Acid throwing (vitriolage) is a form of violent assault. It is described as an act of throwing acid or corrosives on the body of a person with the intention of injuring or disfiguring them. It is a crime like no other and represents the amalgamation of social evils like patriarchy, gender bias, disdain for the laws of the land, and individual deficiencies like jealousy, anger and sexism. Its incidence has increased over the years and it is soundly entrenched in our society. On the brighter side, surgical care has improved, laws have evolved and, most importantly, society is now aware and is playing an active role against this sacrilege. This study intends to analyze the various aspects of vitriolage in the Indian context, i.e. the extent of the problem, how it affects more than one life, and how the laws have evolved to protect the victims. Secondly, the challenges encountered, from the point of view of a health care worker, specifically a Burns/Reconstructive surgeon, are addressed. It is an attempt to bring on board issues that are medical, ad ministrative or legal and are intricately connected with care and support of victims and survivors of vitriolage. The specific questions discussed in this study are related to the dilemmas faced by the medical community/healthcare institutions while dealing with patients of vitriolage and how the laws have evolved over a period of time.

Experimental studies have shown that the effects of stromal vascular fractions and platelet-rich plasma on deep dermal burn healing were encouraging. By measuring the blood level of platelet-derived growth factor (PDGF)-BB, we evaluated their effect on full-thickness burns in this study. Forty-eight Wistar rats were separated into four main groups: group A rats were administered combined SVF and PRP injections, group B rats were topically administered Vaseline, group C rats were administered placebo injections, and group D rats were without burns. Depending on the day of euthanasia, these groups were further divided into subgroups (8th hour, 4th day, 7th day, 14th day, and 21st day). Using enzyme-linked immunosorbent assay, the serum level of platelet-derived growth factor-BB was determined. Friedman’s test or the analysis of variance test was applied, and p-values under 0.05 were regarded as significant. The PRP+SVFs group had the highest mean PDGF-BB levels overall on days 4, 7, 14 and 21 (1.81±1.04 pg/ml, 1.24±0.41 pg/ml, 2.21±0.60 pg/ml, and 3.10±1.02 pg/ml, respectively). The repeated ANOVA test (Mauchly’s test of sphericity) resulted in a p-value of 0.556 (>0.05), indicating that the variance of the PDGF-BB data was the same. Additionally, a p-value of 0.001 demonstrated a significant difference in the levels of PDGF-BB between the groups. Overall, the mean PDGF-BB level by day differed significantly between the PRP+SVFs group and the Vaseline group, the negative control group, and the group of healthy rats.

Burns and burn-related injuries are among the most common causes of morbidity and mortality worldwide. Research has shown that serum albumin levels can predict the burned patient’s condition. Considering the limited studies and conflicting results regarding serum albumin levels around the time of skin grafting surgery in burn patients and its effect on the patient’s recovery process, conducting a study in this field seems necessary. Thus, this study aimed to determine the relationship between serum albumin level and the severity and total body surface area (TBSA) of burns in patients before and after skin grafting surgery. This cross-sectional and correlational descriptive study evaluated 160 patients hospitalized in the burn department of Imam Khomeini Hospital in Urmia who were candidates for skin graft surgery. Serum albumin levels were measured before and after surgery, and basic information such as age and sex, severity and TBSA were collected and analyzed using SPSS version 22 software. The mean age of the patients was 39.16±12.68, and 57% were men. Fire was the most common cause of burns. The serum albumin level in patients with second-degree burns was significantly higher than in patients with third-degree burns before and after surgery. Also, serum albumin level had a negative and significant correlation with burn severity. Serum albumin level significantly correlates with the severity and TBSA of burns before and after surgery. Thus, serum albumin level can be considered a suitable indicator for predicting the patient’s condition and the severity of trauma.

La résistance aux antibiotiques est un défi croissant en santé publique, notamment chez les entérobactéries et Pseudomonas æruginosa. Dans cette étude, menée dans un CTB en Tunisie, nous avons collecté 307 souches non redondantes d’entérobactéries chez des patients hospitalisés en majorité dans le service de réanimation de brulés (59%) dont les principales espèces identifiées étaient Klebsiella pneumoniæ (34,8%). Nous avons évalué l’efficacité de deux antibiotiques, ceftazidime- avibactam (CZA) et ceftolozane- tazobactam (CT). Les résultats ont montré que la résistance globale à CZA était de 11,7%, tandis que celle à CT était de 25,7%. CZA s’est avéré être la deuxième molécule la plus efficace parmi l’ensemble des antibiotiques testés, après la fosfomycine. Parmi les souches résistantes aux céphalosporines de troisième génération, 73,3% étaient sensibles à CZA, et 41,5% à CT. Parmi les soixante-dix-neuf souches CT-R, huit avaient un phénotype BLSE, vingt-deux « céphalosporinase à haut niveau ». Trente-trois étaient porteuses de blaNDM, douze étaient porteuses de blaOXA48, et quatre étaient porteuses à la fois de blaNDM et de blaOXA48. Les métallo- carbapénémases blaNDM étaient les plus fréquentes. En ce qui concerne Pseudomonas æruginosa (n=161), la résistance à CZA était de 42,2%, et celle à CT de 47,8%. Ces antibiotiques se sont classés respectivement en deuxième et troisième place des bêta-lactamines les plus actives après l’aztréonam. Parmi les 71 souches de P. æruginosa résistantes à la fois à CZA et aux carbapénèmes, 54,1% étaient productrices de carbapénémase type VIM2. La résistance aux entérobactéries à CZA et CT est relativement élevée dans notre étude. CZA reste cependant une thérapie de sauvetage pour les infections causées par des organismes résistants aux carbapénèmes, et son usage ne doit être envisagé qu’après documentation et en absence d’autres alternatives parmi les β lactamines.

