Retrospective Case Series of Keragel or Biobrane on Paediatric Facial Burns

Mrs Herni Lutfiah Hussein1, Mrs Nurazlin Azman1, Ms Joanne Jovina SH Cheng1

1Kk Women’s And Children’s Hospital, Sengkang, Singapore


Background:KK Women’s and Children’s Hospital is the referring paediatric hospital in Singapore for a wide variation of burns. The Department of Plastic, Reconstructive and Aesthetic Surgery consults an average of 23 paediatric burns a month, of which facial burns is common and a challenging area for dressing coverage.
Keragel is a thick hydrogel consisting of keratin protein which provides a moisture rich environment. It delivers Replicine™ Functional Keratin® which aids in epithelialisation of a wound. Application of Keragel is advise to apply twice a day to cover the entire wound surface without the need for dressing coverage.
Biobrane is a biosynthetic dressing extract from porcine dermal collagen secured to a silicone membrane. Application of Biobrane requires a sterile environment in the operating theatre as the dressing need to be secured with stitches/staples or securement tapes.

Aim:The aim of this case series is to evaluate the healing rate of using Keragel or Biobrane on pediatric facial burn. The cost of care and pain management will be explore too.

Method: Retrospective data of 4 paediatric patients with partial to deep partial thickness burns to the face were selected. All patients are within the age group of >6months of age to 16 years of age. 2 patients had application of Keragel dressing on their burns while the other 2 patients had Biobrane dressing.

Conclusion: Keragel took an average of 7-14 days to heal completely, while Biobrane dressing took more than 7 days of expected healing time as it converted to deeper burns. The cost of care on Keragel was reduced as it can be managed in an outpatient setting whereas Biobrane dressing required admission for application in the operating theatre. There was also reduce pain experienced in Keragel application as it is easy to clean and re-apply with minimal pain. As compared to Biobrane dressing, the removal of stitches/staples or securement tapes is done in the clinic with pre-medications given.
Keragel is easy to use by parents at the home settings as it does not require hospital admission. It minimizes trauma and requires less visit to the clinic for dressing change.


I have been working for 14 years in KK Women’s and Children’s Hospital. I worked in a surgical ward for 7 years before transferring out to the Department of Plastic Reconstructive and Aesthetics Surgery. I am a nurse clinician and WOCN nurse too. I worked in an outpatient setting where burns cases is one of the common wound dressing I do in my daily job.

Case Review: The use of Telehealth Services for Specialist Facial Burn.

Ms Hannah Leitch1, Ms Dallas Gillespie2, Ms Rebecca Schrale3

1Tasmanian Health Organisation, Hobart, Australia, 2Tasmanian Health Organisation, Hobart, Australia, 3Tasmanian Health Organisation, Hobart, Australia


Background: Meeting best practice guidelines to minimise contracture development in a full thickness, low voltage lip burn in a rural setting utilising Telehealth with the Tasmanian Burns Unit and the Burns Multidisciplinary team

Clinical Case: A 21-year-old man presented to his local community hospital with a full thickness electrical burn to his lower lip. The patient was appropriately managed in the emergency department and referred to the Tasmanian Burns Unit. After initial management at the local hospital the patient was followed up through Telehealth with the Tasmanian Burns Unit. He required weekly outpatient follow up at the satellite Burns Clinic with an Occupational Therapist with support from the Tasmanian Burns Unit- including the Plastic Surgeon, Burns Clinical Nurse Consultant, and Speech Pathologist.
Through extensive patient education- including nutrition, smoking cessation, wound care, mouth exercises and stretching a positive outcome resulted with a significant increase in vertical and lateral range.
The patient will continue to require ongoing follow up for scar management with the Burns Multidisciplinary team – including the local occupational therapist through the utilisation of Telehealth.

Conclusion: Telehealth services were important in contributing to positive outcomes for a rural patient requiring specialist burns input due to facial burns.


Hannah Leitch, Senior Speech Pathologist at the Royal Hobart Hospital. Currently working on the Burns Unit and Inpatient Rehabilitation at the Royal Hobart Hospital.

