Download 7th WORLD CONGRESS ON PEDIATRIC BURNS

7th WORLD CONGRESS ON
PEDIATRIC BURNS
MESSAGE FROM THE SECRETARY
OF THE EUROPEAN CLUB FOR PAEDIATRIC BURNS
The European Club for Paediatric Burns was founded in 1991 by four pediatric surgeons,
passionate about providing the best possible care for burned children. The concept was first
proposed by Martin Meuli from Zurich, and presented in the heart of the Swiss mountains to
Anna Maria Tamisani from Genova, Giovanni Grisolia from Florence, and Helmut Lochbuehler
from Munich. The idea was to avoid forming a new “Association” with an administration
structure and complicated formalities, and that is why it was called a “Club.”
Conceived in the heart of Europe, and originating from three different European countries, it
was decided that the “European Club for Paediatric Burns” was the perfect name for this
brainchild. Since then, the Club has grown to include a worldwide membership, but the goals
remain the same: intimate, honest, and stimulating, exchange of information that will result in
providing “the best possible care for burned children around the world.”
We have the honor and privilege of welcoming you to the 7th World Congress on Pediatric
Burns in Boston, Massachusetts, USA. Two of the previous six Congresses have been held in
Hong Kong, China, and Cape Town, South Africa, and this is the first Congress to be held in the
United States. Boston is a perfect venue, as the Shriners Burns Hospital and the Massachusetts
General Hospital have been major contributors to the advancement of burn care over the past one
hundred years.
Join us as we discuss Scar Wars: the future of excellence in Pediatric Burn Care! The focus of
this Congress will be integrating modern advances in diagnosis, rehabilitation, and regeneration
with an emphasis on post burn scarring. We hope you will enjoy your time here in Boston,
August 29 – September 1, 2014.
Matthias B. Donelan, M.D.
Secretary, European Club for Paediatric Burns
Chief of Staff
Shriners Hospital for Children – Boston
William G. Austen Jr., M.D.
Chief, Division of Plastic &
Reconstructive Surgery
Chief, Burn Service
Massachusetts General Hospital
Integra LifeSciences, a world leader in medical technology, is dedicated to limiting
uncertainty for surgeons, so they can concentrate on providing the best patient
care. Integra offers innovative solutions in orthopedic extremity surgery,
neurosurgery, spine surgery, and reconstructive and general surgery.
Integra was founded on a technology platform to regenerate and restore tissue
with engineered collagen matrices. The Company has developed numerous
product lines for applications ranging from full thickness burn and deep tissue
wounds to the regeneration of dura mater in the brain. It also has engineered
specific collagen solutions for the repair of nerve and tendon. Over the past 25
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Tom Tarca, VP, International –
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[email protected]
Integra is the Platinum Sponsor of the 7th World Congress on Pediatric Burns
Lumenis®, the world's largest medical laser company and a market leader in aesthetic products. Our
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Since 1987, Bio Med Sciences has delivered leading medical technology and
innovative solutions to the global burn treatment, plastic surgery and
aesthetic skin care markets. Our proven, patented Silon® technology provides
a versatile platform for an extensive range of silicone based medical products
to prevent and manage hypertrophic scars and keloids. In exclusive partnership with Polymedics
Innovations GmbH, we are now the USA distributor of Suprathel®.
Please visit our booth during the congress or contact Bio Med Sciences at any time to learn how this
new and emerging material, Suprathel®, can help you to improve the care, comfort and costs for burns.
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Suprathel®Intelligent Solutions for Difficult Wounds
BMS is the Silver Sponsor of the 7th World Congress on Pediatric Burns
The team at Moor has consulted with burns surgeons worldwide for over 15 years to develop our laser
Doppler Burn Imagers. These accurate, clinically proven systems act as a powerful aid to burn wound
diagnosis and offer rapid, non-contact and early diagnosis of burn depth and healing potential. For
indeterminate burn wounds that are difficult to assess by clinical judgment alone, diagnosis of deeper
wounds that require surgical intervention can be confirmed earlier allowing prompt appropriate
management and more efficient surgical planning, thus also reducing length of stay. The moorLDI2-BI
and moorLDLS-BI are the only diagnostic tools to have been through multi-centred,
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Visit the Moor Instruments stand to see our small, rapid laser Doppler burn assessment system
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Tel: +1 302 798 7470 (USA)
Email: [email protected]
+44 (0)1297 35715 (UK and Europe)
Moor Instruments is the Bronze Sponsor of the 7th World Congress on Pediatric Burns
Schedule of Events
th
Friday, August 29
1:00 – 5:00 pm
5:00 – 6:00 pm
6:00 – 8:30 pm
Registration
Key note Address
Welcome Reception
Shriners Lobby
Shriners Auditorium
Paul S. Russell Museum
Saturday, August 30th
7:00 – 12:00 noon
7:30 – 8:00 am
8:00 – 8:30 am
8:30 – 9:30 am
9:30 – 9:45 am
9:45 – 12:00 noon
12:00 – 1:15 pm
1:15 – 3:15 pm
3:15 – 3:30 pm
3:30 – 4:15 pm
4:15 – 5:00 pm
6:00 – 6:45 pm
7:00 – 10:00 pm
Registration
Shriners Lobby
Continental Breakfast
Shriners Lobby
Introduction and Welcome
Shriners Auditorium
Gain without Pain: the Dawn of Elective Surgery
Refreshment Break
Shriners Lobby
Diagnosis and Treatment of Acute
Shriners Auditorium
Burns: Evolving Paradigms
Lunch Break
Skin Substitutes: Past, Present,
Shriners Auditorium
& Future
Refreshment Break
Shriners Lobby
Session I: Free Papers
Kabul Pediatric Burn Update
Shriners Auditorium
Cocktails
The Liberty Hotel
Gala Dinner
Sunday, August 31st
7:30 – 8:00 am
8:00 – 8:15 am
8:15 – 10:30 am
10:30 – 10:45 am
10:45 – 12:00 noon
12:00 – 1:15 pm
1:15 – 2:45 pm
2:45 – 3:00 pm
3:30 – 4:30 pm
4:30 – 5:00 pm
Continental Breakfast
John F. Burke: Surgical Scientist
and Innovator
Advances in Rehabilitative Therapy,
Medicine, and Surgery
Refreshment Break
Autologous and Allogenic Approaches
to Burn Reconstruction
Lunch Break
Session II: Free Papers
Session III: Free Papers
Refreshment Break
Session IV: Free Papers
Session V: Free Papers
European Club for Paediatric Burns
Business Meeting
Shriners Lobby
Shriners Auditorium
Continental Breakfast
Regenerative Interventions in Burn Care
Refreshment Break
Session VI: Free Papers
Next Meeting Announcement
Shriners Lobby
Shriners Auditorium
Shriners Auditorium
Shriners Lobby
Shriners Auditorium
Shriners Auditorium
Thier Conference Room
Shriners Lobby
Shriners Auditorium
Thier Conference Room
Shriners Auditorium
Monday, September 1st
7:30 – 8:00 am
8:00 – 10:15 am
10:15 – 10:30 am
10:30 – 11:30 am
11:30 – 12:00 noon
Shriners Auditorium
Shriners Auditorium
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adhere to the moist wound bed yet adhere gently to the surrounding skin and therefore minimize trauma and pain at removal.
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Candela Corporation
530 Boston Post Road
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Tel: 508-358-7400
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Fax: 508-358-5602
Sciton is a leading manufacturer and provider of superior laser and light based aesthetic solutions. Sciton systems are designed
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Friday, August 29
5:00 – 6:00 pm
Shriners Auditorium
Keynote Address
John Hunter: The First Scientific Surgeon
Dr. W. Hardy Hendren
Welcome Reception
6:00 – 8:30 pm
Paul S. Russell Museum
Saturday, August 30
Shriners Auditorium
7:30 – 8:00 am
Continental Breakfast
8:00 – 8:30 am
Introduction and Welcome
8:30 – 9:30 am
Gain without Pain: The Dawn of Elective Surgery
James W. May, Jr.
9:30 – 9:45 am
Refreshment Break
Shriners Lobby
Shriners Lobby
Diagnosis and Treatment of Acute Burns: Evolving Paradigms
Moderator: Dr. Marc Cullen
9:45 – 10:15 am
Was Voltaire Right? Seven Decades of Change in Burn Patient Management
Dr. Basil Pruitt
10:15 – 10:45 am
Changing Treatments of Massive Burns in Children over Time; Influences of
Depth of Wound and Techniques of Coverage
Dr. David Herndon
10:45 – 11:15 am
The Biologic Basis for the Importance of Burn Wound Depth
Dr. Edward Tredget
11:15 – 11:45am
Burn Depth Assessment through the Ages
Ms. Sarah Pape
11:45 – 12:00
Questions and Discussion
12:00 – 1:15 pm Lunch Break
Skin Substitutes: Past, Present, & Future
Moderator: Dr. Martin Meuli
1:15 – 1:45 pm
Molecular Mechanism for Surface Ligand Activity of a Regenerative Scaffold
Prof. Ionnis Yannas
1:45 – 2:15 pm
Next Generation Skin Substitutes for Advanced Burn Care
Dr. Steven Boyce
2:15 – 2:40 pm
Organ-Engineering of Skin: From Basic Research to Clinical Application
Dr. Ernst Reichmann
Skingineering – Swiss Research on Skin Replacement
Dr. Clemens Schiestl
2:40 – 3:05 pm
Treatment of Burn Injuries with the Synthetic Resorbable Epithelium
Substitute Suprathel
Dr. Helmut Hierlemann
Skin Substitutes: Past and Present Lessons Learned
Dr. Sigrid Blome-Eberwein
3:05 – 3:15 pm
Panel Discussion
3:15 – 3:30 pm
Refreshment Break
3:30 – 4:15 pm
Session I: Free Papers
Shriners Lobby
Moderator: Dr. Matthias B. Donelan
1. Suprathel Changes the Game!
2. Dermal Reconstruction: A 17-Year Experience
3. Introducing Laser Therapy for Burn Hypertrophic Scars in your
Facility: Why get in the game now?
4:15 – 5:00 pm
Kabul Pediatric Burn Update
Moderator: Dr. Clemens Schiest
Dr. Habib Ur Rahman Qasim
Dr. Najia Tariq
Dr. Noorulhaq Yousefzai
6:00 – 6:45 pm Cocktails
The Liberty Hotel
7:00 - 10:00 pm GALA DINNER
Presentation of the Zora Janzekovic Prize
Presented by Dr. Clemens Schiestl
Sunday, August 31
Shriners Auditorium
7:30 – 8:00 am
Continental Breakfast
8:00 – 8:15 am
John F. Burke: Surgical Scientist and Innovator
Dr. Ronald G. Tompkins
Shriners Lobby
Advances in Rehabilitative Therapy, Medicine, and Surgery
Moderator: Dr. Matthias B. Donelan
8:15 – 8:35 am
Hypertrophic Scar following Burn Injury: A Pathophysiologic Approach to
Treatment
Dr. Edward Tredget
8:35 – 8:55 am
Non-Surgical Management of Scars
Mr. Michael Serghiou
8:55 – 9:03 am
Burn Scar History, Path to the Present
Dr. Jane A. Petro
9:03 – 9:10 am
Awe without Shock: The New Era of Burn Scar Rehabilitation
Dr. Matthias Donelan
9:10 – 9:30 am
Dermatology, Lasers, and the Wounded Warrior
Dr. Peter Shumaker
9:30 – 9:40 am
“Under the Skin”- Histology and Biochemistry of Scar Treatments
Dr. David Ozog
9:40 – 10:00 am
A New Hope: Laser and Laser Assisted Delivery for Treatment of Scars
Dr. Jill Waibel
10:00 – 10:15 am
Shine Like Stars in the Summer Night: Laser Remodeling and Resurfacing of
Hypertrophic Burns Scars
Dr. C. Scott Hultman
10:15 – 10:30 am
Questions and Discussion
10:30 – 10:45 am Refreshment Break
Shriners Lobby
Autologous and Allogeneic Approaches to Burn Reconstruction
Moderator: Dr. Curtis Cetrulo
10:45 – 11:00 am
Fat Injection in Severe Burn Outcomes: A New Perspective of Scar
Remodeling and Reduction
Dr. Marco Klinger
11:00 – 11:30 am
Vascularized Composite Allo-transplantation
Dr. W.P. Andrew Lee
11:30 – 11:45 am
The Volar Forearm Fasciocutaneous Extension: A Strategy to Maximize
Vascular Outflow in Post-Burn Injury Hand Transplantation
Dr. Kyle Eberlin
11:45 – 12:00 am
Reconstructive Transplantation: The Search for Immune Tolerance
Dr. David A. Leonard
12:00 – 1:15 pm Lunch Break
1:15 – 2:45 pm
Session II: Free Papers
Shriners Auditorium
Moderators: Dr. Robert L. Sheridan & Dr. Clemens Schiestl
4. Risk Assessment and Management Guidelines to Prevent Venous
Thromboembolism in Paediatric Burn Patients
5. Less Is Best: Impact of Reduced Resuscitation Fluid on Outcomes of
Children With 10-20% Body Surface Area Scalds
6. Update on the Toxic Shock Syndrome in Pediatric Burns Registry
(TSSPB Registry)
7. Value of Transfusion and Clinical Outcome in Burns: A Multihospital
Experience
8. The Scalp as a Donor Site for Skin Grafting in Burns: A Retrospective
Study of Results and Complications
9. Nasal turnover flap for reconstruction of the severely burned nose
10. Clinical Evaluation of a Silver-Impregnated Foam Dressing (Mepilez
AG) in the Treatment of Partial Thickness Burns in a Pediatric Burn
Center
11. An Inpatient (Silver Sulphadiazine) vs. Outpatient (Nanocrystalline
Silver) Model of Care for Pediatric Scald Burns: A Value Analysis
12. The Use of Porcine Xenograft Decreases Pain and Length of Stay in
Pediatric Patients
1:15 – 2:45 pm
Session III: Free Papers
MGH Thier Conference Room
Moderators: Dr. Frederick Stoddard & Ms. Katherine Siwy
13. Intervention to Reduce Stress in 0-5 Year Olds with Burns
14. December 7th - Young Burn Survivors Day in Germany
15. Corrective Make-Up: A Non-Surgical Solution to Increasing Quality
of Life in the Pediatric Burn Victim
16. “The Burden of Guilt” – How to Support Parents in Daily Care
17. Burn Care in the One Day Clinic of the Burn Center, Queen Astrid
Military Hospital, Brussels
18. Medical Treatment as a Matter of Principle - Is This Always the Right
Decision? A Blind and Severely Disabled Burn Victim Caught
Between High Tech Medicine and an Ethical Dilemma
19. Adhesive Contact Therapy as a Leading Scar Treatment Method Over 15 Years of Experience
20. Management of Paediatric Burnt Hands: A Case Report
21. Splinting and Pressure Strategies for Facial Scarring in the UK:
Outcomes from an MDT Working Party assembled by the Katie Piper
Foundation
2:45 – 3:00 pm
Refreshment Break
Shriners Lobby
3:30 – 4:30 pm
Session IV: Free Papers
Shriners Auditorium
Moderators: Dr. Joel Fish & Dr. Herbert Haller
22. Meet the Parents - Allografts for Extensive Burn Injuries
23. Scanoskin, a Novel Imaging Adjunct for the Assessment of Acute
Paediatric Burns
24. Silicone Gloves against Post-Burn Palm Contracture in Small Infants
25. The Effect of Burn Injury Location on Lower Body Physical Function
26. Alleviation of Burn Scar Pruritis with Sub- And Intra-Cictricial Fat
Injection
27. Do We Prefer a Collagen-Scaffold-Structure in Collagen Neosynthesis
After Burn Injury?
28. The Treatment of Partial Burns in Children
29. Incidence and Risk Factors of Burn Injuries Among Infants, Finland
1990-2010
30. Review of Skin Donor Population in a Referral Tissue Bank, 20022013
3:30 – 4:30 pm
Session V: Free Papers
MGH Thier Conference Room
Moderators: Dr. Curtis Cetrulo & Dr. Daniel Driscoll
31. An Introduction to Sequential Multiple Assignment Randomized Trial
(SMART) and Application to Study Laser Treatment of Hypertrophic
Burn Scars
32. Replacing Like with Like Using the Two Ends of the Digestive
System: Case Report for Lip Vermillion Burn Reconstruction
33. Prematures Collective Accident
34. Burn Ear Reconstruction Using Porous Polyethylene Implants
35. Caught in the Web: How To Prevent Burn Scar Syndactyly
36. The Foreskin as a Thin Full-Thickness Skin Graft for Burned Eyelids
37. A Random Interpostitional Skin or Skin-fascia Flap Technique
38. Long Term Results after Split Thickness Skin Grafting of Facial Burn
in Children
39. Clinical Curative Observations of Pediatric Burn Patients Treated by a
Patented Special Effect Burn Ointment with Burn Skin-Grafting Free
Skill
4:30 – 5:00 pm
European Club for Pediatric Burns Business Meeting
Monday, September 1
Shriners Auditorium
7:30 – 8:00 am
Continental Breakfast
Shriners Lobby
Regenerative Interventions in Burn Care
Moderator: Dr. Fiona Wood
8:00 – 8:30 am
Regenerative Medicine through a Surgeon’s Eyes: Forty Years after John
Burke
Dr. Joseph Vacanti
8:30 – 8:45 am
Tissue Copying for Wound Repair
Dr. Joshua Tam
8:45 – 9:15 am
“Fractional” Epidermal Blister Grafting
Dr. R. Rox Anderson
9:15 – 9:45 am
The Role of Cell Based Therapies in Burn Wound Healing
Dr. Fiona Wood
9:45 – 10:00 am
Micro Fractional Ablation: A Novel Approach to Skin and Scar
Dr. Lisa Gfrerer
10:00 -10:15 am
Questions and Discussion
10:15 – 10:30 am Refreshment Break
Shriners Lobby
10:30 – 11:30 am Session VI: Free Papers
Shriners Auditorium
Moderators: Dr. Sigrid Blome-Eberwein & Dr. Martin Meuili
40. Combination of Needling and ReCell for Repigmentation of Burn
Scars – A Promising Approach Also for Youngsters and Tweens?
41. The Influence of Stromal Cells in the Pigmentation of TissueEngineered Human Skin Grafts
42. Assessing the Effects of UVB Radiation on Human Dermo-Epidermal
Skin Substitutes Containing Melanocytes
43. Results from Application of an Absorbable Synthetic Membrane to
Superficial and Deep Second Degree Wounds
44. Cryopreserved Stratagraft, A Human Skin Substitute with Long Shelf
Life, for Treatment of Deep Partial Thickness Burns
45. Practical Outpatient Use of Targeted Enzymatic Debridement in Burns
11:30 – 12:00 noon
Next Meeting Announcement
12:00 noon
Adjourn
Faculty
R. Rox Anderson, MD; Director, Wellman Center for Photomedicine, Massachusetts General
Hospital; Professor of Dermatology, Harvard Medical School
William G. Austen, Jr., MD, FACS; Chief, Division of Plastic and Reconstructive Surgery,
Chief, Division of Burn Surgery, Massachusetts General Hospital
Sigrid Blome-Eberwein, MD; Associate Director Regional Burn Center, Lehigh Valley Hospital
Network
Steven T. Boyce, PhD; Professor, Department of Surgery, University of Cincinnati
Pr. Fabienne Braye, MD, PhD; Professor of Plastic Surgery, Claude Bernard Lyon University,
Head of the Plastic and Reconstructive Surgery Unit of Hospices Civils de Lyon
Curtis Cetrulo, MD; Surgeon, Division of Plastic and Reconstructive Surgery, Massachusetts
General Hospital, Shriners Hospitals for Children, Senior Investigator and Head of
Allotransplantation Laboratory, Transplantation Biology research Center, Massachusetts
General Hospital
Marc L. Cullen, MD; Surgeon in Chief, St. John Children's Hospital; Division Chief, Pediatric
Surgery; St. John Providence Health System
Matthias B. Donelan, MD; Chief of Staff, Shriners Hospitals for Children – Boston, Associate
Clinical Professor of Surgery, Harvard Medical School, Associate Visiting Surgeon,
Massachusetts General Hospital
Kyle Eberlin, MD; Attending Plastic and Reconstructive Surgeon, Massachusetts General
Hospital, Harvard Medical School
Joel Fish, MD MSC FRCS C; Medical Director of Burn Program, Hospital for Sickkids,
Toronto, Associate Professor, University of Toronto Department of Surgery.
