RESUMEN
The pandemic caused by SARS-CoV-2 virus, also known as COVID-19, has generated shockwaves in medical and surgical practice. It has necessitated re-deployment of staff and resources to cater for the unpredictable increase in footfall and demand on healthcare systems. This study aimed to investigate how the restructuring of our service altered the triage and management of non-melanoma skin cancer (NMSC) during the pandemic's first wave rise and peak. We retrospectively analysed all patients who underwent a skin excision under local anaesthetic which revealed the presence of a basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on histopathological analysis between 1st February 2020 - 31st May 2020 compared with the same period in 2019. There was a 158% increase in patients with excision of lesions confirmed on histopathological analysis as a NMSC during the COVID-19 period (168â¯vs. 65). In 2020, more excisions were performed by consultants (42.9% v 21.5%, pâ¯=â¯0.002) with a lower proportion of excisions with a close margin (27.7% v 17.8%, pâ¯=â¯0.096) and an involved margin (3.1% v 1.8%, pâ¯=â¯0.62). Five of these patients had their further management altered due to service constraints at this time The resource constraints secondary to the pandemic have yielded beneficial service adaptations with the incorporation of a more efficient model for the NMSC service. The sustainability of this model and its impact on training will require further examination when non-urgent and benign elective workload is slowly reinstated and plastic surgery trainees return to their original posts.
RESUMEN
The gold standard of treatment for major burns is early burn excision and autografting. In major burns this is complicated by a lack of donor site availability. Another challenge after burn injury is achieving optimal cosmetic and functional outcomes. Dermal regeneration templates (DRT) are biomatrices that help to address these problems. Within our centre the most commonly used are two-stage Integra® and single-stage Matriderm®. We review the use and outcomes of DRT in primary burns reconstruction within our regional burns centre. All patients undergoing primary burn reconstruction using Integra® (n=59) or Matriderm® (n=35) over a 13-year period were included. Integra® was used in patients with significantly larger burns (20.4% TBSA vs 1.7% TBSA). Comparable levels of graft take were seen in both groups. Major infections were significantly higher in the Integra® group (11/35 compared to 3/59). There was no significant difference in haematoma development, hypertrophic scarring or the need for secondary reconstructive surgery. Burn contractures developed in 15 patients treated with Matriderm® and 21 with Integra®. DRT have been used safely and effectively and have played an increasingly important role in our service over the last 13 years. Integra® is used primarily in large burns with limited donor sites and Matriderm® in smaller burns in cosmetically sensitive areas.
Le traitement de référence des brûlures graves est l'excision précoce et la greffe autologue. Dans ces brûlures graves, ce traitement peut s'avérer difficile par le manque de disponibilité de sites donneurs. De plus, l'obtention de résultats satisfaisants tant sur le plan cosmétique que fonctionnel est un véritable challenge dans les suites de brûlures. Les matrices dermiques (DRT) sont des biomatériaux qui peuvent aider à résoudre ces problèmes. Dans notre centre, les matrices le plus souvent utilisées sont Integra® double couche et Matriderm ®. Nous avons étudié l'utilisation des matrices dermiques et leurs résultats dans la chirurgie primaire des brûlures dans notre centre de traitement des brûlures de province. Tous les patients ayant bénéficié d'une chirurgie primaire pour brûlure par Integra® (n=59) et par Matriderm® (n=35) dans les 13 dernières années ont été inclus. Integra® a été utilisé pour des patients présentant des brûlures significativement plus étendues (20,4% TBSA vs 1,7% TBSA). Le taux de prise des greffes est comparable dans les deux groupes. Les infections sévères sont plus élevées de façon significative dans le groupe traité par Integra® (11/59 contre 3/35). Il n'y a pas de différence significative en ce qui concerne les hématomes, l'évolution hypertrophique des cicatrices ou la nécessité de chirurgie secondaire. Des rétractions cicatricielles sont apparues chez 15 patients traités par Matriderm® et chez 21 patients traités par Integra®. L'utilisation des matrices dermiques nous semble sûre et utile et a été largement développée ces 13 dernières années dans notre centre. Integra® est utilisé en chirurgie primaire pour les brûlures très étendues où les sites donneurs font défaut alors que Matriderm® est utilisé pour les brûlures de petite surface à enjeu fonctionnel et cosmétique.
RESUMEN
Fireworks are used worldwide to celebrate national, religious, cultural festivals and holidays. However the use of fireworks is associated with preventable injuries. We aim to review cases of burns and trauma caused by fireworks presenting to a regional burns and plastic surgery unit in the United Kingdom. We hope our findings will help to guide future firework-related safety practices in the UK. A retrospective review was performed of all patients presenting to our tertiary burns and plastic surgery unit with burns and/or trauma sustained from fireworks over a ten-year period from October 2004 to October 2014. A total of 93 patients were identified. Medical case notes were reviewed, patient demographics, aetiology of injury, management and patient outcomes were recorded. A cohort of 93 patients with burn injuries caused by fireworks were identified from our database. A total of 74% injuries occurred in October and November. Mechanism of injury included contact, flash, flame burns and injury secondary to blast force. Most injuries sustained were to the hands, followed by head and neck, torso, limbs and perineum in descending order of frequency. A total of 38.7% of patients required surgery for their wounds. Fireworks not only result in significant burn injuries, but also eye injuries, soft tissue defects and fractures requiring a spectrum of plastic surgical interventions. The number and severity of accidents can be minimised by raising awareness regarding safety precautions.
Les feux d'artifices (FA) sont utilisés mondialement, dans des contextes festifs variés (religieux, nationaux, culturels, locaux). Les accidents qui y sont liés sont évitables. Nous avons étudié les brûlures et les traumatismes liés aux FA se présentant dans notre CTB, espérant que ceci permettra la mise en place de mesures de prévention dans l'ensemble du Royaume Uni. Nous avons revu rétrospectivement les dossiers des 93 patients pris en charge dans notre CTB entre octobre 2004 et octobre 2014 après un accident de FA. Les données démographiques, étiologiques, de prise en charge et évolutives ont été colligées. Les ¾ des accidents étaient survenus en octobre et novembre. Les mécanismes vulnérants étaient le contact, le flash, la flamme et le blast. Les mains étaient la région la plus fréquemment touchée, suivies par ordre décroissant par la région cervico-céphalique, le torse, les membres et le périnée. Trente huit virgule sept pour cent des patients pont du être opérés. Les accidents de FA entraînent non seulement des brûlures mais aussi des atteintes oculaires, des pertes de substance cutanées et des fractures pouvant nécessiter des interventions dans un large spectre de la chirurgie reconstructrice. Le nombre et la gravité de ces accidents peut être diminués par une application accrue des mesures de précaution.
RESUMEN
INTRODUCTION: Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. METHODS: A retrospective case review was performed for all patients with a clinical diagnosis of TEN or SJS/TEN overlap admitted to our paediatric and adult burns centre between June 2004 and December 2016. Patient demographics, percentage total body surface area (%TBSA), mucosal involvement, causation, severity of illness score (SCORTEN), length of stay and survival were appraised with appropriate statistical analysis performed using Graph Pad Prism 7.02 Software. RESULTS: During the study period, 42 patients (M26; F: 16) with TEN (n=32) and SJS/TEN overlap (n=10) were managed within our burns service. Mean %TBSA of cutaneous involvement was 57% (range 10-100%) and mean length of stay (LOS) was 27 days (range 1-144 days). We observed 4 deaths in our series compared to 16 predicted by SCORTEN giving a standardised mortality ratio (SMR) of 24%. CONCLUSION: Management in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes.