The scalp as a donor site for skin grafting in burns: retrospective study on complications

Background:Split skin grafting(SSG)is the cornerstone in the treatment of deep burns and large skin defects.Frequently used donor sites are the thigh,abdomen and buttocks.The scalp is less common while considered as a reliable donor site.Advantages are a large surface area,rapid wound healing,cosmetically favourable results and multiple harvests from the same donor site.Complications include scab formation,chronic folliculitis and alopecia but have been recorded sporadically in previous studies.This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre.Methods:A retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012.Data were collected from medical files of included patients,including gender,age,type of burn(scald,flame,other)and total body surface area(TBSA)burned at the time of first surgery.Postoperative variables were healing time of the donor site and incidence of complications.During follow-up,the incidence of late complications was reviewed.Results:A total number of 105 grafts were analysed in 93 patients:58 males(62%)and 35 females(38%),with a median age of 2 years and 3 months old.Of the patients,30(32%)had flame burns and 57(61%)had scald burns.Eighty-seven percent of patients had a TBSA burned of 5%or less.All donor sites healed within 14 days.No alopecia or scar hypertrophy developed at the donor sites.Two patients(2.2%)developed folliculitis;one patient(1.1%)showed scab formation.Conclusions:The scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature,with quick healing and no long-term complications.Therefore,we propose the consideration of the scalp as a primary donor site,especially in young children,where the scalp offers a larger donor site area than the buttocks or thighs.

Burns in the elderly:a nationwide study on management and clinical outcomes

Background:In modern-day burn care,advanced age remains an important predictor for mortality among burn victims.In this study,we compared the complete treatment trajectory(including prehospital and surgical treatment)and the outcomes between an elderly burn population and a younger adult burn population.Methods:In this nationwide study,data from the Dutch Burn Repository were used.This is a uniform national registration for Dutch specialized burn care.All adult patients that were admitted to one of the three Dutch burn centres from the period 2009 to 2015 were included in the analysis.Burn patients were considered as elderly when≥65 years of age,and were then further subdivided into three age categories:65–74,75–85 and 85+years.Younger adults in the age category 18–64 years were used as the reference group.Surgical managementwas studied comprehensively and included timing of surgery,the number of procedures and details on the surgical technique,especially the technique used for debridement and the grafting technique that was applied.For the comparison of clinical outcome,the following parameters were included:mortality,wound infections,length of stay/TBSA(total body surface area)burned,discharge disposition and secondary reconstructions.Results:During the study period,3155 adult patients were included(elderly,n=505).Burn severity,reflected by the median TBSA,varied between 3.2–4.0%and was comparable,but aetiology and pre-hospital care were different between elderly and the younger adult reference group.Surgical treatment was initiated significantly faster in elderly burn patients(p<0.001).Less selective techniques for surgical debridement were used in the elderly burns patients(hydrosurgery,42.0%vs 23.5–22.6%),and on the other hand more avulsion(5.3%vs 7.3–17.6%)and primary wound closure(6.7%vs 24.5%).The most frequently used grafting technique was meshed skin grafts(79.2–88.6%);this was not related to age.Mortality increased rapidly with a higher age and showed a high peak in the 85+category(23.8%).Furthermore,considerable differences were found in hospital discharge disposition between the elderly and the reference group.Conclusions:In conclusion,elderly burn patients who require specialized burn care are vulnerable and medically challenging.Differences in aetiology,comorbidity,physiology and the management prior to admission possibly affect the initial surgical management and result in significantly worse outcomes in elderly.Elderly patients need optimal,timely and specialized burn care to enhance survival after burn injuries.

Follow-up in patients with a burn-related emergency department visit:a feasibility study

Background:Data on epidemiology, costs, and outcomes of burn-related injuries presenting at emergency departments (EDs) are scarce. To obtain such information, a questionnaire study with an adequate response rate is imperative. There is evidence that optimized strategies can increase patient participation. However, it is unclear whether this applies to burn patients in an ED setting. The objective of this feasibility study was to optimize and evaluate patient recruitment strategy and follow-up methods in patients with burn injuries presenting at EDs. Methods:In a prospective cohort study with a 6-month follow-up, patients with burn-related injuries attending two large EDs during a 3-month study period were included. Eligible patients were quasi-randomly allocated to a standard or optimized recruitment strategy by week of the ED visit. The standard recruitment strategy consisted of an invitation letter to participate, an informed consent form, a questionnaire, and a franked return envelope. The optimized recruitment strategy was complemented by a stamped returned envelope, monetary incentive, sending a second copy of the questionnaire, and a reminder by telephone in non-responders. Response rates were calculated, and questionnaires were used to assess treatment, costs, and health-related quality of life. Results:A total of 87 patients were included of which 85 were eligible for the follow-up study. There was a higher response rate at 2 months in the optimized versus the standard recruitment strategy (43.6%vs. 20.0%;OR=3.1 (95%CI 1.1–8.8)), although overall response is low. Non-response analyses showed no significant differences in patient, burn injury or treatment characteristics between responders versus non-responders. Conclusions:This study demonstrated that response rates can be increased with an optimized, but more labor-intensive recruitment strategy, although further optimization of recruitment and follow-up is needed. It is feasible to assess epidemiology, treatment, and costs after burn-related ED contacts.