Lisa Gfrerer, MD, BA; Research Fellow. Massachusetts General Hospital
Herbert Haller, MD; Trauma Intensive Care Specialist, Sport Orthopedics Specialist,
Unfallkrankenhaus Linz, Austria
W. Hardy Hendren, MD; Chief of Surgery Emeritus, Children's Hospital Boston; Robert E. Ross
Distinguished Professor of Surgery, Harvard Medical School; Honorary Surgeon, Massachusetts
General Hospital
David N. Herndon, MD, FACS; Chief of Staff & Director of Research, Shriners Hospital for
Children – Galveston; Professor of Surgery and Pediatrics, Jesse H. Jones Distinguished Chair in
Burn Surgery, University of Texas Medical Branch
Helmut Hierlemann, PhD; Technical Director, Product Manager, Polymedics Innovations GmbH
C. Scott Hultman, MD, MBA, FACS; Ethel and James Valone Distinguished Professor of
Surgery Chief and Program Director, UNC Plastic Surgery Vice Chair for Finance, Department
of Surgery Founder and Executive Director, UNC Burn Reconstruction and Aesthetic Center
Associate Director, NC Jaycee Burn Center
Prof. Marco Klinger; Director of Reconstructive and Aesthetic Plastic Surgery School,
Department of Medical Biotechnology and Translational Medicine BIOMETRA, University of
Milan, Chief of Plastic Surgery Unit, Humanitas Clinical and Research Center, Rozzano (Milan),
Italy
W.P. Andrew Lee, MD; The Milton T. Edgerton, MD, Professor and Chairman, Department of
Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
David. A. Leonard, MD; Post-Doctoral Research Fellow, Vascularized Composite
Allotransplantation Laboratory, Transplantation Biology Research Center, Massachusetts
General Hospital
James W. May Jr MD, FACS Eng. (Hon).; Prof of Surgery Harvard Medical School, Chairman
of Plastic Surgery ( Emeritus ) Massachusetts General Hospital
Martin Meuli, MD; Chief Physician, Children's Hospital Zurich; Professor, University of Zurich
David Ozog, MD; Senior Staff, Cosmetic and Procedural Dermatology, Henry Ford Medical
Center, Detroit, Michigan
Sarah Pape, MBChB, FRCSEd, MClinEd; The Newcastle Upon Tyne Hospital, Tyne and Wear,
Northeast England
Jane A. Petro, MD, FACS, FAACS; Retired Professor of Surgery NYMC, Former Associate
Director Burn Center Westchester Medical Center Valhalla NY, Currently President of the
American Academy of Cosmetic Surgery
Basil A. Pruitt, Jr., MD, FACS, FCCM, MCCM; Clinical Professor of Surgery, Betty and Bob
Kelso Distinguished Chair in Burn and Trauma Surgery, Dr. Ferdinand P. Herff Chair in
Surgery, University of Texas Health Science Center at San Antonio
Prof. Dr. Ernst Reichmann, PhD; Director, Tissue Biology Research Unit, Department of
Surgery, University Children's Hospital, Zurich
Clemens Schiestl, MD; Director of the Pediatric Burn Center, Plastic and Reconstructive
Suergery, Department of Surgery, University Children`s Hospital Zurich, Switzerland
Michael A. Serghiou, OTR, MBA; Administrative Director, Shriners Hospitals for ChildrenGalveston, Texas
Robert L. Sheridan, MD; Assistant Chief of Staff & Chief of Acute Unit, Shriners Hospitals for
Children - Boston; Associate Clinical Professor of Surgery, Harvard Medical School
CDR Peter Shumaker, MD; Chairman, Dermatology, Program Director, CARE Training
Summit, Naval Medical Center, San Diego, California
Joshua Tam, PhD, Instructor in Dermatology, Harvard Medical School, Assistant in Biomedical
Engineering, Wellman Center for Photomedicine, Massachusetts General Hospital
Najia Tariq, MD, MPPA; Deputy Minister for Health Care Services Provision, Ministry of
Public Health, Kabul, Afghanistan
Ronald G. Tompkins, MD, Sc.D.; Division Chief, Division of Burns, Massachusetts General
Hospital
Edward E. Tredget, MD, MSc, FRCSC; Director of Surgical Research, Professor of Surgery,
University of Alberta, Canada
Habib Ur Rahman Qasim; Chief of Burns and Surgical Emergencies, Indira Gandhi Institute of
Child Health, Kabul, Afghanistan
Joseph P. Vacanti, MD; John Homans Professor of Surgery, Harvard Medical School, Chief,
Department of Pediatric Surgery, Massachusetts General Hospital (MGH), Surgeon-in-Chief,
MassGeneral Hospital for Children, Co-Director, Center for Regenerative Medicine, MGH,
Director, Laboratory for Tissue Engineering and Organ Fabrication, MGH, Chief, Pediatric
Transplantation, MGH
Jill S. Waibel, MD; Medical Director and Owner, Miami Dermatology and Laser Institute
Winthrop Professor Fiona M. Wood, FRACS AM, Director of the Burns Service of Western
Australia, Director of the Burn Injury Research Unit UWA
Ioannis Yannas, PhD; Professor of Mechanical and Biological Engineering, Massachusetts
Institute of Technology
Noorulhaq Yousefzai; Director, Indira Gandhi Institute of Child Health, Kabul, Afghanistan
ABSTRACTS
1.
Suprathel changes the game!
1
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H.Haller , R. Hafner , M. Giretzlehner , J. Dirnberger , S. Thumfahrt , Chr. Ottomann ,; F. Sander , B.
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Hartmann , M. Rapp , J. Kaartinen , D. Lumenta , LP. Kamolz ,
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UKH Linz der AUVA, Austria, Research Institute for Symbolic Computation of Johannes Kepler University
3
Linz, Hagenberg, Austria, Zentrum für Schwerbrandverletzte mit Plastischer Chirurgie Unfallkrankenhaus
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Berlin, Germany, Marienhospital Stuttgart, Germany, University of Tampere, Finland, Klinik für Plastische
und Rekonstruktive Chirurgie der medizinischen Universität Graz, Austria
Suprathel is a synthetic copolymer membrane mostly from polylactids used in burn treatment to provide temporary
coverage of superficial and partial deep dermal burns and donor areas warranting no biological hazards. It degrades
hydrolytically to lactic acid components, such showing negative effect on bacterial growth. It usually is covered with a
layer of fatty gauze and this is covered with a dressing which is left in place till the wound has healed. Primary reason
to use Suprathel in our hospital 2004 was the evident reduction of average time for dressing changes from 87
minutes to 57 minutes. Dressing changes initially done under general anesthesia changed to procedures with
standby of an anesthesiological team and further on to be done nearly without additional anesthetic medication by the
staff.
Pain reduction by Suprathel has been shown to be superior to other membranes used in similar indications giving the
chance to reduce pain medication like opioids and so to decrease fluid retention and to reduce the time of artificial
ventilation such avoiding complications.
Suprathel has been used both in children and in grown-ups for the coverage of partial thickness burns. In children it
was used in mid-dermal burns and SSG were applied in areas not healing after a certain period, such offering the
usability in mixed burns and the reduction of STG. In grown-ups it was used in partial deep burns after tangential
excision, which gave the advantage in extensive burns to save donor areas and to reduce workload. Reduced water
loss also combines with reduced evaporation heat loss such improving the patient‟s metabolic situation.
Tests showed an excellent bactericidal effect of the “Suprathel- Acetic-Acid-Matrix” particularly with problematic
Gram-negative bacteria such as Proteus vulgaris, P. aeruginosa, and Acinetobacter baumannii with an efficiency
superior to silver containing products. Suprathel was successfully used in Over-graft procedures with Mesh and Meek
and provided to be a good treatment choice in combination with keratinocytes spray and enzymatic debridement and
in burn-like syndromes.
2.
DERMAL RECONSTRUCTION : A 17-YEAR EXPERIENCE
F. Braye, Pr; A. Mojallal, MD; H. Shipkov, MD ; M. Guillot
Centre de Traitement des Brûlés, Hôpital E. Herriot, 69437 LYON, France
Introduction E. Herriot Burn Center is a 21 bed unit associated with a Plastic Surgery unit. We treat 400 in-bed
burned patients a year.
Integra® was first approved by the FDA in 1996 We used it and other dermal substitutes since 1997 for acute burns,
burns scars and plastic surgery.
At the light of more than 150 grafts of artificial dermis, we will discuss it‟s place in the armamentarium plastic surgery :
free (split and full thickness) skin transplants, cultured keratinocyte grafting, use of tissue expanders and various free
flap procedures. The place of monolayered and bi layered substitutes is also a question.
Material and methods. The pictures and clinical data of the patients were considered retrospectively. The reasons for
the use of artificial dermis were collected. The satisfaction of the patient and surgeon and complementary
procedures were examined.
Most patients underwent bilayered dermis.
Results. The technical procedures changed as our experience increased and now leads to a low rate of
complications, under 10%. The first week post grafting is critical to prevent detachment of the dermis and infection.
For acute burns, we use artificial dermis for the immediate coverage of tendons of for tricky areas, where secondary
reconstruction is the rule, such as neck or hands. It‟s also of great interest for extensive burns in babies, where
growth will be a tremendous challenge.
For reconstructive surgery, artificial dermis brought a solution for patients suffering extensive burn scars, by providing
big amounts of new coverage. The limits are early retraction and the cosmetic aspect, which remains different from
normal skin.
In our experience, full thickness autograft is the first choice when possible. When healthy skin is available close to the
scar, dermal substitute must be put into balance with tissue expansion.
3.
Introducing Laser Therapy for Burn Hypertrophic Scars : Why get in the game now?
Joel Fish MD MSc FRCS(c), Charis Kelly RN(EC) MN NP Peds
The Hospital for Sick Children, Toronto, Canada
This paper will discuss the early experience with the introduction of a laser therapy program for pediatric burn
hypertrophic scars. Laser therapy is efficacious based on the reported literature to date with good information
regarding overall safety of the therapy. Issues with timing of procedures in the pediatric population, education for
nursing staff and anesthesia are reviewed. A laser database was developed including outcome data in order to track
patients and design future trials. The majority of our cases are under the age of five and have already received
standard available therapies for scar modulation. Financial aspects of introducing this therapy in a socialized medical
system are also reviewed. Our experience documents the early learning curve with introducing this therapy. Future
directions for research are reviewed based on our early experience.
4.
Risk assessment and management guidelines to prevent venous thromboembolism in paediatric
burn patients
F.D‟Asta, C.Thomas, J. Provins, D.Wilson, N.Moiemen, Y.Wilson
Birmingham Children Hospital, United Kingdom
Introduction: Venous thromboembolic disease (VTE) is a recognised complication of burns. Despite this, as
previously reported in surveys in the United States and Canada, a consensus regarding the need of
thromboprophylaxis in burn patients is still lacking, particularly in children. Controversy arises not only from need, but
route, dose, and monitoring regimens.
Aim: The purpose of this study was to review the available literature and also to conduct a survey into current
practice in VTE prophylaxis in UK burns centres in order to develop a thrombotic risk assessment pro-forma to use
alongside our current thrombophylaxis regimen.
Methods: All burns services within the UK as listed by the British Burns Association website were contacted. A
telephone or email survey was conducted with a pro-forma. „Burns‟ and „venous thromboembolism‟ and „Burns‟ and
„venous thrombosis‟ were the terms used in Medline for the literature review.
Results: 27 services were contacted in total and 25 responded. 16 treated adult patients and all used Low Molecular
Weight Heparin (LMWH) in their prophylaxis. 15 services treated children (13 stating that they would use LMWH in
some instances). 22 out of the 25 services stated they had a VTE protocol and the 3 that did not were solely
paediatric centres. No service had a burns specific protocol. 4 services had a VTE protocol that applied to children.
Only 2 centres could ever recall a paediatric thrombotic event. Only 4 regularly monitored anti Xa levels.
Search terms „Burns‟ and „Venous Thromboembolism‟ returned 14 articles of which 10 were relevant. „Burns‟ and
„Venous thrombosis‟ returned 29 articles of which 17 were relevant, giving a total of 27 relevant articles. With
consideration of current literature and our survey results we have devised a protocol including VTE risk score
assessment and a routine anti Xa monitoring regime.
Conclusion
Despite the rarity of VTE events in children, a specific risk score assessment for paediatric burns and a
thromboprophylaxis protocol is highly recommended in every burns service in order to ensure prophylaxis is given to
appropriate patients avoiding potential harm.
5.
Less is best: impact of reduced resuscitation fluid on outcomes of children with 10-20% body
surface area scalds.
1
1
1
1
2
D. Urriza Rodriguez , T.L.J. Walker , K. Coy , A.E.R. Young , L.I. Hollén , R. Greenwood
1
2
3
3
Frenchay Hospital, Bristol, UK, University of Bristol, Bristol, UK, Bristol Royal Infirmary, Bristol, UK.
Introduction
„Permissive hypovolaemia‟ fluid regimes in adult burn care are suggested to improve outcomes. Effects in pediatric
burn care are less well understood.
Since January 2007, the South West Children‟s Burn Centre (SWCBC) changed to a permissive hypovolaemic fluid
resuscitation regimen. Fluid resuscitation is commenced at 15% burn surface area (BSA), at an initial rate of 2
ml/kg/%BSA rate with 80% maintenance fluids and target urine output of 0.5 ml/kg/hour. Prior to 2007, the
resuscitation protocol was based on the traditional Parkland Formula. Resuscitation started at 10% BSA, at a rate of
3 ml/kg/%BSA with 100% maintenance fluids, and urine output target of 1-2 ml/kg/hour.
Methods
Outcomes of children, less than 16 years of age, managed at SWCBC with scalds of 10%–20% BSA with a reduced
volume fluid resuscitation regime (post-2007) were compared to two different cohorts in a retrospective audit:
(a) An historical SWCBC protocol (pre-2007); and,
(b) Current regimes used in burn services across England and Wales (E&W).
Outcomes included length of stay per percent BSA (LOS/%BSA), skin graft requirement, and re-admission rates.
Results
92 SWCBC patients and 475 patients treated in 15 other E&W burn services were included.
Median LOS/%BSA for patients managed with the reduced fluid regime was 0.27 days. Significantly less than pre2007 and other E&W burn services (0.54 days and 0.50 days respectively, p < 0.001). Skin grafting to achieve
healing at SWCBC reduced post-2007 and remains comparable with other services in E&W. Re-admission rates
were comparable between all groups.
Conclusion
The implementation of a permissive hypovolaemic fluid resuscitation regime has significantly shortened LOS/%BSA
without compromising burn depth as measured by skin grafting. A prospective trial comparing permissive
hypovolaemia to current resuscitation regimes for moderate pediatric scald injuries would help clarify if these findings
are reproducible, potentially altering guidelines on the management of these injuries.
6.
Update on the Toxic Shock Syndrome in Pediatric Burns Registry (TSSPB Registry)
1,2
1
2
1
Carol Oliveira , Jung-Pin Yeh , Helene Scheer , Joel Fish , Clemens Schiestl
1
2
2
The Hospital for Sick Children, Toronto, Ontario, Canada; University Children‟s Hospital, Zurich,
Switzerland
Toxic shock syndrome (TSS) is a rare, but potentially life-threatening complication of thermal injuries in children. Due
to the small sample size and descriptive nature of published reports, the necessity for an international disease
registry became evident. A registry allows pooling of patient data and answering currently unanswered research
questions on epidemiology, risk and preventative factors, outcome predictors, symptoms and laboratory findings, a
potential geographical distribution and outcomes.
A worldwide, electronic disease registry (Toxic Shock Syndrome in Pediatric Burns Registry, TSSPB Registry) based
®
on RedCAP software was setup by two pediatric burns centers after obtaining institutional ethics board approval. A
website was generated presenting current knowledge on the disease and information on the registry to healthcare
professionals, giving them the opportunity to link to the registry itself and contribute patient data. Administrative
support in obtaining institutional ethics board approval is offered to all contributors. Patient data may be entered
electronically at this time point.
Challenges faced during registry inception were associated with language barriers between North American and
European burns centres, legal issues related to data sharing, and human and financial resources. A great interest
among the medical community and media, and expert commitment and support were crucial to overcome these
difficulties. First patient data was recorded and will be presented in detail.
Future objectives of the registry include continuous analysis and reporting of results derived from entered patient
data, expansion of the website, translation of results into knowledge accessible to affected families, and securing
long-term funding.
In conclusion, the setup of a worldwide disease registry is feasible. Its success is highly dependent on local and
international support, and driven by the clinical urgency to increase knowledge and evidence on a rare, medical
condition.
7.
Value of blood transfusion and clinical outcome in burns: A multihospital experience
1,3
2
3
Gennadiy Fuzaylov , M.D., Christopher Homsey , M.D., Daniel Driscoll , M.D.
Massachusetts General Hospital, TUFTS Medical Center, Shriners Hospital, Boston
Background: Burns are a major cause of injuries worldwide and more specifically in the developing world. The main
burden falls on the developing countries. Despite its constrained resources, Ukraine continues to be involved in the
care of burn patients annually.
These patients often become anemic and may need blood transfusion. Transfusion carries known risks such as
infection, acute lung injury and death. The objective of this paper is to assess the value of blood transfusion in burns,
by measuring key clinical outcomes: wound infection, sepsis and mortality.
Methods: A retrospective multicenter cohort analysis (2010-2013) of burn patients admitted to twenty hospitals
including burn center in one province in Ukraine. The study included 1760 patients: 81 patients required transfusion
and 1679 did not. The characteristics of the burn (type, total body surface area) were examined as well as three
major complications (infection, sepsis and death). Statistical analysis with Chi-square test was used for comparison.
Results: Transfused patients had deeper burns (22.9± 16.8 vs 2.6 ±5.0, %TBSA). Also 23% of transfused patients
were 5 years old and younger. Furthermore, 30% of the transfused had a TBSA <10%. Wound infection was more
prevalent in the transfused group: 40% in the transfused vs 15% in the non-transfused, (p<0.001). Nine patients
developed sepsis in the transfused in comparison to 2 in the other group (p<0.001). Finally, mortality was significantly
higher in the transfused group 14% vs 1% (p<0.001).
Conclusion: Adverse consequences of transfusion in burn patients were significant in transfused patients with higher
infection, sepsis and mortality and no definite benefit on the other hand. This study reveals the need to study blood
transfusion practice more than in one burn center and also to revise the indications for transfusion and possible
creation of new transfusion policies in the burn population.
8.
The scalp as a donor site for skin grafting in burns: a retrospective study of results and
complications
D.T. Roodbergen MD, dr. J. Vloemans MD, prof. dr. R.F. Breederveld MD.
Burn Unit Red Cross Hospital, Beverwijk, The Netherlands.
Background: Split skin grafting (SSG) is the cornerstone in the management and treatment of burns and (large) skin
defects. Commonly used donor sites are the thigh, abdomen, buttocks and scalp. The scalp is generally considered a
reliable donor site. Advantages are a quick procedure, rapid wound healing, cosmetically favourable results and
multiple harvests from the same donor site. Complications include alopecia, scab formation and chronic folliculitis, but
have been recorded very sporadically in previous studies. This study was performed in order to review the results in
our Burn Unit with the scalp as a donor site for skin grafting.
Methods: A retrospective study was performed of all patients who received a skin graft with the scalp as a donor site
at our Burn Unit at the Red Cross Hospital in Beverwijk between January 2004 and December 2012. A database was
created using medical files of included patients, recording gender, age, type of burn (scald, flame, other), total burned
surface area (TBSA) at time of first surgery, length of surgery and Mesh ratio used, ranging from full sheet to 1:4.
