Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 years, Integra has grown by building upon this core regenerative medicine technology around multiple market segments meeting the unique clinical needs of its target customers. Integra is headquartered in Plainsboro New Jersey. Integra • 311 Enterprise Drive, Plainsboro, NJ 08536 www.integralife.com Tom Tarca, VP, International – RegenerativeMarketing; Extremity Reconstruction 609-936-2317 office • 609-750-4277 fax [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 commitment is to optimize product performance and patient outcomes while ensuring patient safety. The Lumenis UltraPulse laser has been proven to improve the structure, increase range of motion and appearance of the skin. Combine UltraPulse therapy with the LightSheer Infinity, M22 multi-technology platform or QX-Max to treat pigment and vascular conditions. 2033 Gateway Place, Suite 200 San Jose, CA 95110 Tel: (408)764-3235 Fax: (408)764-3695 www.lumenis.com Lumenis is the Gold Sponsor of the 7th World Congress on Pediatric Burns 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. Bio Med Sciences, Inc. 7584 Morris Court, Suite 218 Allentown, PA 18106 1-800-257-4566 www.silon.com 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, worldwide clinical trials and have successfully gained FDA 510k and European CE standards for clinical use in burn wound diagnosis. The National Institute for Health and Care Excellence (NICE) in the UK now support and recommend the implementation of the moorLDI2-BI for clinical burn assessment. Visit the Moor Instruments stand to see our small, rapid laser Doppler burn assessment system (moorLDLS-BI) and find out more about arranging your free, no obligation on-site trial. We look forward to seeing you. Web: www.moorclinical.com 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 In response to the problem in wound care of trauma and pain during dressing changes, Mölnlycke Health Care developed a unique, patented, soft silicone technology for advanced wound care called Safetac®. Dressings with Safetac technology do not adhere to the moist wound bed yet adhere gently to the surrounding skin and therefore minimize trauma and pain at removal. Molnlycke Health Care US, LLC 5550 Peachtree parkway Suite 500 Norcross, GA 30092 Ph: 678-250-7900 Fax: 678-250-7984 Toll Free: 800.805.0585 www.molnlycke.us www.mhcwoundcare.com Syneron and Candela are the global leaders in the aesthetic medical device marketplace. We are one company with two distinctive brands. We combine a level of innovation, expertise and customer understanding superior to that of any company in our industry. Financial stability, through our aligned resources, allows our new company to offer customers the broadest available product portfolio, the best global service organization and an expansive worldwide distribution network. Together, we are more market responsive than ever before. We know how to quickly innovate the safest and most effective products to meet a variety of needs and price points. We are even stronger at anticipating future market trends to help support our customers and their patients. With new breakthrough technologies currently in the pipeline, we are ideally positioned to maintain our global leadership and continue to help you grow your practice. Syneron, Inc. 3 Goodyear, Unit A Irvine, CA 92618 866-259-6661 North America enquiries: [email protected] International enquiries: [email protected] Candela Corporation 530 Boston Post Road Wayland, Massachusetts, USA Tel: 508-358-7400 800-733-8550 (US) Fax: 508-358-5602 Sciton is a leading manufacturer and provider of superior laser and light based aesthetic solutions. Sciton systems are designed to grow with your practice. When the needs of your practice expand, you can upgrade your existing system with new and innovative modules allowing you to offer more treatment options. Stop by the Sciton booth to learn more. Roger's Piano began in 1980 and is now managed under the partnership of Roger Shaffer and Carol Wu. Roger's Piano provides a full range of piano services, from tuning to repairs and rebuilding. Roger's Piano is located at 12 Worcester Street, Natick, MA 01760. Visit http://www.rogers-piano.com for more information. 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 1 2 2 2 3 3 H.Haller , R. Hafner , M. Giretzlehner , J. Dirnberger , S. Thumfahrt , Chr. Ottomann ,; F. Sander , B. 3 4 5 6 6 Hartmann , M. Rapp , J. Kaartinen , D. Lumenta , LP. Kamolz , 1 2 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 4 5 6 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