Putting appearance on the agenda: Supporting paediatric patients with disfigurement-related psychosocial issues

Miss Caroline Gee1, Dr  Jessica  Maskell2, Dr  Heidi  Williamson3, Professor  Roy  Kimble1,4, Associate Professor Peter  Newcombe5

1Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101,   2Gold Coast University Hospital, Social Work Department, 1 Hospital Boulevard, Southport, QLD 4217,  3Centre for Appearance Research, University of the West of England, Frenchay Campus, Bristol, UK, BS16 1QY,  4Pegg Leditschke Children’s Burns Centre, Lady Cilento Children’s Hospital, Level 5, 501 Stanley Street, South Brisbane, QLD, 4101, 5Institute for Teaching and Learning Innovation, LIB Building (17), Level 3, The University of Queensland, St Lucia, QLD, 4072,


Approximately one third of children who live with disfiguring conditions are at risk of developing psychosocial difficulties. Common challenges include body dissatisfaction, social anxiety, poor self-esteem, fear of rejection and stigmatisation. However, children and adolescents are offered little to no support to cope with the psychosocial consequences of their altered appearance.

This research explored the psychosocial impact as well as current support and care needs of paediatric patients living with permanent aesthetic differences. Fifty two interviews with health professionals who work across a range of specialities were conducted, as well as with adolescents and children who live with an altered appearance. Studies within the overall project have specifically explored factors that influence a child’s psychosocial adjustment, gaps and barriers in appearance-related care, perceptions of and preferences for support and treatment.

Overall, findings highlight how psychosocial issues related to disfigurement are often ignored or avoided and health professionals as well as families struggle discussing and treating appearance-related subject matter with young people. Children and adolescents living with a range of appearance-altering conditions have also shared common difficulties, frustrations and suggestions on how they can be more sensitively and effectively supported.

This paper will present a summary of the findings and provide strategies for working with paediatric patients who have an appearance ‘categorised’ as different. It is hoped that the findings will benefit health professionals who work, not only in allied health but also, in medical roles in their future clinical practices.


Caroline is completing her PhD with the Centre for Children’s Burns and Trauma Research, Brisbane, Australia. Her PhD is a large qualitative project exploring appearance-related psychosocial care for children and adolescents living with disfiguring conditions.

The Eye – A Sanctuary from Thermal Injury The J. Fred Leditschke Tribute Paper

Prof. John Pearn1

1Lady Cilento Children’s Hospital, South Brisbane , Australia


All members of Burns Teams are aware that thermal damage to the eye is a rare event. In a recent survey of hundreds of burns to the face, only three lesions involving conjunctival or corneal damage have been identified. The question arises, what are the mechanisms that protect the eyeball in the context of otherwise severe facial and periorbital burns? This paper explores the four mechanisms which comprise this innate protective bulwark, mechanisms produced by genetic selection through vertebrate evolution. In evolutionary terms, any vertebrate, primitive Homo included, died if they were blinded and their genes were lost to the population pool. The four protective mechanisms comprise: (a) the blink reflex, the fastest reflex in mammals; (b) the menace “reflex”, a protective blink and aversion response, present in 97% of infants by four months of age, with a reactive time of 0.25 milliseconds in young healthy adults; (c) Bell’s Phenomenon, absent during the blink reflex but the more intense with enforced involuntary eye closure during thermal threat; and (d) the insulating protection of tears due to their specific heat and specific conductance. This protective armamentarium is bypassed by shorter wavelength radiation outside the visible spectrum, resulting in thermal injury of “welders’ flash”, also known as the “Saturday Night Syndrome”.

Professor Fred Leditschke has given a professional lifetime to both the clinical care of burns patients, especially children, and influential advocacy to reduce mortality from childhood trauma, the two themes embodied in this Tribute Lecture.


Professor John Pearn is a Senior Paediatrician at the Lady Cilento Children’s Hospital; and the Paediatrician to the PEGG-Leditschke Burns Unit. A former Surgeon General of the Australian Defence Force, he has served as the Intensivist and Senior Physician on operational deployments in Papua New Guinea, Vietnam, Rwanda and Banda Aceh. He has published extensively in the research and advocacy domains of trauma management and prevention.

The use of a unique silicone-lined thermoplastic to fabricate a portfolio of head and face orthoses to manage burn scar hypertrophy.

Mr Jonathan Niszczak1

1Bio Med Sciences, inc., Allentown, United States


Introduction: Recent advancements in medicine have vastly improved the survival chances of burn patients.  The focus of the burn recovery has now shifted from survival to early rehabilitation. We have designed 6 head and face splints that, if initiated early, could prevent deformity.

Methods: A Low Temperature Silicone-lined thermoplastic is utilized for the fabrication of the splints.  The chin splint cups the chin and reverses lower lip eversion.  The mouth splint is designed to stretch both commissures vertically. One nose splint is designed to expand the nostril diameter and the other is designed to depress scar hypertrophy around the nasal bridge-ala-epicanthal region.  One of the ear splints is designed to increase the ear canal diameter and the other prevents the ear helix from contracting toward the head.