Post-operative variables were time of healing at the donor site and the incidence of complications. During follow-up
the incidence of late complications was reviewed. Scars were scored on vascularisation, pigmentation, thickness,
relief and expansion or contraction of the original wound surface using the Patient Observer Scar Assessment Scale
(POSAS-scale). The data were analysed using SPSS 12.0.
Results: A total number of 105 grafts were analysed from 93 patients: 58 males (62.4%) and 35 females (37.6%),
with an average age of 7.7 years. Of the patients, 30 (32.2%) had flame burns, 57 (61.3%) had scald burns and 6
(6.5%) had other burns. 86% of patients had a TBSA of less than 5%. All donor sites healed within 14 days. No
alopecia or scar hypertrophy developed at the donor site. 2 patients (2.2%) developed folliculitis, 1 patient (1.1%)
showed scab formation.
Conclusion: The scalp as a donor site shows excellent results with quick healing and few complications. It should
therefore be the first choice of donor site, especially in paediatric patients.
9.
Nasal Turnover Flap for Reconstruction of the Severely Burned Nose
Richard J. Ehrlichman, MD, FACS and Matthias B Donelan, MD.
Shriner‟s Hospital for Children and Harvard Medical School, Boston, MA
The reconstruction of established burns involving the central face can be a difficult problem for the reconstructive
surgeon. Burns in these patients draw attention to the center of the face. Consequently, nasal reconstruction these
patients provide the cornerstone for facial aesthetics. Such reconstruction requires a detailed analysis of tissues that
are missing and a detailed inventory of available donor tissue.
Unfortunately, in many patients with pan-facial burns, little or no donor tissue such as the forehead is available.
Although a multiplicity of free- tissue transfers have been described, as well as the time-honored multiple staged tube
flap, many these are not within the domain of the plastic surgeon who sees these types of patients.
In patients with subtotal nasal amputations and loss of nasal support, the nasal turnover flap can provide an excellent
reconstruction, even severely burned patients. This procedure can generate soft tissue at the nasal tip and lobules
despite the unavailability of forehead tissue, as often the dorsal surface of the nose is made up only of skin graft and
or scar. The flap is drawn out with a wide inferior base and elevated down to periosteum. The flap is then folded down
on itself and the resulting defect is resurfaced with a skin graft.
Over 30 patients Shriners Hospital for children have undergone this type of reconstruction with excellent results.
Often, no cartilaginous tissue needs to be added as the flap has enough bulk. By reconstructing this important area of
the face without sacrificing other tissues, an outstanding way of restoring facial normalcy to this population is
presented.
10.
®
Clinical evaluation of a silver-impregnated foam dressing (Mepilex Ag) in the treatment of partialthickness burns in a pediatric burn center
Paul M. Glat, MD, Brooke Burkey, MD, Wellington Davis, MD
St. Christopher's Hospital for Children, Philadelphia, PA 19134
We conducted an Institutional Review Board-approved retrospective study evaluating the use of a silver-impregnated
®
foam (Mepilex Ag) dressing for the treatment of mixed partial-thickness burns in children. We used the St.
Christopher's Hospital Burn Center registry as well as the outpatient Plastic Surgery clinic registry to identify 60
inpatient and 43 outpatient pediatric subjects who had sustained partial-thickness burns over an 18-month period.
Inclusion criteria included partial-thickness burns and excellent baseline health in patients below the age of 18 years.
Exclusion criteria included inhalation injury, presence of full-thickness burns necessitating surgical debridement,
cellulitic or infected wounds, and percentage total affected body surface area greater than 40%. Outcomes measured
for Mepilex Ag included hospital length of stay, total number of intravenous narcotic administrations, and time to
wound re-epithelialization. Although no direct comparative studies were carried out, Mepilex Ag was demonstrated to
be a safe and effective alternative to other antimicrobial dressings in the treatment of mixed partial-thickness burns,
allowing shorter hospital stays and fewer dressing changes and requiring less pain medication than historical
standards. Having seen the encouraging findings from this retrospective chart review we conducted a small
prospective study involving 22 pediatric patients, aged between 1 and 4 years, with partial-thickness burns. The study
took the form of a substudy of a larger trial involving 101 adults with partial-thickness burns in which 50 patients were
randomized to receive treatment with Mepilex Ag and 51 patients were randomized to receive treatment with
Silvadene. In the pediatric prospective substudy, which was non-comparative, 20 of 22 subjects completed the
investigation. In total, 50% of the pediatric subjects were completely healed following 1 week of treatment with
Mepilex® Ag. Mean time to discharge was 3.77 days and the mean number of dressing changes required was 1.64.
Although narcotic usage was not assessed, in a patient evaluation of the dressing stinging or burning was recorded
as „never‟ in 13 (59.1%) of patients, rarely in 8 (36.4%) of patents, and „sometimes‟ in 1 (4.5%) patient. The
combined findings of the retrospective and prospective studies of Mepilex Ag have led us to conclude that the
dressing is a highly effective and safe dressing for use in pediatric burns and has eliminated the use of topical daily
dressing changes in these types of partial thickness burn injuries in our pediatric burn center.
11.
An inpatient (silver sulphadiazine) vs. outpatient (nanocrystalline silver) model of care for pediatric
scald burns: A value analysis
1
1
Claudia Malic, MD, MRCS, FRCS , Cynthia Verchere, MD, FRCSC , and Jugpal S. Arneja, MD, MBA,
1
FRCSC
1
Division of Plastic Surgery, British Columbia Children‟s Hospital and University of British Columbia,
Vancouver, BC, Canada
Background
Scalds represent the most frequent pediatric burn injury. Inpatient non-surgical burn wound management of small or
medium sized burns (<20% TBSA) represents a significant proportion of the cost of care, with nanocrystalline silver
(NS) and silver sulphadiazine (SSD) amongst the most commonly used dressings. Several articles describe healing
outcomes using these dressings, but there are few concurrent economic analyses. To analyze overall health care
value (outcomes/cost) in burns not requiring surgery, we compare management of scald burns with NS vs. SSD from
a both a quality perspective and using bottom-up microcosting to determine which dressing option optimizes
healthcare value.
Methods:
A value analysis was performed. Published studies using NS and/or SSD in pediatric burns over the past 25 years
were analyzed. Healing time, hospital duration, and frequency of dressings were chosen as quality metrics. A bottomup microcosting analysis was performed to estimate costs associated with the two dressing options.
Results:
Over the 25 year period, 356 articles studied the use of SSD in burns, while 55 studies evaluated the use of NS.
Mean age and burn size were equivalent. Mean time to healing was 14.9 days for NS and 17.2 days for SSD. Mean
duration in hospital was 14.7 days for SSD and 5.2 days for NS. Dressings were performed twice a week for NS and
once or twice a day for SSD. We estimated the mean total cost per patient to the healthcare system to be $65,280 for
SSD and $17,400 for NS.
Conclusion:
Published outcomes of healing time are equivalent or slightly better using NS over SSD for pediatric scalds. The
financial model illustrates a potential significant cost saving with NS, primarily as a result of an outpatient model of
care. Overall health care value is optimized using NS for pediatric scalds.
12.
The use of porcine xenograft decreases pain and length of stay in pediatric patients
A. Arocho HS, R.J. Burgos BSN, A.D. Jaskille MD
The Burn Center at HIMA-San Pablo, Caguas, PR
INTRODUCTION: While an integral part of burn care, daily dressing changes are painful, increase patient and
parental anxiety and tissue inflammation which may lead to autografting wounds that would otherwise heal. This two
part study tests whether the use of porcine xenograft (PX) as definitive management of superficial and mid-dermal
burns decreases length of stay (LOS), time to return to school (RTS), pain and the need to autograft wounds.
Methods: An initial retrospective review (RR) of the data was followed by a prospective randomized trial (PRT). The
RR, evaluated all pediatric second degree burns during a three year period. 258 charts were reviewed, 119 of which
received PX and 139 BID to QOD dressing changes with a silver sulfadiazine cream (Silvadene) or gel (Elta Ag). End
points were LOS and narcotic use. In the PRT, 26 patients with non-infected second degree burns received either 1)
dressing changes or 2) PX placed within the first 48 hours from admission. Student t-test was used for statistical
analysis.
Results:
RR: LOS and narcotic use decreased (P>0.05). LOS from 6.34 to 3.7 days and narcotic use by 87%
PRT: PX decreased (p>0.05) LOS (6.9 to 3.8), RTS (10.9 to 5.5), doses of narcotics (33.9 to 1.67) and autografts
(8/13 to 1/13).
Conclusion: The use of PX for the management of second degree burn decreases LOS, RTS, narcotic use and
autografts required in the pediatric patient.
13.
Intervention to Reduce Stress in 0-5 Year Olds with Burns
J Michael Murphy EdD*#**, Laura D. Stone, Psy.D. Candidate*, Atilla Ceranoglu, M.D.*#**, Erica Sorentino,
MA*, Gwyne White, BA*, David S. Chedekel, Ed.D.*#**, Diana Buterbaugh, RN*, Tracy Doyne, RN*, Taya
Zbell, LICSW*, Katia Canenguez, EdM*#, Stephanie Clark, MT-BC*, CCLS, Jenny K Man BS*, Glenn Saxe,
MD.* ##, Robert L. Sheridan, M.D.*#**, Ronald G. Tompkins, M.D., Sc.D.*#**
* Shriners Hospital-Boston, # Massachusetts General Hospital,** Harvard Medical School, ## New York
University Hospitals, USA
Introduction: This study was driven by our study of 1-4 year olds which indicated that the burned child‟s symptoms
of posttraumatic stress disorder could be reduced by: 1) improving pain control and 2) reducing parental PTSD, and
divided into 3 phases from 2007-2010.
Objective: The overall objective of this 4-year double-blind controlled study, supported by the Shriners Hospitals,
was to test and validate a simple, feasible, evidence-based intervention to reduce stress, particularly posttraumatic
stress, in 0-5 year old children with burn injuries and in their parents.
Method: The intervention, refined for children with burn injuries and implemented, had two components:
The Distress, Emotional Support, and Family Functioning (“DEF”) protocol from the Pediatric Medical
Traumatic Stress Toolkit for Health Care Providers from the National Child Traumatic Stress Network was
operationalized as an initial meeting with the parent(s) or guardian to identify distress, offer emotional
support and clinical referrals.
B. The Creating Opportunities for Parent Empowerment (“COPE”) program is a parent-focused intervention
consisting of a workbook to increase the parents‟ or guardian‟s knowledge of the child‟s response to the
burn injury and of their own roles in their child‟s care.
Results: N = 75. Mean age 2.12 years. Mean TBSA = 25.76% . Comparison of the experimental and control
groups on 6 measures of children and parents‟ stress, at baseline and 6 month followup, including the PSI, PSC,
CSRC, HESF, SASRQ, and the PTSDSSI. The study supported the main hypothesis and the children and parents in
the intervention groups reported greater decreases in stress than controls. Families in the experimental group
reported increased support compared to the control group.
A.
Conclusions: In this study, we learned a great deal from these families and are grateful to them for sharing their
stories and personal struggles. For many, the difficulties they faced of raising a young child were great with financial
limitations or mental health difficulties, compounded their child‟s burns. This study appears to have reached its
objectives of: 1) increasing parental awareness and opportunities for family support for burned children and 2)
reducing the symptoms of PTSD in these children and families.
14.
December 7th - Young Burn Survivors Day in Germany
Gottwald Adelheid 1, Sinnig, Mechthild 2
1 Paulinchen-Initiative for Young Burn Survivors, Norderstedt, Germany, 2 Auf Der Bult, Centre for Children
and Adolescents, dept. of Pediatric Surgery, Hannover, Germany
Background: More than 30.000 children a year seek medical attention for burn injuries in Germany. Almost 80% of
the burn injuries are due to scalding. 76% of the children with burns are younger than 5 years. The Young Burn
Survivors Day on December 7th was launched nationwide in Germany in 2010 by Paulinchen - Initiative for Young
Burn Survivors.
Methods: Since 2010 the Young Burn Survivors Day on December 7th has been repeated annually. The purpose of
this day is to draw attention to the high number of burn and scald injuries and their consequences. The day also
serves to teach first aid skills and to point out treatment options. Families are informed about safety hazards and are
shown how they can best protect their children from burns and scalds.
Results: Many organizations, such as burn units, doctor`s offices, pharmacies, fire departments, kindergartens and
medical supply stores, are participating and in this way contributing to the Young Burn Survivors Day. The day is
coordinated by Paulinchen - Initiative for Young Burn Survivors, which also provides information material and support
for participating organizations. Since the launch in 2010, the number of activities has doubled. In 2013 the media
exposure has increased by almost 200% compared to 2010. The German Society of Pediatric Surgery (DGKCH)
held a press conference in 2012 as did the German Society of Plastic, Reconstructive and Aesthetic Surgeons
(DGPRAEC) in 2013 informing the public about the latest developments in pediatric burn treatment.
Conclusion: In Germany the Young Burn Survivors Day has been widely accepted. We hope that other countries will
th
join in and honor December 7 as the Young Burn Survivors Day and in this way contribute to it becoming a globallycelebrated event increasing awareness of safety hazards and the high numbers of burn and scald injuries.
Information is available on the website: www.tag-des-brandverletzten-kindes.de
15.
Corrective make-up: A non-surgical solution to increasing quality of life in the pediatric burn victim
Jennifer Conway, OTR/L, Robin Liebowitz certified corrective make-up artist
Shriners Hospitals for Children, Boston, Massachusetts USA
Introduction: Burn patients have many obstacles to overcome. While in the hospital, they face life threatening
medical conditions, rehabilitation, and accepting themselves with a disfigurement. Within a medical environment,
pediatric patients have a sense of security, as there are often other people that are in a similar situation. However,
once they are discharged from the hospital, they must face society, and its response to their visible scars. To ease
this transition, corrective make-up can be an effective tool in increasing patient‟s confidence and motivation. A
satisfaction survey was constructed to provide feedback from pediatric burn victims and the use of corrective makeup.
Method: A make-up clinic was set up with a certified corrective make-up artist once a week. The make-up clinic was
offered to pediatric patients ages 1-21 years. For maximum results it was recommended that patients do not receive
make-up consultations until the scars are fully mature. The idea of a non-surgical option was also helpful with parents
of children who had not wanted to subject their children to further surgeries at that time. A quality improvement
project was designed to evaluate the effectiveness of the make-up clinic. Questionnaires were distributed to analyze
patient opinion of effectiveness and usage of the make-up. This allowed the children to provide feedback, enabling
us to make changes, thus ensuring the efficacy of the program.
Results: On the initial visit, 77% of the children reported the use of make-up would help them engage in more
community activities. Upon subsequent visits, 100% stated they would engage in more activities and recommend
make-up to others. All of the patients confirmed it was easy to use. With the use of corrective make-up, school age
children often reported less harassment from other students, and an increasing confidence in social situations.
Conclusion: According to feedback from pediatric burn patients, corrective make-up is an easy, non-surgical
solution to increasing self-confidence and assurance.
16.
“The burden of guilt” – How to support parents in daily care
Cortés V, Preusse B, Schlüer AB, Zikos I
Paediatric burn centre, plastic and reconstructive surgery, Children‟s University Hospital Zurich, Zürich
Switzerland
Objectives: Scald and burn traumas in infants and toddlers are common traumas which often appear at home within
the family setting. Parents or guardians being involved in such a trauma have to deal with feelings of guilt, anxiety
and shame, either because they caused the trauma or because they didn‟t avoid it. The goal of this project was to
define interventions for clinical nursing as well as in interdisciplinary practice to support parents and families
effectively.
Method: Based on a literature review and supported with the findings of expert interviews, a project team of four
experienced paediatric burn nurses defined effective and relevant interventions and strategies to support familys in
daily care .
Results: The defined interventions and strategies include as a first priority to implement an environment of positive
coping strategies for concerned parents and families. Family nursing interventions of adapted communication skills,
offering clear information, and normalizing their struggles, and finally in defining the parents' role after the accident,
are described in literature. The nurses‟ role is to support family members in implementing these strategies in an post
trauma coping. Beside that, an interdisciplinary approach involving psychologists, social workers or other confidant
professionals to support the families is needed.
Conclusion: It is vital to take care of parents ' feeling of guilt and to offer them adequate support.. Early intervention
as part of daily nursing and interdisciplinary care is essential to improve the situation of parents and other concerned
family members.
17.
Burn care in the One Day Clinic of the Burn Centre, Queen Astrid Military Hospital, Brussels
L. Verept BSN RN, E. Vandermeulen PSY, T. Rose MD, S. Jennes MD
Burn Centre, Military Hospital Queen Astrid, Brussels, Belgium
An important change in modern healthcare is the development of day care programs i.e. major wound care and
surgery provided on an outpatient basis. In addition to administrative and financial savings for our burn centre, as
well as advantages for the nursing personnel, day care for burns provides important benefits for the patients. Our
aim is to take care of patients for whom burns management is either too painful and / or too stressful without
supplementary sedation or anaesthesia. Therefore, most of our patients are children. Taking care of the burned
child, however, also requires management of his/her social environment. Health care professionals need to be aware
of the child‟s home circumstances before injury. In order to facilitate management, the care provider needs to instil
confidence and a feeling of comfort in both patient and family from the point of first contact in the emergency room.
We care for burned children in our one day clinic in several stages. Emergency care is administered using simple
analgesics and limited to the essentials in order to avoid unnecessary stress. The next day, following an appropriate
period of fasting, we provide care under anaesthesia/sedation in order to allow more definitive, appropriate wound
care in the absence of pain or anxiety. Most children typically receive two to five additional sessions thereafter, each
time trying to reduce the anaesthesia or sedation requirements. This helps the child to cope with his situation.
In summary, there are clear advantages for one day clinics in burns care. Children should not be treated as small
adults, but should be managed with their parents as one unit. Careful explanation and avoidance of separation are
as important as satisfactory sedation and analgesia to reduce stress and fear of treatments.
18.
Medical treatment as a matter of principle - Is this always the right decision? A blind and severely
disabled burn victim caught between high tech medicine and an ethical dilemma
S. Boehrensen, F. Stang, L. Wünsch, P. Mailänder
University Hospital Lübeck, Germany
Background
“Every person shall have the right to live and physical integrity“ (Art. 2,2) and “No person
shall be disfavored because of disability“ (Art 3,3). This is stated in our German Constitution and had been
emphasized multiple times by the parents of our patient. In contrast there are the Four Principles of Biomedical
Ethics, set up by Beauchamp and Childress in 1977: To treat equal cases equally, to respect wishes and values of a
patient, our medical duty as doctors to improve our patient‟s well-being and to refrain from any harmful treatment.
Case Report
We will shortly present our case of a 9 year old boy, blind and severely disabled since birth who suffered full
thickness burns of 67% TBSA. Despite of three weeks of intensive care and treatment he passed away two days
before his keratinocytes arrived.
Questions and Discussion
Due to the patient‟s background and special circumstances, his treatment became a challenge to every team member
involved. We asked ourselves whether we were still acting in the patient‟s favor and making the right decisions? What
if later on he decided not to consent and we would not be able to revise them? Should the decision be made to move
on to palliative care instead of concentrating on the therapies that high tech medicine has to offer? On the other hand:
had the patient not clearly demonstrated his will to survive despite all circumstances? And has he not always lived on
a different level of life so that he doesn't lose the same quality of life as a person coming from good health? Is our
opinion at all relevant if his parents unmistakably express their will to continue therapy and life support? Shouldn't we
involve our ethical committee for advice and support regarding our decisions? Based on the Four Principles of
Biomedical Ethics we would like to discuss how other centers would have approached our case and how they deal
with ethical conflicts.
Adhesive contact therapy as a leading scar treatment method – over 15 years of experience
19.
D. Wyrzykowski MD; B. Chrzanowska MD, PhD.; P. Czauderna MD, Prof.
Dept. of Surgery and Urology for Children and Adolescents; Medical University of Gdansk, Poland
The aim of the paper is to share the 15 years of experience with an adhesive contact therapy used a first-line form of
scar treatment at the tertiary referral burn treatment facility.
