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Traditional reconstructive methods can fail in achieving a good functional and aesthetic outcome in patients with extensive defects, involving multiple layers of functional tissue, often necessitating numerous, and staged, surgical interventions with unsatisfactory results. Transplantation of vascularized composite allografts(VCA) opened a new, promising era in reconstructive surgery, offering a unique restorative opportunity for those complex situations. VCA transplantation have been performed for life enhancing indications in a selected group of patients under institutional protocols. The controversy of those procedures, having functional benefi ts and the goal of quality of life restoration, rather than life-saving indications, resides to the life-long required immunosuppressive therapy, with implicit side effects. In order to extend VCA indications, translational studies are needed to develop less toxic immunosuppressive regimens and possibly achieve donor-specifi c tolerance, the ideal situation in transplantation. Extensively burned patients, especially of the face and cervical region, having severe mutilations and also unilateral or bilateral hand amputations, like after high voltage electric injuries, present functional and aesthetic defi cits, with devastating impact on their quality of life and, constituting potential candidates for receiving a vascularized composite allotransplantation, as the only reconstructive solution. With this paper, we discuss the indications and limits, from clinical and immunological perspectives, of the consideration of VCA as surgical option for burn patients with complex tissue defects, impossible to approach by conventional techniques. [ABSTRACT FROM AUTHOR]

Severe burn injuries represent a major challenge to the entire healthcare system in developing countries and even for states with a high standard of care. A clear understanding of the physiopathology of burn injuries is essential for providing an adequate prompt treatment to ensure an optimal patient outcome. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. Specific treatment must be conducted according to the characteristics of the patients in order to reduce morbidity and mortality and avoid the development of antimicrobial resistance. A diagnostic and therapeutic algorithm is presented, centered on infectious source prevention and control with early surgical excision and skin grafting together with culture-guided antimicrobial therapy. It is a known fact that, indifferent of the involved germ, the best intervention for both prophylaxis and treatment of infections in the burn patient is the early excision of the devitalized tissue and subsequent closure of burn wounds with skin grafts, measures that diminish local and systemic mediator releasing effects in burnt tissue, attenuating the progressive inflammatory chain. [ABSTRACT FROM AUTHOR]

Introduction: Severe burn injuries still are a major challenge for the entire healthcare system. Multiple predictive factors may influence the prognosis of burn patients and a careful management of those parameters will decrease the morbidity and mortality and will determine an improvement in patient's final functional outcome. Material and Methods: We present a two years study on the burn patients hospitalized in our institution. A total of 355 burned patients were hospitalized during this period, 210 (59%) of them being addmited in Critical Care Burn Unit. A detailed analysis was performed on those 210 critical patients in order to determine the parameters that aggravate the prognosis of burn injuries. A large data panel was taken into consideration regarding burn severity, mechanism of injury, patient characteristics, associated illnesses, promptitude in hospitalizing the patient in our burn center; ABSI score was used to evaluate the mortality risk, burn injury-associated complications were noted and analyzed. Results and discussion: We highlighted a series of parameters regarding therapeutic management that influence the outcome of the patient after severe burn injury: an adequate hydro-electrolytic resuscitation in the acute phase, further support of vital functions, early excision and grafting of deep burn injuries, comorbidities treatment and adherence to rehabilitation and follow-up program. ABSI Score is an important tool in the assessment of mortality in burn patients. Multiple complications were encountered in our patients: infections, pulmonary, cardiac, renal, thrombo-embolic, hematologic, digestive and neurologic disorders. Conclusion: A detailed analysis of the physiopathology of burn injuries and their complications is essential for providing an adequate prompt treatment for decreasing morbidity and mortality. Mortality still represents the primary outcome evaluation for burn care, therefore scoring systems aim to use the most predictive patient and injury-related parameters to appreciate an expected mortality for a given patient. Early excision of the devitalized tissue and subsequent grafting reduce the local and systemic effects of the mediators released from the burned tissue with cessation of the progressive inflammatory chain. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. [ABSTRACT FROM AUTHOR]

Major burn is considered the most severe type of injury, with high mortality risk and poor quality of life prognosis for survivors. Appropriate burn wound management may require multiple treatment modalities, with specifi c sequencing particular to each patient, addressing every injured area depending on burn surface and depth, patient's general status and also available infrastructure and burn center resources. Early excision of burn eschar and grafting with autologous split-thickness skin grafts remains the universal standard of surgical burn care in acute phase. Ongoing research is conducted for developing new skin substitutes that meet the ethical, safety efficiency and economical criteria in order to obtain adequate wound coverage when autologous skin grafts are not available. Each severe burned patient represents a complex case, requiring long-term multiple-stage and interdisciplinary treatment, adequate rehabilitation and follow-up program to obtain optimal functional results and socio-professional reinsertion. [ABSTRACT FROM AUTHOR]

Major burn is considered the most severe type of injury, with high mortality risk and poor quality of life prognosis for survivors. Appropriate burn wound management may require multiple treatment modalities, with specifi c sequencing particular to each patient, addressing every injured area depending on burn surface and depth, patient's general status and also available infrastructure and burn center resources. Early excision of burn eschar and grafting with autologous split-thickness skin grafts remains the universal standard of surgical burn care in acute phase. Ongoing research is conducted for developing new skin substitutes that meet the ethical, safety effi ciency and economical criteria in order to obtain adequate wound coverage when autologous skin grafts are not available. Each severe burned patient represents a complex case, requiring long-term multiple-stage and interdisciplinary treatment, adequate rehabilitation and follow-up program to obtain optimal functional results and socio-professional reinsertion. [ABSTRACT FROM AUTHOR]