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Operative Wound Management

Introduction Surgery for burn injury is a key component to the multidisciplinary care of the burn patient. It usually involves early procedures such as escharotomy and fasciotomy when indicated, followed by burn excision. Early intervention in the form of early burn wound excision and grafting has dramatically changed the outcome and survival of the burn patient. Following burn injuries, tissues affected, including skin, promote an inflammatory…

Body Contouring with Body Definition Surgery

In today’s world, how we look is important and something that gains more and more attention both for males and females is their body definition. Although physiologically, females have more subcutaneous issue that gives them a more curvilinear look, today’s trend of having a more defined look is changing the imaginary ideal for females who today ask also for more body definition. Also, it is important…

Treatment of Infection in Burn Patients

Introduction Skin is the first immune defense mechanism and functions as a barrier against microorganisms. Infections are a significant problem once open wounds compromise this barrier. According to the U.S. National Burn Repository, the four leading causes of burn morbidity are (1) pneumonia, (2) cellulitis, (3) urinary tract infections, and (4) burn wound infections. Infections are a primary factor contributing to mortality, accounting for 51% of…

Evaluation of the Burn Wound: Management Decisions

Introduction Advances in the resuscitation of burn patients have greatly improved survival so that death from burn shock has become uncommon. In the 21st century, prompt functional recovery for the burn patient hinges on proper early management of the burn wound. The greatest advance in burn care to date has been the institution of early surgical burn wound excision with an immediate or delayed wound closure…

Burn Resuscitation

Note: The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Introduction Burns in excess of about 20% of the total body surface area (TBSA) cause shock, manifested by decreased circulating blood volume, decreased cardiac output (CO), and inadequate…

Pathophysiology of Burn Shock and Burn Edema

Note: The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Introduction and Historical Notes Extensive cutaneous thermal injury invariably results in the severe derangements of cardiovascular function and end-organ perfusion known as burn shock . Shock is an…

Prehospital Management, Transportation, and Emergency Care

Introduction Advances in trauma and burn management over the past three decades have resulted in improved survival and reduced morbidity from major burns. The cost of such care, however, is high; it requires conservation of resources such that only a limited number of burn intensive care units with the capabilities of caring for such labor-intensive patients can be found; hence, regional burn care has evolved. This…

Care of Outpatient Burns

Introduction Many small burn injuries can be treated in the outpatient clinic once it is determined that there are no other injuries, complicating medical problems, or suspicion of abuse. As with burn care in the hospital setting, the goals of outpatient burn care are to adequately heal wounds with minimal scarring or deformity, as well as reducing pain, the risk of infection, and impaired function. To…

Burn Management in Disasters and Humanitarian Crises

Disclaimer: The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Introduction Mass casualty events and disasters are marked by a period of mismatch (disproportion) between supply and demand. Rescue organizations must work to reduce the duration of this…

Prevention of Burn Injuries

Introduction Prevention is the cure for the epidemic disease of injury. Burns are one of the most devastating of all injuries and a major global public health issue. Treatment of burn injuries has historically received more focus than burn prevention, but this perspective is starting to shift. Burn centers and other partners in burn prevention efforts face a number of challenges including scarce resources, legislative delays,…

Epidemiological, Demographic and Outcome Characteristics of Burns

Introduction In 2014, approximately 200,000 deaths occurred in the United States from all injuries, and 31 million sustained nonfatal injuries. In a population of 318,857,056 persons, this represents a per capita death rate from injury of 0.063% (or approximately 6 per 10,000), and a nonfatal injury rate of 9.73% (or approximately 1 in 10). Therefore injury is common but related death is uncommon. For injuries from…

Teamwork for Total Burn Care: Burn Centers and Multidisciplinary Burn Teams

Introduction Severe burn injuries evoke strong emotional responses in most people including health professionals who are confronted by the specter of pain, deformity, and potential death. Intense pain and repeated episodes of sepsis, followed by either death or survival encumbered by pronounced disfigurement and disability, have been the expected sequelae to serious burns for most of mankind's history. However, these dire consequences have been ameliorated so…

A Brief History of Acute Burn Care Management

The recognition of burns and their treatment is evident in cave paintings that are more than 3500 years old. Documentation in the Egyptian Smith papyrus of 1500 bc advocated the use of a salve of resin and honey for treating burns. In 600 bc , the Chinese used tinctures and extracts from tea leaves. Nearly 200 years later, Hippocrates described the use of rendered pig fat…

Creating Adequate Projection With Closed Rhinoplasty

The Problem Creating adequate projection with closed rhinoplasty. Successful rhinoplasty requires integration of all anatomic components of the nose to achieve desirable form and function. Creating a beautiful nasal tip begins with analysis of its intrinsic and extrinsic characteristics: width, definition, volume, position, rotation, and projection. The last three characteristics, position, rotation, and projection, are intimately related. Inadequate surgical focus upon any one of these three…

Lateral Crural Steal (LCS)

The Problem 1. Underprojected nasal tip 2. Ptotic nasal tip The Background Underprojection of the nasal tip can be secondary to short medial crura. Goldman first described vertical division of the alar cartilage and underlying vestibular skin to increase the height of the medical crura and increase projection. The degree of tip projection varies based on the location of the cartilaginous incision. The Goldman technique is…

Dorsum Reconstruction and Osteoplasty Using Hand Instruments

The Problem Dorsum reduction and reestablishment of dorsal aesthetic lines is one of the most important steps of rhinoplasty operation. A meticulous dissection of the upper lateral cartilages (ULC) and nasal bones is crucial to achieving an aesthetically pleasing nasal dorsum and avoiding dorsal irregularities. This is especially important in the keystone area, where the caudal portion of the nasal bones overlaps the cephalic portion of…

Structural Reconstruction in Difficult Secondary Cases

The Problem Secondary rhinoplasty presents a unique challenge, testing the surgeon’s artistry, judgement, and ingenuity. Deformities arising from a primary rhinoplasty can range in severity from mild asymmetry on the dorsum or nasal tip to severe distortion and collapse of the osteocartilaginous structures. The most complex secondary rhinoplasty cases are those where structural elements of the nose were overresected. Aggressive resection and weakening of the nasal…

Dome Division

The Problem The nose has an overprojected, underrotated, and wide tip. There is a slightly bony-cartilaginous hump, and the skin/soft tissue envelope is thin. The Background In rhinoplasty, nasal tip surgery is considered to be the most interesting and difficult part of the procedure. The surgeon has to perform a detailed presurgical analysis of each cartilage’s length. This analysis helps the surgeon to assess the patient’s…

Medial Crural Overlay

The Problem 1. Overprojected nasal tip 2. Overrotated nasal tip The Background Precise control of nasal tip position may be one of the most challenging aspects of rhinoplasty. The medial crural overlay (MCO) technique was first described by Soliemanzadeh and Kridel in 2005 after using it for over 15 years. It is a reliable maneuver to retrodisplace and derotate the overprojected and overrotated nose. In 1959,…

Lateral Crural Overlay

The Problem 1. Ptotic nasal tip 2. Overprojected nasal tip The Background Precise control of nasal tip position may be one of the most challenging aspects of rhinoplasty. The lateral crural overlay (LCO) technique was first described by Kridel et al. in 1990 and is a modification of Webster’s lateral crural flap procedure to rotate the tip. LCO is a powerful tool to reliably and accurately…