Upper gastrointestinal bleeding (UGIB) is a rare complication of the ICU stay. Our objective was to study the epidemiological, clinical manifestations, and evolutionary characteristics of UGIB, and identify its risk factors in severely burned patients. This is a retrospective case-control study of burned patients in the ICU in Tunisia over a period of 6 years, including all adult patients with severe burns who presented at least one episode of gastrointestinal bleeding. The control group consisted of severely burned patients with no gastrointestinal bleeding during their ICU stay. The two groups were matched according to age, gender and extent of burns. The incidence of gastrointestinal bleeding was 2.3% with an average time of onset of 19±17 days. Esophagogastroduodenoscopy was performed in 45 patients showing bulbar ulcer, gastric ulcer, and oesophageal ulcerations in respectively 28, 8 and 3 patients. In the multivariate study, acute kidney injury (OR 13.8, CI [2.9-67], p=0.001), fluid intake <2 ml/kg/%TBSA over the first 24h (OR 10, IC [1.5-68.5], p=0.019), and length of ICU stay >10 days (OR 48.2, IC [4.4-530], p=0.002) were independent risk factors for the occurrence of gastrointestinal bleeding. Mortality in the UGIB group was higher (55.8% vs 25%, p=0.001). Upper gastrointestinal bleeding is a serious complication of a burn patient’s ICU stay. Acute renal failure, low fluid intake in the first 24h, and a long duration of ICU stay were independent risk factors for its occurrence.

Survival outcome of burn patients is increasingly higher with early excision and grafting. The problem after excisional debridement is the need for a skin graft or a temporary dressing. By using an amniotic membrane, which is a biological waste, we can limit the use of auto-skin grafts. A preliminary prospective study was conducted on adult patients with no other comorbidities admitted to dr. Cipto Mangunkusumo Hospital Jakarta Burn Unit between 2021– 2022. Patients were divided into three groups, treated with early excision and skin grafting, the amnion bilayer dressing or amniotic bilayer dressings co-cultured with keratinocytes and human amniotic epithelial stem cells (hAESC). The patients were then followed up for two weeks and the resulting epithelization in each group was analyzed, including a skin biopsy for confirmation of the epidermal layer thickness. A total of six patients, two in each group, were included in the study. The amniotic bilayer dressings co-cultured with keratinocytes and stem cell group has a rapid rate of epithelization (10% / day) compared to the early excision and skin grafting and amnion bilayer group (7.14% / day). It also has the thickest epidermal layer (95.7µm - range: 67.4-124.02 µm) and the highest histological score (7.00) at two weeks follow-up. This preliminary study concluded that amniotic bilayer dressings co-cultured with keratinocytes and stem cells had an overall better outcome regarding epithelization rate, suggesting that further study is necessary to evaluate amniotic bilayer dressings co-cultured with keratinocytes and stem cell use in burn patients.

Bloodstream and catheter-related infections frequently occur in patients with burns. Thus, it is important to correctly assess and manage them. This study aimed to investigate the effects of catheter types used in patients with major burns on bloodstream infections and to predict sepsis status and manage its prognosis using a procalcitonin biomarker. The study included 34 patients who were admitted to the burn intensive care unit. These patients were classified into two groups based on whether they used peripheral or central venous catheter. The procalcitonin, thrombocyte and leukocyte levels of the patients were assessed every other day for 4 weeks, starting from the day when they were admitted to the burn center. An intergroup comparison revealed that procalcitonin levels were lower in the peripheral catheter group than in the central venous catheter group after day 10. Furthermore, the procalcitonin levels were significantly lower in the peripheral catheter group than in the central venous catheter group, especially on days 19, 21 and 24 (p 0.05). It is important to consider using peripheral venous catheters instead of central venous catheters in patients with major burns in order to mitigate the risk of catheter-related infections. Monitoring patients based on procalcitonin levels every other day, changing catheters, and administering antibiotic therapy based on changes in procalcitonin levels in patients likely to have elevated procalcitonin levels may reduce unnecessary antibiotic exposure and associated costs to the healthcare system.

