Laser in Burn Scar Management

Dr Sam Hamilton1, Dr Katherine Davis1, Mr Nanda Kandamany1

1Royal Hobart Hospital, Hobart, Australia

Abstract:

Background

Scarring from burns causes considerable morbidity, often resulting in contractions impacting range of motion at joints, suboptimal aesthetics and causing troublesome itch (Willows BM et al, 2017). Lasers are becoming more common place in plastic surgery and burns departments and show great promise when it comes to managing burn scars and their sequel.

Method

Pubmed was searched using the terms ‘laser’, ‘burn’, ‘scar’ and ‘management’ from 2015 onwards. 9 out of the 43 articles were included following exclusion of non-human studies and those that were not specific to burn scar management.

Discussion

A literature review by Willows et al (2017) published in Burns, concluded that lasers have great potential in scar management in burns, showing that they were effective in managing pigmentation, vascularity, pliability and thickness, with ablative fraction lasers being particularly effective. Ebid et al (2017) conducted a randomised control trial showing improvement in itch severity scoring systems and quality of life with high-intensity laser therapy.  There was improvement in patient satisfaction and UNC 4P Scar scale with the use of Erbium-Yag laser when treating burn scars in a cohort of 49 patients (Madni TD et al, 2018). Pulse dye laser is particularly effective in the management of erythematous and pruritic scars (Sorkin M et al, 2017). Fractional CO2 laser has also been shown to be effective in sequel management especially is raised hypertrophic and uneven scars (Sorkin M et al, 2017; Issler-Fisher AC et al, 2017). Other studies have shown histological benefit with newly formed dermal papilla and reduced collagen bundle thickness when using fractional CO2 laser therapy for scar treatment (El-Zawahry BM et al, 2015; Lee SJ et al, 2016; Taudorf EH et al 2015). Lasers are also effective in anatomically important locations such as hands (Sorkin et al, 2017).

Conclusion

Laser therapy shows great promise, but there is still a need for further robust clinical trials (Zuccaro J et al, 2017). Type of laser, side effects, characteristics of the scar and patient and necessity for repeated sessions are considerations that should be deliberated when managing burn scars with laser therapy.


Biography:

Sam is a surgical resident medical officer at the Royal Hobart Hospital, with a keen interest in plastic surgery and burns management.

Friction Burns from Sporting Equipment in the Paediatric Population

Dr Marcus Cheng1, Dr Ebrar Al-Yasery1, Dr  Sarah Lonie1, Mr Wai-Ting Choi1

1Department of Plastic & Reconstructive Surgery, Western Health, Sunshine, Australia

Abstract:

Burns are a common form of injury in the paediatric population. There is an increased incidence of friction burns caused by sporting equipment seen with the rise in affordability and popularity of home exercise equipment. There is also an increasing trend towards the mechanisation of exercise.

Equipment such as treadmills causes not only friction burns on skin, but also damage to deeper structures.

At Western Health, we have noted an increased incidence of exercise equipment related friction burns, in particular the curious toddler age group. Such injuries, often being a full thickness burn to the palm of the hand, while small in terms of total body surface area, can have debilitating functional outcomes from the resultant scarring or damage to underlying tendon or nerve.

This case series of children injured with burns from sporting equipment discusses the assessment and management and raises awareness of such injuries and strategies to prevent them from occurring.

References

  • Goltsman D et al. Pediatric Treadmill Burns: Assessing the effectiveness of prevention strategies. Burns. 2016 Nov;42(7):1581-1587. doi: 10.1016/j.burns.2016.02.007.
  • Marchalik R et al. Upper extremity friction burns in the pediatric patient: a 10-year review. Plast Reconstr Surg Glob Open.2018 Dec 4;6(12):e2048. doi: 10.1097/GOX.0000000000002048.
  • Jeremikenko L et al. Paediatric treadmill friction injuries. J Paediatr Child Health. 2009 May;45(5):310-2. doi: 10.1111/j.1440-1754.2008.01329.x.
  • Friedrich J, Muzaffar A, Hanel D. Pediatric hand friction burns from treadmill contact. Hand. 2007 Dec; 2(4): 188–193. doi: 10.1007/s11552-007-9046-2.