Material and Methods:
A contact scar therapy with “Hypafix” S&N self-adhesive dressing retention tape was introduced at our Outpatient
Burn Care Clinic in 1998, soon becoming the first-line scar treatment for both, post-burn and other kinds of scars. It
would be used either as a single method, or in cases with a non-satisfactory initial response; followed by silicone
sheeting application, alone or combined with pressure therapy. Applied in over 1000 patients, it has proven over the
years to be a simple, versatile, reliable and inexpensive method, which has almost eliminated in our hands the need
to use pressure therapy. Shortly after the introduction at the Clinic, its use was extended into the OR, where it had
become a skin graft fixation method and an “ultra-early” method of scar therapy.
Conclusions:
1.
2.
3.
4.
Adhesive contact scar therapy with “Hypafix” S&N is a simple, versatile, reliable and inexpensive method.
It can be used as well in post-burn scars, as in other kinds of scars in children.
“Hypafix” also additionally serves as a successful sun protection.
Contact scar therapy with adhesive dressing retention tape works best in limited areas of scarring, typical
sequelae of scalds.
20.
Management of paediatric burnt hands: a case report
X.Deng BSc, C.W. P Li‐Tsang PhD
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom,Kowloon, Hong
Kong SAR, China
Background
A 2‐year old girl had accidentally dipped her right hand into a jar of hot water during lunch resulting deep second
degree burn injuries on the whole hand, covering palmar and dorsal side of the hand and all five fingers. Initial
assessment at the rehabilitation clinic showed the scars appeared very red, raised and highly vascular particularly on
the dorsum of hand and the finger web space. There was flexion contracture over the IP joints of ring and little finger.
The child was emotionally unstable while parents had strong sense of guilt feelings and were very anxious.
Intervention
1. Scar Management 1.a. Scar on dorsum of hand 2 pcs of pressure gloves prescribed, a newly developed pressure
padding, the smart pressure monitored padding (SPMP) was inserted underneath the pressure glove to increase the
pressure on the flat skin surface and at the same time, provide scarsoftening effect. 1b. Scars on fingers A thin sheet
of silicone strip was used to wrap the finger scars and keep the finger IP joints into extension. 1c. Scars on finger
webs A web spider was made with rubber band and strapping. The tension created by the rubber band and the
padding will add extra pressure on the finger web space. 2. Caregiver Education: the caregiver was educated on
scar massage, wearing regime of the pressure glove, paddings and accessories. They were taught on home
exercises and play activities to encourage child to use the right hand.
Results:
Reassessment was conducted 3 months after intervention. Parents‟ compliance to pressure therapy was excellent.
The scar on dorsum of hand and fingers appeared less red, slightly raised, less vascular and more pliable. The child
was able to make full fist and found actively engaging the hand into various daily tasks.
Conclusion:
A comprehensive treatment regime has to be implemented to tackle the complex hand problems. Caregiver
education is of significance throughout the process.
21.
Splinting and Pressure Strategies for Facial Scarring in the UK: Outcomes from an MDT Working
Party assembled by the Katie Piper Foundation
1
2
K.Whiting O.T., J. Evans O.T., R. Fanstone
1
2
3
3
Birmingham Children's Hospital, Morriston Hospital Swansea, P.T. Katie Piper Foundation
Customised transparent facial masks are used to control post-burn hypertrophic scarring; they offer an alternative to
fabric pressure masks, being more socially acceptable with greater wearer compliance. In the UK the fabrication of
facial splints is undertaken by Prosthetists, either on or off site. The Katie Piper Foundation (KPF) perceived a
potential a lack of standardisation in the process and access to transparent face splints within the UK. To investigate,
KPF co-ordinated a working party of burn care experts (3 OT‟s, 1 PT, 1 Surgeon, 4 Prosthetists) to review current
provision. This paper presents the outcomes from the working party i) a UK survey on current practice for facial
pressure ii) development of guidelines on best practice for facial splinting and pressure.
The working party was selected to represent relevant and experienced healthcare professionals and geographical
spread, including 4 burn centres and 2 burn units. An online survey containing 43 questions on current practice of
facial splinting and pressure therapy was distributed in December 2013 via email to the burn therapists group and the
network for maxillofacial & plastic surgery prosthetists. The development of best practice guidelines was coordinated
within this working group and presented at BBA in April 2014.
Although the numbers for facial splinting may be low, best practice must be accessible to each service due to the
importance of controlling facial scarring. Better standardisation of manufacture, process and access could result in
better and more equitable outcomes. The guidelines produced aim to offer a guide to facilitate standardisation and
best practice. Some key issues for consideration are the appropriateness of pediatric masks being fitted offsite in
adult services, poor patient compliance, prosthetics waiting times especially with offsite provision, importance of MDT
communication and working, limited access to 3D scanning technology, national and regional access strategies to
low volume but crucial skills, robustness of evidence base.
22.
„Meet the Parents“ – Allografts for extensive burn injuries
S.Böttcher-Haberzeth MD, K.Neuhaus MD, M.Meuli MD, C.Schiestl MD
Children‟s Hospital Zurich, Switzerland
Background
While increasing focus is laid on skin substitutes and fancy reconstructive methods to cover large burn wounds, other
therapeutic possibilities are being neglected, such as close-relative allografts.
Methods and results
We will report about five severely burned children with an inadequate donor site surface area for wound coverage
that were treated with allografts harvested from their parents at our children‟s hospital in Zurich, Switzerland. We will
share the experiences that we made during the treatment and show the results that we achieved.
Discussion
Using close-relative allografts raises fundamental issues such as problems with infectious diseases and tedious
ethical disputes. We would like to discuss the relevance of close-relative allografts in today‟s practice, whether they
are a valid alternative at burn centers around the world, or if their use is restraint to countries with limited resources.
23.
TM
Scanoskin , a novel imaging adjunct for the assessment of acute paediatric burns
1
2
A. Burke-Smith BSc , I. Jones MBBS MD FRCS(Plast) , J.M. Collier MA BM BCh BDS MFDS FRCS(OMFS)
2
PhD .
1
2
Imperial College London School of Medicine, Chelsea and Westminster Hospital, London, UK
Background – Early objective assessment of burn depth facilitates timely management of acute burns, in particular
providing evidence for early excision of the mixed-dermal burns, which are notoriously difficult to assess. Currently,
laser Doppler imaging (LDI) remains the only evidence-based adjunct. However, initial unit costs, cumbersome
equipment and slow scanning speeds restrict LDI use to the assessment of small burns in compliant patients treated
TM
in a few specialist units. More recently, Scanoskin has shown potential to be a useful clinical adjunct for burn depth
TM
assessment. Scanoskin is an adapted D-SLIR camera that uses polarised light, which interacts and is remitted by
the skin. Using complex mathematical models, computer analysis software converts raw image data into a series of
three images: a clinical photograph, a perfusion image, and a pigment image. These are then interpreted to provide
information about the ability of the burn to heal.
Methods – 10 paediatric burns presenting between 48 hours and 5 days post-burn were enrolled in this pilot study.
TM
During planned dressing changes, images were captured using Scanoskin . Subsequent clinical management was
continued as planned and outcome was subsequently collected from patient records.
TM
Results – Scanoskin interpretation was 100% consistent with clinical outcome. Burns that heal in less than 21 days
with conservative management show increased perfusion and reduced melanin. Burns that require surgical
intervention or are unlikely to heal within 21 days show reduced perfusion and either increased or a complete
absence of melanin.
TM
TM
Conclusions – This is the first reported series of Scanoskin use in children. Scanoskin presents advantages to
TM
LDI in terms of cost, ease-of-use and acceptability to patients. The analysis of pigment with Scanoskin may more
accurately indicate the depth of burn compared with LDI perfusion alone. At present, the LDI colour-coded palette is
TM
the easiest method for image interpretation, whereas Scanoskin monochrome colour-palettes are more difficult to
TM
interpret. We suggest development of Scanoskin software to include a simplified colour-palette similar to LDI and
TM
further work to support Scanoskin as the new gold standard.
24.
Silicone gloves against post-burn palm contracture in small infants.
1
2
2
1
K. Pfurtscheller MD, L. Kamolz , MD, PhD, M. Schintler , MD, M. Trop , MD
1
2
Children‟s Burn Unit, Medical University Graz, Austria, Division of Plastic and Reconstructive Surgery,
Department of Surgery, Medical University Graz, Austria
Contact hand burns cause significant morbidity in small infants and children. A conservative approach is favorised in
superficial or deep partial-thickness wounds with good spontaneous healing tendency. In case of full thickness burns,
surgery can be done either by split-thickness (STSG) or full-thickness skin grafts (FTSG). Post-burn palm
contractures in small infants remain a challenge for the whole burn team. Combination of physical therapy and
splinting is essential in the post-acute phase. However, tolerance of splints is limited in small infants.
Here we present our first experience with new individual custom-made silicone gloves in three infants (mean age at
accident 24 months) with post burn palm contractures (5 hands, 3 FTSGs). Acceptance of dorsal extension splints
was limited if both hands were involved and therefore application time was low. Our gloves with a friendly appearance
and made from silicone in a stable manner, resulted in good acceptance from the kids and their parents. Silicone
seems to soften the scar tissue and the splinting effect is acceptable.
25.
The Effect of Burn Injury Location on Lower Body Physical Function
Nicole C. Benjamin, BS, Clark R. Andersen, MS, David N. Herndon, MD, FACS, Oscar E. Suman, PhD.
Shriners Hospitals for Children, Galveston, Texas, USA and University of Texas Medical Branch, Galveston,
Texas, USA.
Introduction
To attenuate burn-induced catabolism, patients are often enrolled in a resistance exercise program as part of their
physical rehabilitation. However, the effect of burn location on physical function and performance is unknown.
Therefore, this study assessed how lower body burn locations affected strength and peak cardiorespiratory function
(peak VO2).
Methods
Children aged 7-18 years and with burns less than 40% of their total body surface area were included. Multiple
regression was used to model the relation of the outcomes peak VO2 and peak torque per body weight (%PTW), to
regional burn areas on the subject‟s lower body. Analysis of variance was used to model the relation to these
outcomes due to burns around the subject‟s joints. A 95% level of confidence was used, and significance was set at
p<0.05. Peak VO2 was determined by indirect calorimetry during a modified Bruce treadmill test. The muscle strength
test was determined by isokinetic dynamometry performed on the dominant leg extensors and tested at an angular
velocity of 150 degrees per second.
Results
Significant differences were found in peak VO2 for burn areas that transverse lower body joints. Burns at the hip joint
-1
-1
corresponded to a significant decrease of 6.5 ml∙kg ∙min (p=.003, statistical power= 87%). For %PTW, there was a
significant relationship of peak muscle torque per percent body weight and burns at the hip joint (p=.015, statistical
power= 52%), with a 27 N∙m decrease in torque.
Conclusion
Physical function and performance are detrimentally affected by burns that transverse specific lower body joints. The
most significant effect on exercise performance was that of hip joint burns. Hip joints should be considered when
developing exercise programs or interpreting exercise test results involving the lower extremities. Providing focused
exercise movement to hip joints may improve exercise performance and therefore less reconstructive surgeries may
be needed as similar studies have found such positive results. Future studies could focus on ways to adjust for the
effects of burns that transverse the hip joint.
26.
Alleviation of burn scar pruritus with sub- and intracicatricial fat injection
Ludwik K. Branski, MD, David N. Herndon, MD, FACS, and Ted T. Huang, MD
Shriners Hospitals for Children, Galveston, Texas, USA and University of Texas Medical Branch, Galveston,
Texas, USA.
Introduction: Pruritus and paresthesia are two of the most common complaints associated with hypertrophic burn
scars, leading to severe scratching, skin infections, and prolonged impairment of quality of life. Traditional treatment
options include antihistaminic agents, sedatives, gabapentin, lotion application, steroid injection, and pressure
garments, all of which have variable and often insufficient efficacy. Based on the authors‟ experiences with fat
injection in cosmetic patients, where a temporary numbness of the areas injected represents a common side effect,
we hypothesized that fat injection in patients with burn scar pruritus may lead to alleviation of their complaints.
METHODS: Retrospective cohort study of one hundred and forty-three burn patients between 2006 and 2013 (age
range: 3 to 21 years, average age: 13). These patients had undergone unsuccessful pharmacological and
conservative treatment of severe burn scar pruritus and agreed to an operative treatment option with subcicatrical fat
injection. Fat was harvested manually from the gluteal region, thighs, and/or the lower abdomen, the liquid phase was
discarded, and injection was then performed in hypertrophic burn scar areas of the hand, thighs, chest, and back
using a 17gage angiocath needle. The mean volume of injection was 8ml, ranging from 2 to 35ml. The children were
followed at regular time intervals, at least every 6 months, and alleviation of burn scar pruritus and complications
were recorded.
RESULTS: In over 90 percent of patients, burn scar pruritus was greatly reduced following fat injection and patients
remained symptom free for the period of observation. They were followed for 1 to 6 years, with an average of 1.74
years. No complications other than transient low hemoglobin in one patient were noted. Three patients required a reinjection of fat for persistent scar pruritus.
CONCLUSION: In spite of a lack of a clear mechanistic hypothesis, fat injection is a highly efficient and low-risk
procedure for alleviation of severe burn scar pruritus in patients where pharmacological and conservative options
have failed. The procedure is technically simple and morbidity is low.
27.
Do we prefer a collagen-scaffold-structure in collagen neosynthesis after burn injury
C.Scherer, C.Brochhausen, V.Engel, S.Turial, S.Berger
Department of Pediatric Surgery University Hospital, Bern, Switzerland
Introduction
Reconstructive surgery after burn injury needs a collagen matrix to optimize forming a neodermis. Crucial is the
collagen neosynthesis in a collagen matrix as a scaffold. The questions arise, whether we need a scaffold and
whether parallel configured bovine Collagen matrices or disordered collagen fibers represent the better scaffold?
Method
In 10 children after burn injury and split skin grafting with a collagen matrix, Integra® or Matriderm®, were compared
in their clinical outcome using the Vancouver scar scale. In 4 patients punch biopsy were done, as already
demonstrated from us, histological investigation with haemotoxylin eosin (HE) stain, Elastica van Gieson, cluster of
differentiation 68 (CD 68) and electronic microscopy were invested. Using a pig model Matriderm® and Integra®
were compared in their histological and electronic microscopy results.
Results
In 6 patients Matriderm® was used and in 4 patients Integra® was applicated. The Vancouver scar scale had a range
in all patients from 3 to 11. In the Matriderm® group from 3 to 11 and in the Integra® group from 3 to 10.
Histologically was the structur of the collagenneosynthesis more physiological in the Matriderm® group. Also
Matriderm® shows less inflammatory signs as macrophages, activated endothelial cells and foreign bodies
inclusions. There were no differences in human neodermis and in the pig model.
Conclusion
Wound healing and scar formation after split skin grafting is dependent to various factors. One of them is the
collagenneosynthesis. We observed no differences in clinical outcome using Matriderm® or Integra® inspite of better
histological results in the Matriderm group.
28.
The Treatment of Partial Burns in Children
J. Vloemans
Burn Centre, Red Cross Hospital Beverwijk, The Netherlands
The treatment of partial thickness burns in children is a challenge for the treating physician as these burns are likely
to deepen to full thickness burns. Optimal wound treatment, with prevention of infection and effecting a moist wound
environment may prevent the occurrence of deepening of the wound. In a systematic review on the different
treatment modalities of partial thickness burns in children 51 studies were investigated.
The level of evidence in most studies was low; only twelve were randomized controlled trials; of the twenty-two
comparative cohort studies seven were prospective and fifteen were retrospective, thirteen cohort studies were non
comparative and finally there were four case reports.
As infection prevention is of utmost importance in wound treatment in many studies the effects of topical antiseptics
were investigated. In fifteen out of thirty comparative studies silver sulfadiazine (SSD) was the standard of care
treatment. However a suitable and properly applied membranous dressing may also prevent wound infection, and
has the advantage of the creation of a moist wound environment that promotes wound healing. The competitor
dressing for SSD was Biobrane in four studies and amnion membrane in three. Tulle gauze, or tulle gauze
impregnated with an antibacterial addition were the standard of care treatment in seven studies. Biobrane and
amnion membrane performed better than the standard of care on epithelialisation rate, length of hospital stay and
pain for treatment of partial thickness burns in children.
A few considerations have to be made in the interpretation of the studies. First of all only in one study the depth of the
burn was objectively determined by LDI. The use of SSD for a prolonged time in many studies is disputable. The
cream base of this topical antiseptic is effective during the first period of treatment, but it may thereafter inhibit
epithelial outgrow. Only a limited number of studies considered long term results as scar formation. Moreover, when
scar formation was recorded it was not measured in a scar scale.
Consensus on the preferred treatment of partial burns in children requires many more randomized controlled trials on
early and late results.
29.
Incidence and risk factors of burn injuries among infants, Finland 1990-2010
1
2
1
1
3
E.Laitakari MD, V.Koljonen MD, PhD, S.Pyörälä MD, R.Rintala MD, PhD, M.Gissler , MSocSci, PhD
1
2
Children‟s Hospital, Helsinki University Hospital, Finland, Department of Plastic Surgery, Helsinki
University Hospital, Finland, Institute of Clinical Medicine, Helsinki University, Helsinki, Finland, , National
Institute for Health and Welfare, Helsinki, Finland, Nordic School of Public Health, Gothenburg, Sweden
Background: Several reports around the world state that admissions for burn injuries in infants < 1 year of age are
increasing. The objective of this study was to determine the number and trends over time of burn-injured patients
younger than 1 year presenting in Finland. In addition, we aimed to specify etiological and risk factors for infant
burns.
Methods: This study was a retrospective analysis of the National Hospital Discharge Register, the Finnish Medical
Birth Register, and the Cause of Death Register of Finland databases for 1990-2011. Cases were patients with a first
diagnosis code of a burn and aged less than 1 year at the time of injury. A personal identification code was used as a
key when tracking the patients.
Results: This study comprised 1842 children, female to male –ratio 1:1.5. The inhospital mortality was zero; three
deaths occurred at the burn accident site and were excluded from the study. The annual overall incidence for
inhospital and outpatient admissions increased during the study period from 0.77 to 2.04 per 1000, (p<0.05). Major
risk factors were being male, and mother‟s parity, socioeconomic status, and young age. The most common causes
were scalds and contact burns, and typically burns were located on the wrist and hand. Birth weight, gestation of
pregnancy, number of fetuses, mothers‟ smoking, or marital status did not influence the risk for burn injury. The
highest risk for burn injuries occurred at the beginning of the week during wintertime. The incidence of burn injuries
was higher in girls in the age group of younger than 6 months. Severity of the injury increased along with increasing
age, and children aged 9 to 12 months had the highest prevalence of surgical treatment.
Conclusions: Incidence for burn injuries in children under 1 year has significantly
increased during recent decades in Finland. Firstborn 9- to 12-month-old boys of young mothers of low
socioeconomic status are at higher risk for burn injuries on Mondays and Tuesdays in wintertime. Preventative work
needs strengthening to reduce infant burn injuries.
30.
Review of skin donor population in a referral Tissue Bank, 2002-2013.
1
2
2
2
S. Gaucher MD, PhD, Z. Khaznadar , Pharm.D, JC Gourevitch Pharm.D, M. Jarraya MD, PhD
1
Faculté de Médecine, Université Paris Descartes, Service de chirurgie générale, plastique et ambulatoire,
2
AP-HP HUPC Site Port-Royal, Paris, France; Banque de Tissus Humains, AP-HP Hôpital Saint Louis,
Paris, France.
Background:
Our Tissue Bank is the referral centre for Paris and its area, ensuring the delivery of skin allografts for pediatric and
adults burn units. The aim of this retrospective study was to describe our population of skin donors.
Patients & Methods:
This study included all skin donors harvested between June 2002 and June 2013.
Results:
Skin was procured from 336 donors, representing a total skin surface of 753 234 cm².
