Use of Integra® in the Treatment of Third Degree Burns to the Penile Shaft: A Case Series With 6-Month Follow-Up:

Prevention and Treatment of Burn Scar Contracture: A Practical Review

Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies are necessary to decrease morbidity and unnecessary costs. This scoping review aimed to summarize prevention and treatment strategies used for management of burn scar contractures published in the literature since 2000. A comprehensive PubMed review was performed in October 2022 to identify methods of burn contracture prevention and treatments. Non-English, duplicate, and unavailable articles were excluded. Data were extracted including publication year, techniques, and outcomes. A total of 327 publications met criteria for inclusion. Most articles were published in 2011 (n = 22). Treatment strategies were discussed in 82.9% of studies, prevention in 16.5%, and both in 0.6%. The most common areas discussed included the upper extremity (n = 127) and neck (n = 102). Flaps were the most frequently used method (n = 208), followed by autografts (n = 89). Most preventative therapies were still in early stages of development. Burn contracture management requires a highly individualized approach with many available reconstructive techniques available. Further research is needed to improve prevention techniques and decrease morbidity and cost to patients.

Dermal regenerative matrix use in burn patients: A systematic review

BACKGROUND

Dermal regenerative matrices (DRMs) have been used for several decades in the treatment of acute and reconstructive burn injury. The objective of this study was to perform a systematic review of the literature to assess clinical outcomes and safety profile of DRMs in full-thickness burn injury.

METHODS

Comprehensive searches of MEDLINE, EMBASE, CINAHL, and Cochrane Library were performed from 1988 to 2017. Two independent reviewers completed preliminary and full-text screening of all articles. English-language articles reporting on DRM use in patients with full-thickness burn injury were included.

RESULTS

Literature search generated 914 unique articles. Following screening, 203 articles were assessed for eligibility, and 72 met inclusion criteria for analysis. DRM was applied to1084 patients (74% acute burns, 26% burn reconstruction). Of the twelve studies that described changes in ROM, significant improvement was observed in 95% of reconstructive patients. The most frequently treated reconstructive sites were the neck, hand/wrist, lower extremity, and axilla. Vancouver scar scale was used in eight studies and indicated a significant improvement in the scar quality with DRM. The overall complication rate was 13%, most commonly infection, graft loss, hematoma formation, and contracture.

CONCLUSIONS

Although variability in functional and cosmetic outcomes was observed, DRM demonstrates improvements in ROM and scar appearance without objective regression. Essential demographic data were lacking in many studies, highlighting the need for future standardization of reporting outcomes in burns following application of dermal substitutes.

The foreskin advancement flap: an alternative technique for reconstruction of penile burns

Penile burns are devastating injuries and are frequently associated with significant functional and psychological sequelae. The goals of penile reconstruction after burn injury include: 1) skin coverage, 2) preservation of penile length, sensation and erectile function, 3) esthetic integrity, and 4) permissive for penile growth in the pediatric patient. A multitude of different techniques have been proposed, including skin grafts, local, regional, and free flaps, each of which fail to address all goals of reconstruction. We introduce the foreskin advancement flap that, when available, successfully addresses these key challenges and as such provides for an ideal reconstruction.

High-voltage electrical burn of the genitalia, perineum, and upper extremities: the importance of a multidisciplinary approach

High-voltage electrical burns on genitalia and perineal areas are very rare and only sporadic reports are available in the literature with often confusing diagnoses and inconspicuous treatment protocols. Although the surgical treatment of extremities lesions is well established and includes appropriate debridement, temporary wounds coverage, and final adequate soft-tissue reconstruction, management of genital lesions remains controversial and challenging. The authors present a rare case of severe high-voltage electrical injury with involvement of upper extremities and complex lesions localized to the genitalia and perineal region. Treatment required a multidisciplinary approach including the plastic surgery and the urologic and andrologic teams.

Penile emergencies

The penis is a very sensitive organ and even minor injury or discomfort may cause a patient to seek emergency evaluation. Emergency practitioners must be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis, namely ischemic priapism, paraphimosis, and entrapment injury. Any penile trauma should be considered an emergency until proven otherwise. This article discusses emergent penile complaints in adults, with emphasis on the most serious and common conditions.

Management of genital burns: a review

We review the etiology and the management strategy of genital burns. The incidence of genital burns ranges from 2.8 to 13%. Most are part of larger injuries. Scald burns are typical for children, whereas flame and chemical burns happen more often in adults. For first and second-degree genital burns, a conservative approach with physiological dressings and topical antimicrobials is advised. Only third degree burns need to be treated with removal of necrotic tissue and grafting. Indwelling catheters or suprapubic drainage systems must be avoided whenever possible.