Biography:

Marcus Cheng is currently unaccredited plastic surgery registrar at Western Health in Melbourne.

The Iceberg Effect: The hidden morbidity of burn injuries in patients with sensorimotor deficits

Dr Michael Taylor1, Dr Hannah Woodford2, Dr Monique  Bertinetti1

1Children’s Hospital Westmead, Westmead, Australia, 2Nepean Hospital , Penrith, Australia

Abstract:

Introduction: Children with sensorimotor deficits present treating teams with additional complex challenges in the coordination of their care.

The epidemiology of burns in children with sensorimotor deficits is anecdotally established to be more prevalent, complex and resource intensive, however minimal data of the incidence and sequelae has been collected.

Method: We performed a 15 year retrospective analysis of all paediatric burn patients under the age of 16 in the NSW ACI database. A cohort identified to have sensorimotor deficits including cerebral palsy, trisomy 21, spina bifida, global developmental delay, and neural-sensorimotor deficits resulting from trauma, was analysed against a control population.

The outcomes measured included TBSA, mechanism, length of stay (LOS), graft and re-graft rates, wound infection, additional visits to theatre, ICU/ventilation requirements, and outpatient follow-up. Linear regression was used to analyse the correlation between the presence of sensorimotor deficit and subsequent outcomes.

Results: 13,011 burn injuries were identified. 95 occurred in patients with an established sensorimotor deficit.

The sensorimotor deficit cohort was older (6.93 years (±4.1) vs 4.0 (±3.9)), had a greater TBSA (4.72% (±10.3) vs 2.48% (±3.9)) and an increased LOS (8.6 days (±13.1) vs 3.1 days (±7.9)) when compared to the control group. 48.5% of cohort patients required more than 1 nights admission. Flame burns were overrepresented in the cohort 11% vs 6%.

6% of cohort patients required ICU admission, and 2.1% required intubation and ventilatory support, compared to only 1% and 0.08% respectively in the control group.

Grafting was required in 39% of sensorimotor deficit patients, opposed to only 19.9% in the control group. Regrafting and wound infection rates were 3 times more likely in the cohort group.

Conclusion: Children with sensorimotor deficits have a higher TBSA, are at greater risk of complications, and experience prolonged and more complex admissions when compared to their non-disabled peers. Future research into improving care and targeted prevention strategies is required for this resource rich, high-risk group.


Biography:

Dr Michael Taylor is a Paediatric Surgery SRMO at the Children’s Hospital Westmead. His research interests lie Paediatric Surgery, Trauma, and Burns.

Burns through the ages: A Comparative Review of Chemical burns at the Tasmanian Burns Unit

Dr Rory Middleton1, Dr Thomas Whitton1, Dr Jennifer Martins1

1Royal Hobart Hospital, Hobart, Australia

Abstract:

Background: Although accounting for only a small percentage of total admissions to hospital for burns, chemical burns require special consideration due to their potential for delayed presentation, progression of tissue destruction and these burns frequently require surgical intervention.  There has been an ongoing need for increased awareness and education about the risks of chemical burns and their management which have previously been outlined in many Burns centres, including the Tasmanian Burns Unit.

Method:  We performed a search for patients of all ages admitted to the Tasmanian Burns Unit between 2008-2019 for chemical burns.  42 patients were identified and their cases reviewed.  The results of this review were then compared with the findings of Ricketts and Kimble (2003).