On average the bank collected skin from 42 donors per year, the number of donors doubled between 2006 (27
donors) and 2010 (58 donors). 199 (59%) were men and 137 (41%) women, median age was 51 years (range 15-82).
307 (91%) were multi-organ heart-beating donors, whereas 29 (9%) were cadaveric donors. Stroke was the cause of
death in 189 (56%) donors, followed by cardiac arrest in 70 (21%) donors.
For the multi-organ heart beating donors, median length of stay in an intensive care unit, median delay between
death and clamping (i.e. warm ischemia) and median delay between clamping and cryopreservation, were 2 days
(range 1-17), 11:45 hours (range 2-39:37) and 18:20 hours (range 7:30-47:35) respectively.
The amount of harvested skin per donor (median 2 235.5 cm²; range 594-5 894) correlated with the total body
surface area (median 1.88 m²; range 1.22-2.56) (r²=0.2675, p<0.0001).
All donors were negative for HIV, HTLV and syphilis. One case of HCV was detected. For hepatitis B virus, no
serological evidence of present infection was found; HBs Ag was not detected in all the 336 donors. One donor
showed a serology compatible with past infection with positive HBcAb and HBsAb. Both donors with HCV and past
HBV infections were discarded. Three more donors were discarded for presence of kidney cancer.
In addition, 69 260 cm² were rejected for microbiological contamination.
Finally, mean number of recipient per donor was 1.45 (range 1-4).
Conclusions:
Rate of discards is low because of the use of multi-organ heart beating donors who are screened for
serologies and medical history before procurement.
The increasing number of donors provides enough skin allografts to treat burn patients in Paris area.
31.
An introduction to sequential multiple assignment randomized trial (SMART) and application to
study laser treatment of hypertrophic burn scars
1
2
2
1
1
3
Friedstat JS , Hibbard J , Kosorok MR , Edkins RE , Lee CN , Cairns BA , Hultman CS
1
1
2
University of North Carolina Division of Plastic and Reconstructive Surgery; University of North Carolina
3
School of Public Health, Department of Biostatistics; University of North Carolina Department Surgery,
Division of Burns
Introduction: Randomized control trials (RCTs) are considered the strongest level of evidence in clinical medicine.
These trials are typically well controlled, but sometimes that control limits the applicability to more heterogeneous
patient populations. Also when treating patients, one often utilizes a series of therapies for the treatment of a given
disease and this sequential decision-making is not usually studied in traditional RCTs. To address these limitations,
a new RCT methodology known as sequential multiple assignment randomized trials (SMARTs) has been
developed. SMARTs utilize heterogeneous patient populations to determine optimal treatment sequences. A
successful SMART has the potential to develop evidence-based, patient-specific treatment regimens, that can
adjust based on a patient‟s response to previous therapies. The purpose of this review is to describe SMART
applications in medicine and introduce its application to study laser treatment for hypertrophic burn scars.
Methods: A review was performed using PubMed with the term “sequential multiple assignment randomized trial.”
Inclusion criteria were that the article used/described SMART in a clinical application. Articles were excluded if they
were not in English, focused solely on statistical design, or not relevant to the topic. Results: SMART design has
been utilized in at least 7 clinical trials to date. It has covered a broad range of diseases including: Alzheimer‟s
disease, schizophrenia, depression, cancer, smoking cessation, and neurological sequela from malignant
melanoma. There were no applications of SMART design in use or being considered in surgery. Our study design
will compare sequences of pulsed dye laser (PDL), CO2 laser, and medical therapy (compression garments,
silicone, massage, and physical therapy) using SMART design. Its novel design will also contain a traditional RCT
comparing PDL, CO2, and medical therapy.
Conclusion: Utilizing the potential strengths of SMART design to evaluate laser treatment of hypertrophic burn scars
may allow us to determine the optimal timing, sequence, and duration of laser treatments for hypertrophic burn scars.
To our knowledge this represents the first systematic review of SMARTs as well as the first description of a study
design within both burns and surgery.
32.
Replacing Like with Like using the Two Ends of the Digestive System: Case Report for Lip Vermillion
Burn Reconstruction
Benjamin Levi MD, Joseph A. Ricci MD, and Matthias B. Donelan, MD
Shriners Hospitals for Children, Boston, Massachusetts, USA
Background: Lip reconstruction following burn injury poses a significant challenge given the different subunits and
the unique epithelium that compose the lip vermillion. If a defect exists in the lip vermillion, placing a skin graft from
epithelium that is not transitional in nature would go against the principle of replacing “like with like” and would create
a significant aesthetic defect. Thus, we set out to find a region of epithelium with similar histology with the lip
vermillion. One such tissue with a similar anatomic mucocutaneous border to the vermillion is the anal transition
zone. In this case report, we describe the use of a full thickness skin graft from the non-keratinized, transitional
epithelium of the anal verge to reconstruct the non-keratinized transitional epithelium of the lip vermillion.
Methods: Two patients with significant vermillion defects from facial burns were identified. Both patients underwent
release of the upper lip scar without any scar excision. Next, a template of the defect was transposed to the anal
verge and a full thickness skin graft was harvested from this transition of epithelium. Patients were both followed for
at least one year.
Results: Both patients had 100% take of their full thickness grafts and a favorable aesthetic improvement. The
patient with the acid burn has symmetry, fullness of the vermilion, an aesthetically pleasing vermilion border, and
contour have been restored. Both lips were able to hold lip stick which other skin grafted areas normally do not. Both
patients did have hyperpigmentation of the graft which is easily remedied with a phenol peel. We also saw a similar
pattern and thickness of non-keratinizing transitional epithelium in a histologic analysis of the anal verge and the lip
vermillion.
Conclusion
The vermillion is unique to the human species and is a transition from the oral cavity to the lip elements. There are
several gross and histologic similarities between the muco-cutaneous borders of the lip vermillion and the anal verge.
The muco-cutaneous border gives a visual demarcation between skin and mucosa that is only present at these two
locations. We describe two cases where we use a full thickness graft from the anal verge to reconstruct the lip
vermillion which led to patient satisfaction, an improved appearance, and gave the patient the ability to wear lipstick.
33.
PREMATURES COLLECTIVE ACCIDENT
Prof. Dr. Dan Mircea Enescu, Dr. Dan Ionita, Dr. Brădean Ana-Maria, Dr. Elena Petrisor, Dr. Florin Rusu
The Emergency Hospital For Children „Grigore Alexandrescu‟, Bucharest, Romania
Introduction
Burns in neonates has extreme severity regardless of their cause.
An unusual and extremely severe accident happened as a fire broke in a neonates department. Eight (8) out of 11
initial victims were admitted in our burn center. They had burns between 40% and 80% TBSA, postcombustional
shock, respiratory injury that added to their severe state that kept them in the intensive care unit. Although our burns
unit has been treating constantly a large number of pediatric burns with variable severity, this accident presented as a
completely new challenging experience for the entire staff involved.
Material and method
A particular accident involved neonate babies and their burns were treated in our clinic. 8 victims, infants with burns
between 40% and 80% TBSA were admitted in our burn center. Adequate general and local treatment was applied.
Results
Five of the eight victims survived, returned to their families, had normal subsequent growth. The healing pattern was
unique, resembling fetal wound healing.
Conclusions
The collective accident was an overwhelming tragedy. Neonatal burns pose various extreme risks but ultimately good
results are to be obtained even in serious cases. Particular aspects of collective accident were the large number,
higher surfaces affected, very good results after adequate treatment. Serious burns in this age group are extremely
rare, and this case series shows up a unique experience. Certain patterns arise regarding treatment planning,
preventing, organizing the team and long term evaluation of these extremely severe and special burns.
34.
Burn Ear Reconstruction Using Porous Polyethylene Implants
Justin Fernandes, MD, Daniel N Driscoll, MD
Shriners Hospital for Burns, Boston, Harvard Medical School.
Introduction: Reconstruction of the external ear after a burn is particularly challenging for the plastic surgeon. The
nature of the injury poses many problems such as extensive scar tissue, poor blood supply and the lack of adequate
and appropriate materials for a framework. Options include z-plasty, skin grafts, cartilage grafts, conchal
transposition flaps, costochondral and porous polyethylene (Medpor) reconstruction. In severely burned skin, due to
the thick scar, the use of costochondral grafts often leads to poor outcomes, which do not justify the morbidity of the
procedure. Children under the age of 10 commonly have insufficient cartilage for a costochondral graft. Medpor
offers minimal morbidity and a very effective result. In this series we describe our experience using Medpor to
reconstruct severely burned ears.
Methods: A total of 17 patients underwent 19 reconstructions, with two patients receiving bilateral procedures.
Patients ranged from three to twenty years of age. All patients received Medpor implants. Twelve patients were
tissue expanded for alopecia during the staged ear reconstruction for an average of 4 months. Eleven
temporoparietal fascial flaps were performed. In the remaining patients, coverage of the implant was achieved by
local advancemant flaps, tissue rearrangements and skin grafts.
Results: Only two patients had complications with exposure of the Medpor construct after several years. In these
two cases the implants were removed. Our experience has shown porous polyethylene reconstruction to be very
efficient, with low morbidity and good cosmetic outcomes.
Conclusions: Medpor is an excellent option for the reconstruction of both fully and partially burned ears as you may
implant only the helical rim, base or both pieces. Our best results were achieved after scalp tissue expansion and
with a temporoparietal fascial flap for implant coverage. This has become our preferred method for reconstruction of
the severely burned ear.
35.
CAUGHT IN THE WEB: How To Prevent Burn Scar Syndactyly
1
1
1
1
2
E. Goldwasser , A. Dowlatshahi , S. Figy , G. Fudem , C. Perera ,
1
2
UMass University Medical School Division of Plastic Surgery, Burns and Reconstructive Surgical Unit,
National Hospital of Sri Lanka, Colombo, Sri Lanka
Introduction: Management of pediatric and adult hand burns presents a functional and aesthetic challenge to the
burn team. One area in particular, the web space, is critical to hand function. Burns involving the latter have been
associated with higher rates of complications including scar contracture and burn syndactyly. In this study, we
discuss different reconstructive approaches illustrated with case examples and documented with photographic and
video imaging.
Methods: Several patients with bilateral hand burns that included the web spaces underwent surgical excision and
grafting with unmeshed/sheet grafts. The main technical innovation we are comparing is grafting the webs or not.
The nongrafted webs were left to heal secondarily.
Results: There was no significant difference in graft survival comparing negative pressure therapy and standard
dressings. Expedient web space epithelialization occurred in the nongrafted web spaces with much less tendency
toward syndactyly. These webs also showed better aesthetic contour ie more normal. Grafted web spaces showed
evidence of early postoperative hooding and syndactyly. Early active range of motion did not differ between sides.
Conclusions: The goal of this bilateral comparison is to examine the unique features of the web space and
determine how this affects reconstructive options after burn injury. Web space contracture and burn syndactyly are
very common complications of hand burns and reconstruction. This may be related to the naturally adducted posture
of the digits and concave nature of the web spaces which promotes graft shortening. The concept of minimal or no
excision and allowing secondary healing is not unique in burn surgery e.g. the nipple-areolar complex and certain
areas of the face. These are areas which are very difficult to satisfactorily reconstruct. We propose adding the finger
web spaces to this list. In our patients, excision without grafting of the web spaces appears to have led to a superior
functional and aesthetic outcome.
36.
The foreskin as a thin full-thickness skin graft for burned eyelids
Mechthild Sinnig, Katharina Schriek
Kinderkrankenhaus Auf Der Bult, Hannover, Germany
Deep dermal burns of the eyelids are a special challenge in terms of functional and cosmetic cover after necrectomy.
Shrinking split skin grafts often cause ectropion Full-thickness skin grafts heal poorly in the acute burn or are too thick
for this region. The donor areas of the thin retroauricular full-thickness skin are usually incinerated in burns of the face
and thus not available . In uncircumcised boys we face as a donor site the prepuce as a thin, hairless and very elastic
full-thickness skin graft to cover burnt eyelids available.
In the literature, case reports have been described in which the prepuce in adult men for primary coverage or was
used for secondary reconstruction of burned eyelids. Cases in boys are not described.
We would like to present the experience of our center with the possibilities and limitations of the method by means of
two case reports.
37.
A Random Interpositional Skin or Skin-fascia Flap Technique.
FWilliams MD, THuang MD,
ShrinersBurnsHospital, Galveston, Texas, USA
Introduction: Transposing a random skin flap is a useful technique in reconstructing contractural deformities in burn
patients. The length-to-width ratio of a flap could be increased from 2:1 to 4~5:1 if the fascia underneath is included
in the flap fabrication. The techniques have been continuously used to correct contractural deformities in burn
patients for more than 10 years at our hospital.
Surgical technique: A right-angled triangle with its cathetus adjacent is drawn at the end and perpendicular to the
line of proposed release. The angle adjacent of the triangle is set at 20°- 45°. The length-to-width ratio of a proposed
flap could be increased; i.e., 4~5:1 if the fascia underneath is included in the flap fabrication. The skin incision is
made initially along the cathetus adjacent of a triangle. The dissection is continued through the subcutaneous
tissues; the fascial layer is included for a FC flap fabrication. A back-cut is made at the apex of triangle to complete
the flap fabrication. Locating the exact site for vascular pedicles supplying the skin and the underlying fascia is not
necessary. The flap is rotated 90° to cover the tissue deficit to complete the releasing procedure.
Clinical materials: Of 11031 procedures performed on 1341 children between 2003 and 2012, the technique was
used 3495 times. The common indications included 1913 flaps used for upper extremity contractural releases and
872 flaps used in the head and neck area. The technique was also used 397 times in lower extremity deformity
reconstructions.
Results: While the technique was effective in alleviating contractural deformities, partial necrosis around the tip of
triangular skin flap had occurred in 2.37% of all instances; it occurred most commonly in the lower extremities; i.e.,
9.57% and the least in the upper extremities. The incidence of problems such as hemorrhaging and infection was nil.
Conclusion: Fabrication of a flap as described is technically simple and the transfer of the flap to reconstruct the
wound defect is readily achievable. The morbidities are minimal. The flap therefore, should be considered as a
proper alternative to skin graft for burn scar contracture release.
38.
Long term results after split thickness skin grafting of facial burns in children
Dr. N. Marathovouniotis, T. Klein, Prof. Dr. Dr. T.M. Boemers
Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital of Cologne, Germany
Facial-burns require an intensive and complex primary treatment in specialized centers to avoid esthetic and
functional complications like scaring of the eyelid and impairment of the opening of the mouth in the long term. In
general the high density of epithelial appendages and the excellent blood supply in the face account for the
remarkable ability of the face to epithelialize even deepest burn wounds. If surgical intervention is necessary the
following aspects should be considered. Each facial esthetic unit should be treated as an individual entity and
reconstruction should proceed within the unit. Furthermore scars should be set parallel to relaxed skin-tension lines.
Following surgical reconstruction functional and esthetic rehabilitation has to be provided by consequent long term
conservative scar management.
In our presentation the operative therapy of facial burns in children is discussed based on case reports and a review
of current literature.
39.
Clinical Curative Observations of Pediatric Burn Patients Treated by a Patented Special Effect Burn
Ointment with Burn Skin-Grafting Free skill
Jin-An Zhang
Chang‟an Jin-An Zhang Burn Clinic, Shijiazhuang, Hebei, China, 101-4-4 Tange St., Shijiazhuang, Hebei
Prov., China
Good Pain Stopping Effect
Stop pain after applying the patented ointment for a while; without tearing up the skin and no pain when change
dressings. Patients „suffering is reduced to a minimum and avoids the painful shock.
1. Quick in Healing
I-degree burn can be cured in a day; II-degree burn can be cured in 5 or 7 days; III-degree burn can be cured in
3 weeks basically. After applying the patented ointment, it can quickly form the medicinal scab, cover the wound
surface, diminish inflammation and sterilization and regenerate skin; the scab drops off and wound is healed
before infection.
2. Skin-Grafting Free
Stop the deep burn patient from skin grafting. The ointment and technique has a stronger effect of sterilizing
bacteria, resisting infection and regenerating skin. 90% large area of burn patients do not need to make skin
grafts.
3. No Scar Left
Make burn patient no scar left after using the ointment which activates blood circulation to dissipate blood stasis
and dissipates a mass. Make over 90% burn patients‟ skin to be flat and soft. Without hyperplasic scar left after
healing and no need to perform a plastic surgery.
4. No Face Destroyed
The new technology for curing burn has been applied for curing varieties of burn patients especially for tens of
cases of facial burn patients without anyone destroyed their faces. Its curative effect is much better than
traditional method.
5. No Cut for Relieving Swell
Traditionally it needs to conduct anesthesia and operation for incision and relieving swell; applying the patented
ointment, the swell can be relieved in 2-3 days.
6. Special Effect for Anti-Pseudomnas Aeruginosa Infected Burn Wound
For rotten burn wound deeply infected by pseudomonas aeruginosa, no need to use polymyxin E. It could be
cured in 3 days after applying the patented ointment.
40.
Combination of Needling and ReCell for repigmentation of burn scars – a promising approach also
for youngsters and tweens?
M.C. Aust, R. Bender, N. Walezko, K.H. Busch
Department for Plastic and Reconstructive Surgery, Malteser Hospital, Bonn, Germany
Introduction: Burn scars are still a serious physical and psychological problem for the
affected people and especially for childern or youngsters. Clinical studies as well as basic
scientific research have shown that medical needling can significantly increase the quality of
burn scars with comparatively low risks and stress for the patient with regards to skin
elasticity, moisture, erythema and transepidermal waterloss. However, needling has no
influence on repigmentation of large hypopigmented scars.
Methods: The goal is to evaluate whether two established methods - needling (improvement
of scar quality) and ReCell (repigmentation) - can be combined. So far, 3 youngsters with
mean age of 11 (7 – 15 years) and 3 „tweens“ with mean age of 25 (22 – 27 years) with deep
second and third degree burn scars have been treated. We additionally treated 14 adults with
mean age of 42 years (30 – 61 years). The average treated tissue surface was 8% (2-18%
TBSA) and was focused on areas like face, neck, chest and arm.
Intervention: Percutaneous collagen induction or „medical needling“ is performed with a
roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally
rolled over the scar, inducting several microtrauma. Then, ReCell (autologous cell
suspension) is applied, according to the known protocol. The patients have been followed
postoperatively. Pigmentation changes were measured objectively, as well as with patient
and observer ratings. Patient satisfaction/preference was also obtained.
Results: Taken together, the pigmentation ratings and objective measures indicate individual
improvement in most of the 6 youngsters and tweens. The melanin increases seen 12
months after ReCell treatment in the study group as a whole (n=20) are statistically
significant.
Conclusion: Medical needling in combination with ReCell shows promise for repigmentation
of burn cars for adults as well as for youngsters and tweens.
41.
The influence of stromal cells on the pigmentation of tissue-engineered human skin grafts
T. Biedermann, PhD, S. Böttcher-Haberzeth, MD, A. Klar, MSc, D. Widmer, PhD, L. Pontiggia, PhD, A.
Weber, MD, D. Weber, MD, C. Schiestl, MD, M. Meuli, MD, E. Reichmann, PhD
University Children‟s Hospital Zurich, Department of Surgery, Zurich, Switzerland
It has been shown in vitro that melanocyte proliferation and function in palmoplantar skin is regulated by
mesenchymal factors derived from fibroblasts. Here, we investigated in vivo the influence of mesenchymal-epithelial
interactions in human tissue-engineered skin substitutes reconstructed from palmar- and non-palmoplantar-derived
fibroblasts. Tissue-engineered dermo-epidermal analogs based on collagen type I hydrogels were populated with
either human palmar or non-palmoplantar fibroblasts and seeded with human non-palmoplantar-derived melanocytes
and keratinocytes. These skin substitutes were transplanted onto full-thickness skin wounds of immuno-incompetent
rats. Four weeks after transplantation the development of skin color was measured and grafts were excised and
analyzed with regard to epidermal characteristics, in particular melanocyte number and function. Skin substitutes
containing palmar-derived fibroblasts in comparison to non-palmoplantar derived fibroblasts showed a) a significantly
lighter pigmentation; b) a reduced amount of epidermal melanin granules; and c) a distinct melanosome expression.
