. The donor site was monitored continuously. Results: The mean size of the donor site was 122.9 cm2, and that of the recipient site was 206.9 cm2. The mean period until epithelialization was 13.2 days with a range of 11–15 days without ulcer outbreak. Hypertrophic scars and pigmentation occurred in one patient each. There were no other complications in this case report. Conclusion: Small-slice thin-thickness skin harvesting in a net pattern is a very simple and useful skin harvesting method for dealing with thin, loose, and fragile skin. This method can be adapted to some burn patients with skin vulnerability because it can reduce the complications at the donor site and it allows harvesting multiple times at the same site. Keywords: Skin graft, Donor site, Wound healing, Net pattern, Skin vulnerability

Objective: The skin stapler is a useful device to fix skin grafts to the wound bed. However, complications often occur, possibly because of failure in removing staples. We have used a transparent dressing, Mepitel One (Mölnlycke Health Care), to solve this problem. Methods: We performed stapling on the surface of the dressing to fix the skin grafts in 14 cases with burn wounds or other skin defects. Tie-over dressing or negative pressure wound therapy (NPWT) dressing was then applied. Results: All staples could be removed without missing them at the same time as removing the transparent dressing. Conclusion: Stapling through the transparent dressing on skin grafts is a safe and useful method to prevent missing staples and to allow monitoring of the wound condition. Keywords: Skin graft, Staple, Transparent dressing