Results: We have found that utilizing these splints at the first evidence of scar hypertrophy or tightness, results can be very positive.  Nostril and ear canal diameters can increase by 5mm in about 10 days.  Vertical and horizontal mouth opening can increase between 1cm-1.5cm in approximately 1 month.  Lower lip eversion and scar hypertrophy around the ala/nasal bridge/epicanthal region can be inhibited when the chin and nose splint are worn underneath a garment mask.

Discussion: The splinting material is coated with silicone which provides for a comfortable contact to the skin.    The combination of silicone and thermoplastics in splinting theoretically enhances the principles of gentle, prolonged sustain stretch and promotes scar hydration/pliability that could lead into elongated tissues and flat scars.


Jon has an advanced Master’s Certification in Hand and Upper Quadrant rehabilitation as well as a Master’s of Science in Occupational Therapy. Jonathan has been working in burn
rehabilitation for over 17 years. He is a Clinical Care Specialist for Bio Med Sciences, Inc. in Allentown, PA. Additionally, he works in the Burn Center at Temple University Hospital and
serves as a Medical Diplomat with Physicians for Peace on burn care missions throughout Central and South America and the Middle East. He is an active member of the American Burn
Association; European Burn Association; International Society for Burn Injures and the Australian New Zealand Burn Association. He has published and presented in domestic and
international peer reviewed journals primarily on burn rehabilitation and scar management of the upper extremities and face.


Predictors of Outcomes in Patients with Facial Burns: A Retrospective Chart Review

Dr Isobel Yeap1, Dr Aruna Wijewardana1, Anne Darton1, Dr John Vandervord1

1Royal North Shore Hospital, St Leonards, Australia


Background: As well as allowing one to see, hear, speak, eat and breathe, the face is central to one’s ability to communicate expression and emotion. Consequently, burns to the face are especially debilitating and are associated with poorer functional and psychological outcomes.

Method: We conducted a retrospective chart review on 726 patients with facial burns who presented to Royal North Shore Hospital’s Severe Burns Unit during a ten-year period (2008 to 2017). Data were analysed using SPSS®. Multiple linear regression and binary logistic regression models were used.

Results: 82% of patients were male and 64% of patients had < 10% total body surface area (TBSA) burned. Amongst patients with TBSA > 10%, those with non-accidental burns were at a 5.27 times increased chance of dying during initial admission. The presence of inhalational injury was found to have no effect on mortality, once TBSA % burned and facial burn depth was accounted for. Amongst patients with TBSA < 10%, the presence of inhalational injury increased length of stay by 4.70 days on average, while those with non-accidental burns had an increased length of stay of 4.83 days.

Conclusions: Special care should be taken when treating patients whose burns are due to non-accidental causes, since they have a much higher chance of dying during initial admission. While the presence of inhalational injury increases a patient’s length of stay, it does not influence mortality, suggesting that our current treatment approach to inhalational injury may be highly successful.


Isobel is a resident medical officer who has worked with the Severe Burns Unit and Plastic Surgery Department at Royal North Shore Hospital. Prior to studying medicine, she completed her Bachelor (Honours) in Economics.

Chondritis in the burned ear: a narrative review

Dr Isobel Yeap1, Dr Aruna Wijewardana1, Dr John Vandervord1

1Royal North Shore Hospital, St Leonards, Australia


The burned ear represents a unique challenge for several reasons. One of the reasons is that the ear has little soft tissue coverage, such that deeper burns result in damage to cartilage. Related to this, exposed cartilage is vulnerable to infection, which can lead to further damage to the ear structure. A deformed ear, while not life threatening, can lead to problems with hearing, as well as long-term psychological problems. Before the topical application of antibiotics became commonplace practice, chondritis in the burned ear was a common and well-recognised complication. Since the 1960s, however, incidence rates have been decreasing and, as per some estimates, are now approaching zero.

In this study, a narrative review on chondritis in the burned ear was conducted. First, we describe the organisms most commonly implicated. Second, we discuss the clinical manifestations and approach to the diagnosis of chondritis. Finally, we take a historical approach and look at the range of management strategies for chondritis that have been described in the literature. We find that the declining incidence of chondritis is attributable to a paradigm shift whereby the emphasis is placed on early coverage of cartilage, routine use of topical antibiotics and immaculate pressure care.


Isobel is a resident medical officer who has worked with the Severe Burns Unit and Plastic Surgery Department at Royal North Shore Hospital. Prior to studying medicine, she completed her Bachelor (Honours) in Economics.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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