However, the number of melanocytes in the basal layer remained similar in both transplantation groups. These
findings demonstrate that human palmar fibroblasts regulate the function of melanocytes in human pigmented dermoepidermal skin substitutes after transplantation, whereas the number of melanocytes remains constant. This
underscores the influence of site-specific stromal cells and their importance when constructing skin substitutes for
clinical application.
42.
Assessing the effects of UVB radiation on human dermo-epidermal skin substitutes containing
melanocytes
1,3
1,3
1,2,3
Teresa Michalczyk , Thomas Biedermann , Sophie Böttcher-Haberzeth , Agnieszka S.
1,3
1,2,3
4
2,3
1,3
Klar , Luca Mazzone
, Petra Boukamp , Martin Meuli , Ernst Reichmann
1
2
University Children‟s Hospital Zurich, Tissue Biology Research Unit, Zurich, Switzerland; University
3
Children‟s Hospital Department of Surgery, Zurich, Switzerland; Children‟s Research Center, University
4
Children‟s Hospital Zurich, Switzerland; Division of Genetics of Skin Carcinogenesis, German Cancer
Research Center, Heidelberg, Germany
Melanocytes can be added to tissue engineered dermo-epidermal skin substitutes (DESS) and thereby allow
restoration of the original human donor skin color. For future clinical application of melanocyte-containing fullthickness skin analogs, it is of major importance to prove their physiological functionality under exposure to UV
radiation. In this experimental study we analyzed engineered DESS with and without melanocytes in an animal model
before and after UVB irradiation. Human DESS were engineered with keratinocytes, melanocytes and fibroblasts of
the same donor, isolated from light or dark pigmented skin biopsies. Keratinocytes and melanocytes were seeded on
collagen type I hydrogels, previously populated with fibroblasts. Skin substitutes were transplanted onto full-thickness
wounds of immuno-incompetent rats. A single dose of 250mJ/cm2 or 500mJ/cm2 UVB irradiation was applied four
weeks after transplantation. Transplants were followed for 6 additional weeks in order to measure skin color. Punch
biopsies were taken from the grafts for immunohistochemical staining regarding skin differentiation, proliferation and
DNA damage, as well as melanocyte number and function. Analysis of skin substitutes after irradiation indicates
significant cell proliferation of basal and suprabasal keratinocytes, but not of melanocytes. We observe induction of
the wound healing marker cytokeratin 16, an increase of cytokeratin 19 positive basal cells and altered expression of
epidermal differentiation markers such as involucrin, loricrin, filaggrin. Skin grafts recover to the pre-irradiation
homeostatic state 3 to 4 weeks after irradiation. Chromameter measurements reveal a stronger tanning in the light
substitutes, while dark substitutes seem to tan less, but, in particular, show an expansion of supranuclear melanin
caps to the upper layers of the epidermis when examined with Fontana Masson staining. Melanocytic markers, such
as HMB45, Tyrosinase, TYRP 1, MITF, c-Kit remain unaffected after irradiation. We observe cyclobutane pyrimidine
dimers in punch biopsies taken 2 days after irradiation, but absence after 5 days and later, indicating their rapid
depletion. Our findings suggest a functionality of dermo-epidermal substitutes with melanocytes that is comparable to
normal skin under the exposure to UVB radiation. This implies protection against harmful radiation and thus reconfirms the importance beyond purely aestheticadvantages when considering melanocyte-containing DESS for
clinical application.
43.
Results from application of an absorbable synthetic membrane to superficial and deep second
degree wounds
S. A. Blome-Eberwein, MD, H. Amani, MD, D. D. Lozano, MD, MBA, FACS, D. Boorse, RN, CNP, P.
Pagella, RN, CNP
Lehigh Valley Hospital, Allentown, PA
Introduction: The care of 2ndº burns remains challenging because of pain during daily dressing changes and
unpredictability of healing time and scarring. Temporary coverage solutions have been studied in the past (xenograft,
allograft, amniotic membrane, Biobrane®, Transcyte®, Mepithel® etc.), in an attempt to limit the amount of painful
dressings and accelerate healing. Infection and integration into the healing wounds have been the major drawbacks
nd
and there are minimal final outcome reports. The ideal treatment of 2 º burns would 1-decrease pain, 2-limit
dressing changes,3-allow assessment of healing progress, 4-prevent infection, 5-accelerate healing, 6-improve long
term outcome, 7-save treatment cost. This new dressing material seems to fulfill 6 out of the 7 above mentioned
requirements.
Methods: In 18 months we treated 130 patients with 2nd ºburns (superficial and deep) with Suprathel®, a porous
synthetic copolymer membrane made of DL-lactide. It is biodegradable and creates a wound PH of 4-6 during
degradation. In this physiologic skin PH environment most microorganisms do not thrive. Patients were taken to the
operating room. Wound bed preparation was achieved by dermabrasion or hydrodissection or thin Weck blade
excision. Suprathel® was applied after hemostasis and an outer dressing of fatty gauze, bridal veil, absorptive gauze
and ace wrap was applied. The outer dressing was removed on day one. The wound bed was followed through the
translucent Suprathel® and fat gauze layers. The dressing separated spontaneously after epithelialization was
complete.
Results: All wounds in this series healed without grafting. Our infection rate was <1%. Time to epithelialization was
accelerated compared to similar wounds that received daily dressing changes and wounds that were placed in
biobrane® or allograft (some in the same patient). No integration into wound beds was noted. It appears that
repigmentation of the healed burn occurs accelerated. The only complication was severe itching in one adolescent
patient.
nd
Conclusions: The application of Suprathel® to 2 º wounds offers a new simple option of treatment with potential for
better outcomes and less pain. Cost was not calculated, but considering less frequent dressing changes, less pain
medication and lower infection rate it can be predicted that cost will be at least equivalent to current standard of care.
44.
Cryopreserved StrataGraft®, A Human Skin Substitute Tissue With Long Shelf Life, for the Treatment
of Deep Partial-Thickness Burns
1,2
3
1
4
B. Lynn Allen-Hoffmann, PhD , Michael J. Schurr, MD , Lee D. Faucher, MD , Kevin N. Foster MD , Steven
5
6
2
2
2
E. Wolf, MD , LTC Booker T. King, MD , Kelly Barbeau , Allen R. Comer, PhD , Mary A. Lokuta, PhD ,
7
James H. Holmes IV, MD
1
2
3
University of Wisconsin-Madison; Stratatech Corporation, Madison, WI, USA; University of Colorado at
4
5
Denver, Aurora, CO, USA; The Arizona Burn Center, Phoenix, AZ, USA; University of Texas
6
Southwestern, Dallas, TX, USA; US Army Institute for Surgical Research, Fort Sam Houston, TX, USA;
7
Wake Forest University, Winston-Salem, NC, USA
Standard of care for deep partial-thickness (DPT) burns is surgical excision and autografting. However, because
autografting generates painful donor site wounds prone to infection and scarring, alternatives to autografting are
urgently needed. Our current clinical trial is designed to evaluate safety and efficacy of an off-the-shelf allogeneic
human skin substitute to prevent autografting. The results presented provide initial support for the evaluation of
StrataGraft tissue in the treatment of children, a significant population in the burn indication with unmet needs.
A dose escalation clinical trial of StrataGraft to promote the healing of DPT burns without autografting is being
2
conducted at six sites. Patients with 3-49% TBSA burns were enrolled in three cohorts, receiving up to 440 cm of
refrigerated or cryopreserved StrataGraft tissue. Each patient had two areas of DPT burn randomized to autograft or
treatment with StrataGraft. Primary clinical endpoints are percentage of StrataGraft-treated area requiring
autografting by day 28 and wound closure at 3 month. Other assessments include safety, cosmesis, donor site pain,
immunological responses, and presence of allogeneic DNA.
Enrollment is complete and patient follow-up is ongoing. There has been no safety signal related to use of either
refrigerated or cryopreserved StrataGraft. Of the subjects enrolled across all cohorts, none required autografting of
the StrataGraft treatment site by day 28. Across all cohorts, 27 of 28 subjects who have reached the 3 month time
point and whose wounds were treated per protocol have shown complete wound closure of both StrataGraft-treated
and autograft-treatment sites. DNA from StrataGraft has not been detected after 3 months.
Results to date suggest that StrataGraft tissue reduces or eliminates autografting of DPT burns, promotes healing
and is gradually replaced by autologous tissue. Cryopreserved StrataGraft tissue has a significantly increased shelflife making it a cost-effective, readily-available alternative to autografting of severe burns, reducing pain and other
complications associated with donor site wounds. Subsequent studies will include pediatric populations which
comprise a significant percentage of the burn patient population.
45.
Practical Outpatient Use of Targeted Enzymatic Debridement in Burns
R Sheridan, B Weaver, C Chu, J Weber, P Chang, S Fagan, J Goverman, D Lawlor, M Donovan, J Fabbri, A
O‟Brien, J Peterson
Shriners Hospitals for Children, Boston, MA, USA
Introduction
Enzymatic debridement of burns is attractive in concept but has had limited use in practice. The concept of accurate,
painless, bloodless elimination of necrotic dermis is appealing and may enhance rates of wound healing and reduce
the need for surgery.
Methods
A 4-year review (calendar years 2010-2013 inclusive) was done describing use of a debriding enzyme derived from
Clostridium histoliticum at a regional pediatric burn unit. The enzyme was used under a strict protocol, applied only to
areas within wounds demonstrating necrotic dermis, requiring approval in each case by one a limited number of
attending surgeons.
Results
A total of 375 children were treated at least once. Numbers of children grew each year as the staff became more
comfortable with the material and its efficacy from 41 to 169 children. Cost per patient was reduced and hospital cost
kept level by in-house preparation of individual patient dosing portions. Only children with areas of deep dermal burn
were chosen for enzymatic debridement; 78 of whom (20%) subsequently required operation.
Conclusion
Enzymatic debridement does have an adjunctive role in outpatient burn management. Expense can be controlled by
targeted application only to deep dermal areas. It seems likely that this practice reduced the frequency of operation
for these patents.
Faculty
W. Hardy Hendren, MD
Chief of Surgery Emeritus, Children's Hospital Boston; Robert E. Ross Distinguished Professor of
Surgery, Harvard Medical School; Honorary Surgeon, Massachusetts General Hospital
Dr. W. Hardy Hendren, Emeritus Chief of Surgery of Children’s Hospital and Robert E. Gross
Distinguished Professor of Surgery of Harvard Medical School, was born in New Orleans, LA. After
graduating from the Woodberry Forest School in 1943, he entered the US Navy and qualified as a carrier
pilot. After World War ll, he then attended Dartmouth College and Dartmouth Medical School and went
on to complete his medical education at Harvard Medical School, graduating in 1952.
He trained in general surgery at the Massachusetts General Hospital and completed his pediatric surgical
training at the Children Hospital, Boston.
In 1960 Dr. Hendren then began his pediatric surgical career developing a new Pediatric Surgical Service
at the Massachusetts General Hospital. In 1982 he moved to Children’s Hospital, Boston as Chief of the
General Surgical Department. He was appointed as the first Robert E. Gross Professor of Surgery at
Harvard in 1985.
During his surgical career he published more than 200 peer-reviewed articles, 100 book chapters and
several monographs. He has been Visiting Professor to lecture and operate in more than 70 Institutions
in the US and abroad. He is a member of many surgical organizations, and served as President of The
New England Surgical Society, the American Pediatric Surgical Association, the Surgical Section of the
American Academy of Pediatrics, the Society of Genitourinary Reconstructive Surgery and President of
the Massachusetts Chapter of the American College of Surgeons. He is a member of the American
Surgical Association , the American Urological Association, the British Association of Pediatric
Surgeons, and an honorary member of the Surgical Associations of Greece, Poland, Switzerland, Brazil,
Columbia, Texas, Kansas City, and the Royal Colleges of Surgeons in Ireland, England, and Glasgow.
In 1998 he was Vice-President of the American College of Surgeons.
He was awarded the Bigelow Medal of the Boston Surgical Society, the William E Ladd Medal and the
Urological Medal of the American Academy of Pediatrics, and the Denis Browne Medal of the British
Association of Pediatric Surgeons. He also received the Arnold Salzberg Award of the American
Academy of Pediatrics, and the Valentine Medal of the New York Academy of Medicine. In 1982 he was
given a degree Docteur Honoris Causa, de L’Universite d’Aix-Marsielle, France and Doctor of Medical
Science, Honoris Causa, Drexel College of Medicine, Philadelphia.
In 2012 he received the Jacobson Innovation Award given by the American College of Surgeons in
recognition of his multiple unique innovations to the new field of pediatric reconstructive urology.
Currently he is working on the development of an online Educational Non-profit Foundation for Pediatric
Surgery and Urology.
James W. May Jr MD, FACS Eng. (Hon).
Prof of Surgery, Harvard Medical School, Chairman of Plastic Surgery (Emeritus), Massachusetts
General Hospital
Dr. May, a native Kentuckian, attended Northwestern Medical School and arrived at the Massachusetts
General Hospital in 1969 as an intern in the Harvard Surgical Program. He continued his general surgery
and plastic surgery training and embarked upon an 18 month fellowship in hand and microsurgery at the
University of Louisville, Kentucky and Melbourne, Australia. Dr. May returned to the Massachusetts
General Hospital as an Instructor in Surgery in 1976 and ascended through the academic ranks at Harvard
culminating in full professorship appointment in 1994.
At the Massachusetts General Hospital in the Division of Plastic Surgery, Dr. May became Chairman in
1982 and over the next twenty-six years led the division, retiring from that position in 2008. Dr. May has
served as guest examiner and examiner for the American Board of Plastic Surgeons for 27 consecutive
years and was chairman of the American Board of Plastic Surgery in 1992. He has had many leadership
roles in plastic surgery and has served as a member of over thirty societies and associations involving
leadership opportunities as President. He has been a Bunnel Traveling Fellow for the American Society
of Surgery for the Hand and has served as an international Visiting Professor for the Plastic Surgery
Education Foundation in addition to numerous basic science and clinical awards from the Education
Foundation as a junior and senior member. He has participated in a number of editorial boards including
Plastic and Reconstructive Surgery, Aesthetic Surgery, and the Journal of the American College of
Surgeons.
Dr. May has taken part in many clinical milestones within the Division of Plastic Surgery during his
career. Amongst these include initiating microsurgery as an applied clinical technique in plastic surgery
at the Massachusetts General Hospital. Dr. May also established microsurgical extremity reconstruction
as a plausible solution to osteomyelitis and published over 100 cases in Plastic and Reconstructive
Surgery. He authored the initial report of this work in the New England Journal of Medicine. During the
course of Dr. May’s career he has authored over 240 papers and chapters and has edited seven books and
monographs in the field of plastic surgery.
Ronald G. Tompkins, MD, Sc.D.
Division Chief, Division of Burns, Massachusetts General Hospital
Dr. Ronald Tompkins is the Sumner M. Redstone Professor of Surgery at Harvard Medical School. He
graduated from Tulane University School of Medicine as a member of Alpha Omega Alpha and earned
SM and ScD degrees in chemical engineering at the Massachusetts Institute of Technology. He
completed his surgical residency in 1986 at Massachusetts General Hospital where he has continued on
the staff of the MGH Surgical Services. Dr. Tompkins directs the newly established center for research
and innovation, which is based upon the Burns Division’s collaborative track record and expertise in
securing more than $200 million in federal, foundation, and industrial support for basic research and
clinical programs.
Dr. Tompkins has an outstanding track record in high-impact publications, outstanding trainee outcomes,
and productive research translation and commercialization. He has published more than 445 research
papers in medicine and engineering journals and has contributed to the advancement of science and
engineering through service on institutional advisory panels, moderating mini-symposia and workshops
on biotechnology, and studying the genomics and proteomics of immunology and metabolism resulting
from injury. He has delivered over 1,000 invited keynote and scientific meeting presentations.
Beginning as an intern in 1976 and continuing as Chief of the MGH Burns Service from 1990-2014, Dr.
Tompkins had the privilege to know Dr. John (Jack) Burke as a colleague, mentor, and close friend.
Basil A. Pruitt, Jr., MD, FACS, FCCM, MCCM
Clinical Professor of Surgery, Betty and Bob Kelso Distinguished Chair in Burn and Trauma Surgery, Dr.
Ferdinand P. Herff Chair in Surgery, University of Texas Health Science Center at San Antonio,
Professor of Surgery, Uniformed Services University of the Health Sciences
Dr. Pruitt, Commander and Director of the U.S. Army Burn Center (1968-1995), is a past president of the
ISBI and the ABA, as well as the American Association for the Surgery of Trauma, the Surgical Infection
Society, the Shock Society, and the American Surgical Association. He has served on 19 Editorial
Boards and was the Editor of the Journal of Trauma from 1994 to 2011. Dr. Pruitt has presented the A.B.
Wallace Memorial Lecture for the British Burn Association, the Rudi Hermans Lecture for the European
Burn Association, and the Semmelweis Lecture for the Surgical Infection Society-Europe. He has served
on the NIH Surgery, Anesthesiology, and Trauma Study Section, the VA Merit Review Board for
Surgery, and four advisory boards for the Shriners Hospitals for Children. He has authored and coauthored 465 papers, 178 textbook chapters, and 13 books and monographs. Dr. Pruitt’s awards include
eleven honorary memberships, the Curtis P. Artz Memorial Award, the Harvey Stuart Allen
Distinguished Service Award, the American Surgical Association’s Medallion for Scientific
Achievement, the G. Whitaker International Burns Prize, and the Tanner-Vandeput-Boswick International
Burn Prize. Since 2008, he has been a co-winner of the King Faisal International Prize in Medicine,
received the Lifetime Achievement Award of the ABA, become the first foreign honorary member of the
Japanese Association for Acute Medicine, been designated Honorary Member of the ISS/SIC, and
received the Lifetime Achievement Award of the Society of Critical Care Medicine. He presently serves
on the Board of Directors of the American Trauma Society and the National Trauma Institute.
David N. Herndon, MD, FACS
Chief of Staff & Director of Research, Shriners Hospital for Children – Galveston; Professor of Surgery
and Pediatrics, Jesse H. Jones Distinguished Chair in Burn Surgery, University of Texas Medical Branch
David N. Herndon, MD, is Professor of Surgery at The University of Texas Medical Branch. He came to
Galveston in 1981 where he was jointly appointed Chief of Staff at Shriners Hospital for ChildrenGalveston, and Director of Burns Services at UTMB. After receiving the Annie Laurie Howard
Professorship in 1988 he was honored with the Jesse H. Jones Distinguished Chair in Burn Surgery in
September of 1990.
Dr. Herndon has pursued areas of research that include resuscitation, infection, hypermetabolism, early
wound closure, inhalation injury, scarring and rehabilitation. He has been continuously funded for the
past 30 years by the National Institutes of Health and the Shriners Hospitals for Children. Through
research in these areas, the mortality of burned children has been significantly reduced such that a child
with a burn injury of 98% Total Body Surface Area has a 50% chance of survival.
In April 2014 Dr. Herndon was awarded the prestigious Medallion for Scientific Achievement by the
American Surgical Association. In October 2014 he will receive the Tanner-Vandeput-Boswick Burn
Prize from the International Burn Foundation. Dr. Herndon is active in national and international
organizations. He currently serves as Treasurer of the Southern Surgical Association. He is Past
President of the International Society for Burn Injuries, the American Burn Association, the Society of
University Surgeons and the Singleton Surgical Society. He has written more than 950 articles in peerreviewed journals, 140 book chapters and edited 10 books.