Results: In comparison to the data collected by Ricketts and Kimble (2003), the majority of patients continue to be men between the ages 20-49 years, however the mean age has increased by 6 years to 38 years of age. There is a slight change observed in the location that the injury occurred, with 50% occurring in a domestic, and 38% occurring in an industrial setting.  The most common causative agents were cement (33%) and Sodium hydroxide (31%).  There was a 56% decrease in cases involving either sulphuric acid or hydrofluoric acid when compared to the previous study.  The upper and lower limbs were involved in 79% of cases, with the face being involved in 24% of cases.  The mean total surface area affected was 2.2% (compared with the previous 3.4%) and the mean length of stay was 5.5 days, a decrease from 9 between the years 1989-1999.  Management of injuries continued to consist of various surgical and conservative management options which include debridement and split-thickness skin grafting as well as various dressings.

Conclusion: In comparison with the findings of Ricketts and Kimble (2003), there appears to be ongoing potential in both community and professional education for the prevention and management of chemical burns, with an emphasis on early management.

References: 1) Ricketts S and Kimble F, 2003. ‘Chemical injuries: the Tasmanian burns unit experience’.  ANZ J Surg 73 (1-2): 45-48


Biography:

Rory Middleton is a RMO at the Royal Hobart Hospital, interested in pursuing a career in Plastic Surgery.

Venous thromboembolism in burns patients: are we underestimating the risk and under-dosing for prophylaxis

Mr Patrick Lu1,2, Karl-Anton Harms2, Cheng Lo1,2, Heather Cleland1,2

1Department of Surgery, Central Clinical School, Monash University, , Australia, 2Victorian Adult Burns Service, The Alfred, , Australia

Abstract:

Methods:

Prospective data was collected from all adult admissions with >10% total body surface area (TBSA) burns for AFXa levels to identify if recommended levels for adequate prophylaxis was achieved or not.

Preliminary results (at 3 months):

Preliminary results demonstrate that 92.3% of patients (12/13) had less than prophylactic AFXa levels on initial measurement. 75% (9/12) of these sub-prophylactic patients failed to achieve prophylactic levels of AFXa by discharge. Currently, no predictive factors of ability to achieve prophylactic AFXa levels have been identified, however, participant recruitment is ongoing.

Conclusions:

Many burn patients are receiving inadequate doses of prophylaxis to achieve target AFXa levels for prophylaxis. Identifying patient factors which predict sub-prophylactic AFXa levels may provide guidance for future studies trialing various dosing regimens to improve thromboprophylaxis. Updated results and recommendations will be presented at the ANZBA conference.


Biography:

Venous thromboembolism (VTE) is a preventable complication among hospitalised burn patients that is associated with significant morbidity and mortality. There is no current consensus on the best form of prophylaxis. At our institution, subcutaneous low molecular weight heparin in the form of enoxaparin sodium (Clexane©) is used at a daily dose of 40mg. However, due to the unique metabolic changes in the acute phase of burn injury, the pharmacokinetics of Enoxaparin is altered resulting sub-prophylactic anti-factor Xa (AFXa) levels. Although the current evidence base is limited to a single centre, this data creates concern that our current protocolled Enoxaparin dose may be inadequate.

Launch Into The Future Of Burns Care In Space

Dr Alicia Tucker

Abstract

Humans have always looked up to the stars with wonder.   Our innate need to explore the unknown has evolved over the millennia.  The post WWII boom in space technology development spurned the Space Race and has now ignited the Commercial Spaceflight Industry.  However, from the time Yuri Gagarin first went into space, to the establishment of the permanently inhabited, International Space Station, we have been working to overcome the challenges that the spaceflight environment has on human physiology and psychology.

Whether it’s a friction burn from a treadmill being used to prevent bone and muscle mass loss from microgravity, or a thermal burn from an exploding lithium canister being used in a space station oxygen generation system, the spaceflight environment is not immune to acute burn injury.  What could normally be a minor inconvenience on Earth, can affect mission objectives by altering astronaut performance.  Coupled with resource limitations, potential communication disruptions and the inability to quickly return to Earth, acute burn and trauma care in Space needs to be considered, creative and adaptable.

In this session, we will explore the challenges of human spaceflight, possible aetiologies of burn injury in Space as well as an overview of the past, present and future prevention and management of burns in space.

About ANZBA

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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