Edward E. Tredget, MD, MSc, FRCSC
Director of Surgical Research, Professor of Surgery, University of Alberta, Canada
Dr. Edward (Ted) Tredget received his medical degree with distinction from the University of Alberta,
Canada in 1976 and went on to complete his internship, general surgery and plastic surgery training from
the University of Alberta in 1984. He undertook a Post-Doctoral Fellowship at the Massachusetts
Institute of Technology Massachusetts General Hospital and Harvard Medical School in Boston from
1984 to 1987 where he received his Masters of Science degree in Applied Biological Sciences. He was
awarded the American Burn Association’s Travelling Fellowship in 1988. Upon his return to the
University of Alberta in 1988, Dr. Tredget became Director of the Firefighters’ Burn Treatment Unit and
the Plastic Surgery Wound Healing Research Laboratory of the University of Alberta. The focus of their
research includes basic science research relating to nocosomial infections, wound healing, hypertrophic
scarring and gene therapy. They have several ongoing clinical trials and research projects relating to
metabolism following burn injury, rehabilitation of the burn patient, wound healing and the potential role
of gene therapy for the management of post burn hypertrophic scarring. Their group has received funding
from several major granting agencies, including the Canadian Institute for Health Research, Canadian
Foundation for Innovation, the Natural Sciences and Engineering Research Council of Canada, the
International Foundation of Fire Fighters’ Association to support their work and have published numerous
manuscripts depicting their activities. Dr. Tredget is currently a Professor in the Department of Surgery,
Divisions of Plastic & Reconstructive Surgery and Critical Care Medicine and Director of the Division of
Surgical Research, Department of Surgery at the University of Alberta. Dr. Tredget is the current
President of the Canadian Society of Plastic Surgeons and Vice-President Elect of the American Burn
Association.
Dr Sarah A. Pape MB., ChB., FRCSEd(Plast), MA Clin Ed
The Newcastle Upon Tyne Hospital, Tyne and Wear, Northeast England
Sarah Pape is a Consultant Plastic Surgeon in Newcastle upon Tyne, UK. Her special interests are burns
and laser surgery. She has been a pioneer in the use of Laser Doppler Imaging for the assessment of burn
depth and has extensive experience in its clinical applications.
In addition to her clinical work, Sarah is the Clinical Lead for a national e-learning project for plastic
surgery (e-LPRAS).
Ioannis Yannas, PhD
Professor of Mechanical and Biological Engineering, Massachusetts Institute of Technology
Yannas and John F. Burke, MD discovered the first scaffold with regenerative activity. This
biodegradable scaffold, a highly porous analog of the extracellular matrix, with highly critical levels of
degradation half-life and surface chemistry, led to synthesis of a neodermis in the guinea pig (1975-81).
When this scaffold was seeded with keratinocytes it led to simultaneous regeneration of the dermis and
the epidermis in animals and in humans (1981-84).
This outcome was totally unexpected: Although the epidermis regenerates spontaneously in the adult
mammal on a pre-existing dermis, the dermis itself does not regenerate spontaneously. This work led
directly to development of a medical device (IntegraTM) that is used with increasing frequency to treat
patients who have lost skin due to trauma, plastic surgery and patients with chronic skin wounds.
This work has been extended by Yannas and coworkers at MIT to regenerate peripheral nerves over
unprecedented distances and the conjunctiva in adult animals (1985-2000). The molecular-biological
mechanism of scaffold regenerative activity was also elucidated by the same group.
The collagen scaffold work has provided the original paradigm in the fields of regenerative medicine and
tissue engineering. His book Tissue and Organ Regeneration in Adults is now in its second edition (NY:
Springer, 2014)
Yannas has degrees from Harvard College (BA, chemistry, 1957), MIT (MS, chemical engineering, 1959)
and Princeton University (MS, 1965; PhD, 1966, physical chemistry). He has been on the MIT faculty
since 1966 and is currently Professor in the Departments of Mechanical Engineering and Biological
Engineering.
Steven T. Boyce, PhD
Professor, Department of Surgery, University of Cincinnati
During Dr. Boyce’s training as a cell biologist, his interests turned instinctively toward medical
applications for cell therapies. These interests have resulted in faculty positions within departments of
surgery during his entire professional career. Working with surgeons, dermatologists, nurses,
microbiologists, therapists and other basic scientists, engineered skin substitutes (ESS) were developed
for investigative studies in treatment of life threatening
acute burns, burn scars, chronic wounds, and congenital giant melanocytic nevi. Composition and
performance criteria for ESS required understanding and regulation of skin cell proliferation and
differentiation, degradable medical polymers, wound and microbial management, and assessments of scar
and psycho-social recovery. This inter-disciplinary process was called “tissue engineering”. The
published studies provide records of innovative advances in discovery, development and delivery of ESS
as an effective alternative to conventional treatments for acute and chronic wounds. However, past
progress has reached an asymptotic limit due to the dependence of tissue engineering on wound healing
physiology, and a relative absence of developmental biology. Consequently, the current ESS conserves
donor tissue and provides stable, indefinite wound closure, but does not develop hair follicles, sebaceous
glands, sweat glands, normal skin pigmentation, a native structure of dermal matrix, or a complete neurosensory system. These results constitute an acceptable scar, but do not regenerate uninjured skin
tissue. During the past decade, a clear distinction has been made between tissue engineering which is
based on wound healing physiology that leads to scar, and regenerative medicine which is based on
mechanisms of developmental biology that produces the native, uninjured tissue. His current research
focuses on regulation of the Wnt/β-catenin pathway at the cellular and genetic levels in a human model.
The Wnt/β-catenin pathway is known to control formation of hair follicles, and to be involved in
development of the pilo-sebaceous unit. He is the author of numerous publications on this research in
peer-reviewed journals.
Prof. Dr. Ernst Reichmann, PhD
Director, Tissue Biology Research Unit, Department of Surgery, University Children's Hospital, Zurich
Prof. Ernst Reichmann was born in Germany. He studied Biology at the Universities of Giessen
(Germany) and Bern (Switzerland). In 1988 he obtained his PhD in Bern at the Ludwig-Institute for
Cancer Research. In 1989 he started a post doc (and then became staff scientist) at the Institute of
Molecular Pathology in Vienna, where he specialized in cell and cancer biology. In 1994 he became a
group leader at the Swiss Institute for Experimental Cancer Research (ISREC) in Lausanne (Switzerland).
In 2001, he became the head of the Tissue Biology Research Unit (TBRU) in Zurich. In 2004 he obtained
his habilitation (receiving the title of a Privatdozent) in the field of experimental surgery developing and
applying his expertise in cell and tissue biology. In 2012 he acquired a professorship at the Faculty of
Medicine at the University of Zurich (Switzerland). His areas of expertise are cell biology and tissue
engineering. The philosophy of the Tissue Biology Research Unit is to undertake basic research in order
to transform its results into personalized regenerative medicine. One focus of the studies of the TBRU are
the mechanisms of vascularization in human skin and the generation of blood and lymphatic capillary
networks in bio-engineered skin in vitro. A second focus of research is the characterization of the
melanocyte compartment in human skin. The TBRU has developed novel dermal and dermo-epidermal
skin grafts, which are presently applied in clinical phase I studies.
Clemens Schiestl, MD
Director of the Pediatric Burn Center, Plastic and Reconstructive Suergery, Department of Surgery,
University Children`s Hospital Zurich, Switzerland
Clemens Schiestl was born in 1958 in Freiburg, Germany. In 1991, he graduated from the Medical School
at the Albert-Ludwigs-Universität of Freiburg, Germany. Afterwards, he was trained as a paediatric
surgeon in Germany and board-certified in 2001. In 1995, he became Head of the Pediatric Burn Center at
the Children`s Hospital "Park Schönfeld" in Kassel, Germany. Since 2003, he is holding the position of
the Director of the Pediatric Burn Center, Plastic and Reconstructive Surgery at the University Children`s
Hospital in Zurich, Switzerland. Since 2000, Clemens Schiestl is also a member of the Tissue Biology
Research Unit, University of Zurich. In 2010, he submitted his habilitation thesis with the title "Large
scale skin replacement in children". Together with his team he organized the 6th World Congress on
Pediatric Burns in 2011 in Zurich. He is the current secretary of the European Club for Pediatric Burns.
Clemens Schiestl is married to Gaby Willaredt-Schiestl. They live in Zurich together with their three
daughters Anna, Chiara and Fanny.
Helmut Hierlemann, PhD
Technical Director, Product Manager, Polymedics Innovations GmbH
Born in 1958, studied Chemistry at the University of Stuttgart, PhD on fibers of polyurethanes at the
Institute of Textile Fibers / Macromolecular Chemistry. Since 1991 scientific member of staff at the
Institute of Textile and Process engineering, Denkendorf, Germany, especially in the areas of synthesis
and processing of resorbable polymers for medical devices, development of medical devices and implants
in the framework of research projects of the German Research Society (DFG), different european BRITEEURAM projects and several industrial sponsored projects.
Beginning in 1997, research at the interdisciplinary competence center Stuttgart-Tuebingen (BMOZ),
heavily involved in new and innovative developments such as atraumatic gastrointestinal stent systems,
cruciate ligaments, biohybride organ replacement systems for liver and kidney and traumatic and chronic
wound dressing systems. One result of these reseach studies the alloplastic skin substitute Suprathel was
developed for burn injuries, clinically tested and successfully introduced as a medical product in the
market. At 2008 change to PolyMedics Innovations GmbH, Denkendorf, as Technical Director and
Product Manager. Dr. Hierlemann is a member of various biomaterial and medical societies (German
Burn Association, European Society for Biomaterials, American Burn Association).
Sigrid Blome-Eberwein, MD
Associate Director Regional Burn Center, Lehigh Valley Hospital Network
Sigrid Blome-Eberwein, M.D., is the associate director at the Regional Burn Center in Allentown,
Pennsylvania since 2002. She is a member of the VDPRAEC, an associate member of the ASPS,
associate professor of surgery at the University of South Florida and a Burn/Plastic Surgeon at Lehigh
Valley Hospital Network. After completion of a Burn fellowship at USC Los Angeles, California and a
completed residency in plastic and reconstructive surgery at the University of Heidelberg, Germany, she
joined the Lehigh Valley Hospital staff in the Burn unit in 2002. The Lehigh Valley Hospital Network
Regional Burn Center treats approximately 200 pediatric and 500 adult acute Burn patients per year and is
accredited by the ABA for pediatric and adult Burn care. In addition, Dr. Blome-Eberwein performs
reconstructive procedures on both, pediatric and adult patients on an ongoing basis.
Habib Ur Rahman Qasim, MD
Chief of Burns and Surgical Emergencies, Indira Gandhi Institute of Child Health, Kabul, Afghanistan
Dr Qasim graduated from medical college of Balkh University Afghanistan in 2001. He started
specialization in Pediatric Surgery at Indira Gandhi Institute of Child Health (IGICH) Kabul in 2002, and
completed it in 2006. Since then he continued working as trainer of specialization in Pediatric Surgery in
IGICH. In 2012, a department of Pediatric Burn Care was created in IGICH, in 2013 Dr. Qasim was
promoted as chief of this Burn unit. In 2013 Dr Qasim attended a Pediatric Burn Care training in
Switzerland offered by PD Dr. Clemens Schiestl and the University Children Hospital in Zurich. He
joined the 2013 ECPB Workshop in Munich and got a presentation about Afghan burn services. It was
the first time that he talked about Afghan Pediatric Burn Care situation in an international meeting. The
ECPB awarded him an extraordinary membership. This presentation in ECPB workshop brought PD Dr
Clemens Schiestl to Kabul where he saw the burn care situation. With the support of Swiss Government
he decided to support IGICH burn care unit. Finaly in July 2014 a Memorandum of Understanding was
signed between Swiss Cooperation Agency (SDC), Ministry of Public Health Afghanistan, and University
Children Hospital Zurich. With this agreement, IGICH Burn Care Unit will receive technical and
financial support from Switzerland in order to improve burn care in Afghanistan. On the 7th ECPB World
Congress in Boston, Dr Qasim will present the one year progress and improvements of the pediatric burn
care in Afghanistan.
Najia Tariq, MD, MPPA
Deputy Minister for Health Care Services Provision, Ministry of Public Health, Kabul, Afghanistan
Dr. Najia Tareq was born in Kabul in 1970. She obtained her baccalaureate certificate from Afshar high
school and completed her MD in Kabul Medical Institute in 1991, having obtained her
Obstetric/Gynecology postgraduate degree from the Department of Continued Medical Education & Post
Graduation of the Ministry of Public Health in 1998. In 2010, she earned her Master’s degree from the
University of Washington State through the nomination of the Ministry of Higher Education on Public
Policy and Public Administration. Dr. Tareq joined the Coordination of Humanitarian Assistance (CHA),
a national NGO providing health services, as a trainer. By 2001, she was appointed as the second call
doctors in Rabia Balkhi (RBH) the only national women’s complex public hospital in Afghanistan, and
was promoted to obstetric/ gynecology Specialty Trainer in 2003. From 2004 through 2012, Dr. Tareq
served as the director of RBH, working on establishment of hospital executive board, improvement of
hospital management, human resource development in clinical and administrative areas, nursing and
midwifery field, expanded program on immunization, OB/GYN as well as other medical subunits. Dr.
Najia Tareq has received awards from the US Department of Defense, Afghanistan Ministry of Public
Health, Midwifery Association, Ministry of Women Affairs, and International Medical Corps, for her
excellent performance, effective coordination, collaboration, and excellent hospital management and
administration. At present, Dr. Tareq is the Deputy Minister for Health Care Service Provision in the
Ministry of Public Health.
Michael A. Serghiou, OTR, MBA
Administrative Director, Shriners Hospitals for Children-Galveston
Michael has been practicing in the area of burn rehabilitation exclusively for 26 years. He has published
articles, book chapters on the rehabilitation of burn survivors along the continuum of care and coauthored a book on splinting for burn patients. He has been recognized by the American Burn
Association (2004 Barbara Knothe Burn Therapist Achievement Award) and by the International Society
for Burn Injuries (2010 Andre Zagame Rehabilitation Specialist Prize) for his contributions to burn care
and rehabilitation. He has been actively serving both the ABA and ISBI for 25 years through
participating on various committees. Has been a volunteer in burn related missions internationally and has
been recognized by Physicians for Peace as their 2013 Ambassador of the year for his contributions in
burn rehabilitation internationally. Michael is currently serving on the Board of Trustees of the American
Burn Association.
Jane A Petro MD FACS FAACS
Retired Professor of Surgery NYMC, Former Associate Director Burn Center Westchester Medical
Center Valhalla NY, Currently President of the American Academy of Cosmetic Surgery
Trained at the University of Louisville, Hershey Medical Center and Albert Einstein/Montefiore with
board certification in General Surgery, Plastic Surgery and more recently in Cosmetic Surgery. My major
influences included Dr. Harry Stambaugh and Hiram Polk, Bill Graham and Stanley Levinson. I did
fellowships in burns, with Stanley Levinson and microsurgery with Berish Strauch. For 25 years was
associate director of the Burn Center at the Westchester Medical Center. Became a full Professor of
Surgery at New York Medical College. After "burning out" spent 10 years in private practice mostly
doing breast surgery. Now retired, doing consulting, editing and writing, and long distance sail boat
deliveries. My interest in medical history goes back to medical school itself and I enjoy trying to piece
together how knowledge is accumulated, and what personalities seem to have an impact. As the coauthor of "Rising from the Flames" I collected and read a huge number of old burn articles, and books and
still have quite a collection of both books and "wrappers" from the days when print was the main source
of information. Of course, now, none of the books or journals have value as they are almost all available
in digital form. While I could give a full semester course on burn history, I am honored to present this
brief overview of a couple of significant events contributing to burn survivorship.
Matthias B. Donelan, MD
Chief of Staff, Shriners Hospitals for Children – Boston, Associate Clinical Professor of Surgery, Harvard
Medical School, Associate Visiting Surgeon, Massachusetts General Hospital
Dr. Matthias B. Donelan graduated from Harvard College in 1967 and received his medical degree from
Tufts University School of Medicine in 1972 after spending an elective year as a Student Fellow in
Pathology. He received his surgical and plastic surgical training at the Massachusetts General Hospital
and subsequently spent an invaluable year as Plastic Surgical Tutor Specialist with Sir William
Manchester at the Middlemore Hospital in Auckland, New Zealand. Dr. Donelan is currently an
Associate Clinical Professor at Harvard Medical School and an Associate Visiting Surgeon at the
Massachusetts General Hospital. He has been the Chief of Plastic Surgery at the Boston Shriners
Hospital since 1982 and is currently also the Chief of Staff. Dr. Donelan is a widely recognized expert in
the field of burn reconstructive surgery and has developed numerous innovative techniques to enhance the
care of the burn patients. He has multiple publications in peer-reviewed scientific journals, and has
written definitive chapters on burn reconstruction. Dr. Donelan has long been an advocate for scar
rehabilitation through tension relief and the use of the pulsed-dye laser. He is currently investigating
fractional CO2 laser treatment for aesthetic and reconstructive indications in burn and trauma patients. In
addition to clinical and scientific activities he is involved in residency training and is on the executive
committee of the Harvard Combined Plastic Surgery Training Program.
CDR Peter Shumaker, MD
Chairman, Dermatology, Program Director, CARE Training Summit, Naval Medical Center, San Diego,
California
Dr. Peter Shumaker is a Commander in the United States Navy and currently serves as Chairman of the
Department of Dermatology at the Naval Medical Center San Diego (NMCSD). He carries an
appointment as a Clinical Associate Professor of Dermatology at the Uniformed Services University of
the Health Sciences and is an instructor in Mohs and procedural dermatology in the residency training
program at NMCSD. Dr. Shumaker received his undergraduate degree from Penn in 1993 and his
medical degree from Georgetown in 1997. Following internship and a tour in Puerto Rico as a Naval
Flight Surgeon, he completed dermatology residency at NMCSD in 2005 and went on to lead the
dermatology service at the Naval Hospital Yokosuka, Japan, until 2007. Following a fellowship in
procedural dermatology at Scripps Clinic in La Jolla, CA, he joined the dermatology teaching staff at
NMCSD in 2008. Since that time Dr. Shumaker and colleagues have been dedicated to facilitating the
functional and cosmetic recovery of our wounded warriors with traumatic scarring and other related
injuries. He has presented nationally and internationally on cutting edge scar management, serves as
Program Director for a national multidisciplinary summit on trauma rehabilitation, and has co-authored
publications in top journals from six different medical specialties. In recognition of his contributions to
the field, Dr. Shumaker was recently selected to receive the 2014 President’s award from the American
Society for Dermatologic Surgery.
David Ozog, MD
Senior Staff, Cosmetic and Procedural Dermatology, Henry Ford Medical Center, Detroit, Michigan
David M. Ozog, currently serves as Vice-Chair, Director of Cosmetic Dermatology, and is a Mohs
surgeon in the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA. He received
his Undergraduate degree from the University of Michigan, completed post baccalaureate work at Bryn
Mawr in Philadelphia and then obtained his medical degree from University of Rochester Medical
School, Rochester, New York. He completed his dermatology residency at Henry Ford Hospital in
Detroit where he served as Chief Resident. His Mohs, Cosmetic and Procedural fellowship was
completed with Dr. Ron Moy at UCLA Medical Center and the Moy-Fincher Medical Group in Beverly
Hills, California. He has published more than 30 articles and book chapters, and is a frequent national
lecturer in procedural dermatology. His active research interests include scarring prevention and
treatment, as well as laser delivery for cosmetic and malignant conditions.
Jill S. Waibel, MD
Medical Director and Owner, Miami Dermatology and Laser Institute
Dr. Waibel is board certified by the American Board of Dermatology. She specializes in cutaneous laser
surgery, general and cosmetic dermatology. She is currently the medical director and owner of the
Miami Dermatology and Laser Institute in South Miami. Dr. Waibel is also the Subsection Chief of
Dermatology at Baptist Hospital. In addition Dr. Waibel serves as a Clinical Voluntary Assistant
Professor at the University of Miami. Dr. Waibel’s undergraduate degree is from Indiana University. She
completed medical school and dermatology residency at the Wright State School of Medicine in Ohio
where she was at the top of her class, graduating Alpha Omega Alpha. Dr. Waibel served as chief
resident and went on to do three laser preceptorships. She has received numerous awards for her
contributions to medicine, including an award given by Surgeon General Koop. Dr. Waibel is also a
recipient of The American Society of Dermatologic Surgery Cutting Research Award. In her practice she
has over 35 laser devices and treats a wide variety of cutaneous disease. The treatment of scars by
applying today’s latest cutaneous laser technologies is one of Dr. Waibel’s primary passions. She has
successfully developed industry leading procedures and techniques with lasers. She works with a team
that has developed patents related to laser and stem cells. Dr. Waibel is active in basic science clinical
trials at the University of Miami and oversees a clinical trials division of Miami Dermatology and
Research. Dr. Waibel lectures nationally and internationally and she has published over thirty peerreviewed journal articles and several textbook chapters.
C. Scott Hultman, MD, MBA, FACS
Ethel and James Valone Distinguished Professor of Surgery Chief and Program Director, UNC Plastic
Surgery Vice Chair for Finance, Department of Surgery Founder and Executive Director, UNC Burn
Reconstruction and Aesthetic Center Associate Director, NC Jaycee Burn Center
Dr. C. Scott Hultman currently serves as the Chief of Plastic Surgery and as Residency Program Director,
at the University of North Carolina at Chapel Hill. He is a Full Professor of Surgery and is the holder of
the Ethel and James Valone Distinguished Chair in Plastic Surgery. Furthermore, Dr. Hultman is the
Associate Director of the NC Jaycee Burn Center and is the Founder and Executive Director of the UNC
Burn Reconstruction and Aesthetic Center. After graduating from Brown University with a concentration
in Psychology, he obtained his medical degree from the University of Pittsburgh. He subsequently
completed full training in General Surgery and Surgical Critical Care at UNC, followed by plastic surgery
at Emory University, and he remains board-certified in all three disciplines of surgery. His favorite
Boston bands include the Pixies, Galaxie 500, and of course, Boston.
Prof. Marco Klinger
Director of Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology
and Translational Medicine BIOMETRA, University of Milan, Chief of Plastic Surgery Unit, Humanitas
Clinical and Research Center, Rozzano (Milan), Italy
Born in Milan on August 11th 1955, Prof Marco Klinger graduated in Medicine and Surgery at Milan
Statal University in 1980. In the same University he also obtained specialization in Plastic Surgery in
1985 and in Microsurgery and Sperimental Surgery in 1988. Chief of Plastic Surgery Unit at Humanitas
Clinical Institute from 2004, Prof. Klinger is director of Plastic Reconstructive and Aesthetic Surgery
Specialization School. From 2003 he is coordinator of “Luigi Donati” Morphodinamic Aestethic Surgery
Master of the same University. From 1996 to 2002 he was chief of Plastic Surgery Unit at S. Pio X
Hospital of Milan; previously he was assistant (1993) and (1994) at Plastic Reconstructive Surgery
Institute of Milan. He was also assistant at Clinical Surgery III Institute of Milan University (1986), and
at Plastic Surgery Chair (directed by Prof. L. Donati) of the same University (1987). Professor Marco
Klinger was Clinical fellow from 1984 to 1985 at Harvard Medical School in Boston. In the summer of
1997, finally, he has done a holiday study fellow at Manuel Gea Gonzales Hospital in Mexico City.
Clinical activity at Plastic Surgery Unit of Humanitas Clinical Institute is based on skin cancer treatment,
breast reconstruction, aestethic surgery, dimorphism and malformation correction, scar treatment, post
bariatric surgery. Now at Plastic Surgery Unit of Humanitas Clinical Institute he has conducted researches
on tuberous breast and in collaboration with other Plastic Surgery Units in Italy he has conducted a
multicentric research study on infections of surgical wounds and on autologous fat graft in scars.
W.P. Andrew Lee, MD
The Milton T. Edgerton, MD, Professor and Chairman, Department of Plastic and Reconstructive
Surgery, Johns Hopkins University School of Medicine
W. P. Andrew Lee, M.D. is the Milton T. Edgerton, MD, Professor and Chairman of Department of
Plastic and Reconstructive Surgery at the Johns Hopkins University School of Medicine. A hand surgeon
and basic science researcher, he has conducted investigation on tolerance strategy for vascularized
composite allografts, such as hand or face transplants, to ameliorate the need for long-term systemic
immunosuppression. He established multi-disciplinary programs for hand transplantation at University
of Pittsburgh and Johns Hopkins using an immunomodulatory protocol based upon findings in his
laboratory. He led the surgical team that performed the first bilateral hand transplant (2009) and the first
above-elbow transplant (2010) in the U.S. A salient feature of the protocol is single-agent (monotherapy)
immunosuppression that minimizes the risks of hand transplantation.
Dr. Lee served as the Chair of the American Board of Plastic Surgery (2012-13) and the President of the
American Society for Surgery of the Hand (2011-12). In 2008 he helped to found the American Society
for Reconstructive Transplantation, for which he now serves as the President-Elect. He was elected the
Chairman of Plastic Surgery Research Council in 2002 and President of the Robert H. Ivy Society of
Plastic Surgeons in 2010-11. Dr. Lee has received more than 70 awards and honors, including the Kappa
Delta Award from the American Academy of Orthopaedic Surgeons, and Sumner Koch Award and
Sterling Bunnell Traveling Fellowship from the American Society for Surgery of the Hand.
Dr. Lee has mentored more than 70 pre-doctoral and post-doctoral researchers in over two decades, and
has authored over 150 original publications in peer-reviewed journal and 40 textbook chapters on hand
surgery and composite tissue transplant subjects. He served on the editorial boards of Transplantation and
Journal of Surgical Research, and has been an invited speaker or visiting professor in more than 40
institutions around the world. The book co-edited by him, Transplantation of Composite Tissue
Allografts, was published by Springer in 2008.
An honors graduate in physics from Harvard College, Dr. Lee received his medical degree from Johns
Hopkins University School of Medicine, where he also completed his general surgery residency and
microvascular research fellowship. He completed his plastic surgery fellowship at the Massachusetts
General Hospital and his orthopedic hand fellowship at the Indiana Hand Center. In 1993 he joined the
plastic surgery faculty at Massachusetts General Hospital, Harvard Medical School, and became director
of the Plastic Surgery Research Laboratory and subsequently chief of hand service in Department of
Surgery. In 2002 Dr. Lee was recruited to the University of Pittsburgh, where he served as Division
Chief of Plastic Surgery. He became the inaugural Chair of the Department of Plastic and Reconstructive
Surgery at Johns Hopkins in 2010.
Kyle Eberlin, MD
Attending Plastic and Reconstructive Surgeon, Massachusetts General Hospital, Harvard Medical School
Dr. Kyle Eberlin grew up in Buffalo, NY and completed his undergraduate and medical school education
in the Seven Year Accelerated Medical Program at Boston University. He trained in the Harvard
Integrated Plastic Surgery Residency Program and recently completed an Orthopaedic Hand Surgery
fellowship at Massachusetts General Hospital in July of 2014. Dr. Eberlin has published more than 20
peer-reviewed scientific articles and has authored numerous book chapters. He is an active reviewer for
the journals Plastic and Reconstructive Surgery, Hand, the Journal of Reconstructive Microsurgery, and
for the Journal of Plastic Surgery and Hand Surgery. He has joined the faculty in plastic surgery at MGH
where his practice will focus on hand and reconstructive microsurgery.
David. A. Leonard, MD
Post-Doctoral Research Fellow, Vascularized Composite Allotransplantation Laboratory, Transplantation
Biology Research Center, Massachusetts General Hospital
Dr. Leonard has been a post-doctoral research fellow in the Vascularized Composite Allotransplantation
Laboratory at the Massachusetts General Hospital Transplantation Biology Research Center since 2010.
He holds concurrent enrolment as a graduate student at the University of Manchester, UK, as part of a
collaborative study into the induction of immunologic tolerance for vascularized composite
allotransplantation through establishment of stable hematopoietic mixed chimerism, on which he has
recently submitted his thesis for the degree of PhD.
Following graduation from medical school at the University of Glasgow in 2006, where he also studied
molecular and cellular biology and undertook Wolfson Institute funded research into regulation of the
non-canonical Wnt pathway, Dr. Leonard entered clinical residency in Belfast, Northern Ireland,
completing foundation and then core surgical training, in preparation for specialty surgical training in
plastic and reconstructive surgery. He attained membership of the Royal College of Surgeons in 2009. He
intends to return to clinical training following completion of his PhD studies.
In addition to investigating the immunologic mechanisms operational in induction of vascularized
composite allograft tolerance, Dr. Leonard has contributed to development and pre-clinical testing of
tolerance protocols in preparation for clinical translation, and investigation of genetically modified
porcine skin as an alternative to allograft skin in the acute management of large burns.
Curtis Cetrulo, MD
Surgeon, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Shriners
Hospitals for Children, Senior Investigator and Head of Allotransplantation Laboratory, Transplantation
Biology research Center, Massachusetts General Hospital
Dr. Curtis L. Cetrulo, Jr., is the Senior Investigator and Head of Vascularized Composite Tissue
Allotransplantation Laboratory at the Transplantation Biology Research Center, Massachusetts General
Hospital. He graduated from Stanford University in 1992 and Tufts University School of Medicine in
1999. Following completion of plastic surgery residency training, Dr. Cetrulo practiced reconstructive
microsurgery and hand surgery at the University of Southern California Medical Center and the Shriners
Hospital for Children – Los Angeles where he performed pediatric reconstructive microsurgery, burn
reconstruction, cleft lip and palate surgery, and pediatric hand surgery. In 2009, Dr. Cetrulo joined the
Division of Plastic and Reconstructive Surgery of the Massachusetts General Hospital and the staff of the
Shriners Hospital for Children – Boston. His laboratory is investigating tolerance induction strategies for
vascularized composite tissue allografts (VCA) in the immunogenetically-defined MGH miniature swine
model. Current research efforts are directed toward use of mixed hematopoietic chimerism to induce
transplantation tolerance to VCA and toward exploring the immunologic mechanisms involved in
tolerance and rejection of the skin component of VCA.
Joseph P. Vacanti, MD
John Homans Professor of Surgery, Harvard Medical School, Chief, Department of Pediatric Surgery,
Massachusetts General Hospital (MGH), Surgeon-in-Chief, MassGeneral Hospital for Children, CoDirector, Center for Regenerative Medicine, MGH, Director, Laboratory for Tissue Engineering and
Organ Fabrication, MGH, Chief, Pediatric Transplantation, MGH
Dr. Joseph Vacanti received his Bachelor of Science, summa cum laude, from Creighton University in
1970 and graduated first in his class. He received his MD, with high distinction, from University of
Nebraska College of Medicine, and an MS from Harvard Medical School. He trained in General Surgery
at the Massachusetts General Hospital, in Pediatric Surgery at Children’s Hospital, Boston, and
Transplantation at the University of Pittsburgh. Dr. Vacanti has held academic appointments at Harvard
Medical School since 1974. He has authored over 320 original reports, 69 book chapters, 54 reviews, and
over 473 abstracts. He has 81 patents or
patents pending in the United States, Canada, Europe, and Japan. To further the field of tissue engineering
and regenerative medicine, Dr. Vacanti was a founding copresident of the Tissue Engineering Society,
now named the Tissue Engineering Regenerative Medicine International Society (TERMIS). It currently
has 4000 active members from 80 countries worldwide. He
also was founding senior editor of the journal “Tissue Engineering.” It currently serves all of the members
of TERMIS, 1700 libraries in 20 countries, and is provided free online to 106 developing nations. It has
over 250,000 full text downloads and 500,000 abstract downloads per year with an impact factor of
approximately 4.5 Awards include: The James Bartlett Brown Award from the Society of Plastic and
Reconstructive Surgery and The Clemson Award from the Society for Biomaterials. In addition, he was
elected in 2001 to the Institute of Medicine of the National Academy of Sciences. In 2007, the Board of
Directors of City Trusts acting for the City of Philadelphia awarded Dr. Vacanti the John Scott Medal.
The John Scott Award is given to “the most deserving” men and women whose inventions have
contributed in some outstanding way to the “comfort, welfare and happiness” of mankind and has been
awarded in memory of
Benjamin Franklin since 1822. Previous recipients include Marie Curie, the Wright Brothers, Thomas
Edison and Jonas Salk. He has also received The American Surgical Association’s Flance-Karl Award
and The 2013 William E. Ladd Medal, the highest honor awarded by the Surgical Section of the
American Academy of Pediatrics to a pediatric surgeon.
Joshua Tam, PhD
Instructor in Dermatology, Harvard Medical School, Assistant in Biomedical Engineering, Wellman
Center for Photomedicine, Massachusetts General Hospital
Joshua Tam, PhD is an Instructor in Dermatology at the Wellman Center for Photomedicine,
Massachusetts General Hospital. He received his Ph.D. in Biomedical Engineering in 2009 from the
Harvard-MIT division of Health Sciences and Technology, where he studied the role of angiogenesis in
adipose tissue development. After graduation he joined the laboratory of Rox Anderson, M.D., at the
Wellman Center, and since then has focused his research efforts on developing new technologies to
improve skin wound healing.
R. Rox Anderson, M.D.
Director, Wellman Center for Photomedicine, Massachusetts General Hospital; Professor of
Dermatology, Harvard Medical School
Dr. Anderson graduated from MIT, and then received his MD degree magna cum laude from the joint
MIT-Harvard medical program, Health Sciences and Technology. After completing his dermatology
residency and an NIH research fellowship at Harvard, he joined the faculty where he is now Harvard
Medical School Professor in dermatology, Director of the Wellman Center for Photomedicine; and
adjunct Professor of Health Sciences and Technology at MIT. Dr. Anderson conceived and developed
many of the non-scarring laser treatments now widely used in medical care. These include treatments for
birthmarks, microvascular and pigmented lesions, tattoo and permanent hair removal. He has also
contributed to treatment for vocal cords, kidney stones, glaucoma, heart disease, photodynamic therapy
for cancer and acne, optical diagnostics and non-invasive fat removal. He co-invented fractional laser
treatment, which is useful for improving burn scars, and recently developed a new strategy for epidermal
grafting of wounds. His research has advanced the basic knowledge of human skin photobiology, drug
photosensitization mechanisms, tissue optics, and laser-tissue interactions. In addition to research at the
Wellman Center, Dr. Anderson practices dermatology at Massachusetts General Hospital and teaches at
Harvard and MIT. Active research includes diagnostic tissue imaging and spectroscopy, photodynamic
therapy, mechanisms of selective laser-tissue interactions, adipose tissue biology and novel therapy for
skin disorders. Dr. Anderson has been awarded over 60 national and international patents, and has coauthored over 250 scientific books and papers.
Winthrop Professor Fiona M. Wood, FRACS AM
Director of the Burns Service of Western Australia, Director of the Burn Injury Research Unit UWA
Professor Fiona Wood is a plastic and reconstructive surgeon specialising in acute burn care and scar
reconstruction. She is the Director of the Burn Service of Western Australia, Consultant at
Royal Perth Hospital and Princess Margaret Hospital in Perth, the Cofounder and Director of AVITA
Medical (formally Clinical Cell Culture {C3})and Co‐founder and Chair of the McComb Foundation.
Through the McComb Foundation (which she co‐founded with scientist
Marie Stoner), Fiona aims to conduct further research into tissue repair, regeneration and reconstruction
with the aim of improving patient quality of life and return to pre‐injury condition. In 2002, the world
media profiled Fiona and her team’s tireless work on burns victims of the Bali bombings ‐ especially
bringing positive recognition for her revolutionary spray‐on skin cell technique which was used
successfully, along with the holistic multidisciplinary burn care. Fiona was the recipient of an Order of
Australia Medal for her work with Bali bombing victims. On 16th February 2004 Fiona Wood accepted
her conferment as Clinical Professor with the School of Paediatrics and Child Health at the University of
Western Australia. On 2nd October 2008 Fiona Wood was offered the position of Professor (Burns Injury
Research Unit) at the School of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of
Western Australia. Fiona was named West Australian of the Year in 2004, and was nominated as a
National Living Treasure and Australian Citizen of the Year in 2004. Fiona was again named West
Australian of the Year in 2005, and also received the honour of being named Australian of the Year for
2005. In 2005, Fiona (along with Marie Stoner) also won the 2005 Clunies Ross Award for their
contributions to Medical Science in Australia. In 2008, Fiona was voted Australia’s Most Trusted Person
in the annual Reader’s Digest survey for the fourth consecutive year. She said that trust is a core value
important in all situations from small to massive as it influences performance and outcomes. “I believe we
could live in a society dependent on the integrity of each individual rather than the intellect of a few‐ trust
is central to that concept,” Fiona said. “On a personal level this acknowledgment is overwhelming and all
I can do is try to do my best.”
Lisa Gfrerer, MD, BA
Research Fellow. Massachusetts General Hospital
Dr. Gfrerer obtained an MD and degree in public health at the Medical University of Vienna. She
completed her PhD thesis at the Harvard Center for Regenerative Medicine. Her research focused on the
genetic background of common cleft lip and palate and oblique orofacial clefting. In addition to her basic
science endeavors, she completed a clinical research fellowship in plastic and reconstructive surgery
outcomes at the Massachusetts General hospital. She is currently completing a postdoctoral translational
research fellowship at the Austen Plastic Surgery Innovation Group at the Massachusetts General
Hospital. Dr. Gfrerer is applying her basic and clinical science expertise to translational research projects
aimed at innovative solutions for common problems encountered in plastic and reconstructive surgery. In
particular, she is developing and studying novel methods for scar and skin rejuvenation. One such method
of mechanical fraction ablation appears to hold great promise and is currently in clinical trials. She has
won numerous awards for her research including the prestigious Austrian DOC award and the Shenaq
international research price by the Plastic Surgery Research council. She has authored numerous peerreviewed publications.
Pr. Fabienne Braye, MD, PhD
Professor of Plastic Surgery, Claude Bernard Lyon University, Head of the Plastic and Reconstructive
Surgery Unit of Hospices Civils de Lyon
Pr Fabienne BRAYE, is a Plastic Surgeon. She works in Lyon, second bigger town of France, as a
Professor of Plastic Surgery in Claude Bernard Lyon 1 University, and as the Head of the Plastic and
Reconstructive Surgery Unit of Hospices Civils de Lyon. In the field of burns, since 1995, she is
responsible of local care and surgical treatment into a 20-bed Unit, which will increase up to 30 beds in
2016. Burn reconstruction is her main field of interest. Her research activities take place in Lyon Skin
Substitutes Laboratory (Dr Damour) which is involved in therapeutics (cultured epidermis, artificial
dermis), and in fundamental research (living skin equivalent, adipose tissue derived stem cells). She has a
special interest for clinical applications of all kind of skin substitutes in the field of reconstructive surgery
and burns. She is the regional co-ordinator for Plastic Surgery education, and is strongly implicated in the
education of young physicians and para-medicals. She created a “Burns” diploma. Fabienne Braye and
her colleagues will have the honor to welcome you in Lyon, France, for the 2015 European Club for
Pediatric Burns Workshop.
Herbert Haller, MD
Trauma Intensive Care Specialist, Sport Orthopedics Specialist, Unfallkrankenhaus Linz, Austria
Dr. Haller was birn in 1952 and attended school in Linz. He graduated from the medical university, Karl
Franzens Universitat in Graz in 1977 and worked as a general practitioner until 1984 when he began work
in burn care at Unfallkrankenhaus in Linz. He was a specialist in trauma Surgery in 1989 and Senior
Surgeon working in trauma and burns in 1994. He built the new Burns Unit, the Zentrum fur
Schwerbrandverletze, at the trauma Hospital Berlin as Medical Director from 1997 – 2000, which is today
the largest unit in Germany for adults and children together with the Childrens Hospital Lindenhof. In
200 he returned to the Unfallkrankenhaus in Linz, Austria as a senior surgeon working in trauma and
burns. In 2011 he was a specialist in intensive care in trauma and a specialist in sport orthopedics. He
was President of the Austrian Society for Disaster and Emergency Medicine and has memberships in the
ISBI, EBA, The Europen Shock Society, the Austrian Society of Trauma Surgeons among others. He is
married with three children.
Notes