Keloid is a benign dermal condition that occurs due to excessive activation of fibroblasts, which leads to an abnormal accumulation of collagen. There are several treatment options, but none have been satisfactory or optimal. Often, combined treatments are used due to its high recurrence rate after surgical excision alone. The aim of this study is to evaluate the efficacy of adjuvant radiotherapy after surgical excision. A retrospective study was performed including patients with keloid scars who underwent surgical excision and adjuvant radiotherapy between May 2016 and March 2020. The data was collected from the radiotherapy and plastic surgery medical charts. There were 13 patients identified. The patient and observer scar assessment scale (POSAS) was performed in all 13 patients. The treatment used was surgical excision of the scar associated with 9 Gy radiotherapy dose within the first 24 hours after the surgery, plus another session after 7 days. 13 patients and 16 keloid scars were evaluated during a mean follow-up period of 13,5 months 95%CI (5,84; 21,16). There was no major adverse event from the treatment used. According to POSAS, the overall satisfaction rate was significantly good (mean of 2,29 on a scale from 1 to 10). Only one recurrence was observed (6.25%). Keloids are difficult to treat due to their high recurrence rate. There is no consent about the best treatment. This study showed that surgical excision combined with adjuvant radiotherapy is an excellent option, even for refractory keloids. The aesthetical result was satisfactory and the recurrence rate was low.

Loss of substance is the second most common reason, after burns, for which plastic surgeons are called to the emergency room in our context. Although not very frequent, loss of substance in the dorsal skin of the fingers has certain characteristics and remains complex. There are numerous coverage techniques available using local and locoregional flaps and their dissection requires a good knowledge of the dorsal vascularization of the fingers and hand. This review article is the result of the experience of the team of reconstructive, plastic, aesthetic and burn surgery of the University Hospital of Tangier - Tetouan - Al Hoceima with this type of lesion in a patient treated by the abdominal flap.

Le lambeau delto-pectoral (LDP), après avoir été largement utilisé pour la reconstruction cervicale après brûlure, est maintenant supplanté par d’autres techniques si bien qu’il est relégué dans l’histoire de la chirurgie. Nous avons toutefois décrit l’utilisation de ce lambeau dans un précédent article. Nous en présentons ici une variante, dans la même indication posée chez 3 patients : le lambeau perforant mammaire interne expansé (pre expanded internal mammary artery perforator - IMAP). Il se caractérise par sa simplicité et sa fiabilité, son principal avantage étant l’expansion préalable. Les autres sont la qualité de la palette cutanée, l’autonomisation distale du lambeau, la faible morbidité au site donneur et l’absence de nécessité de sevrage secondaire du lambeau. Il représente une bonne indication dans la reconstruction cervicale, en particulier en cas de bride verticale.

Les ruptures du tendon rotulien avec perte de substance importante sont rares et leur traitement peu codifié. Leur prise en charge doit répondre à un double enjeu : reconstruction tendineuse et couverture cutanée dans le même temps. Quelle que soit la technique choisie, les facteurs de bonne récupération fonctionnelle à distance semblent être la précocité de la réparation et l’utilisation de tissu autologue. Nous rapportons le cas d’une patiente de 36 ans qui a subi un purpura fulminans compliquant une angine streptococcique dans le cadre d’une prise d’anti inflammatoire non stéroïdien. Le tableau a été compliqué de nécroses extensives des extrémités requérant une quadri amputation dont trans fémorale à gauche et trans tibiale à droite. Pour des raisons fonctionnelles et d’appareillage secondaire il était impératif de conserver le genou droit, malgré l’exposition de tout l’appareil extenseur avec vitalité osseuse précaire de la rotule et nécrose du tendon rotulien. L’objectif thérapeutique était de couvrir tout l’appareil extenseur et de reconstruire le tendon rotulien en associant bandelette du tractus iliotibial homolatéral et lambeau pédiculé de gastrocnémien médial. A six mois de suivi, la flexion et l’extension active du genou autorisent la marche sous couvert d’un appareillage adapté sans béquilles.

Necrotizing fasciitis (NF) is a rare and potentially fatal infection of the soft tissues characterized by widespread fascial necrosis and rapid evolution. Diagnosis is often difficult and relies on a high index of suspicion. The approach to this disease requires a timely diagnosis, early antibiotic therapy, aggressive surgical debridement, and reconstructive procedures. All patients treated by the Plastic Surgery department with the diagnosis of NF between 2006-2019 were identified. A retrospective study was conducted with the treatment of patients’ demographic and clinical data. Sixty patients with NF who underwent surgical procedures by Plastic Surgery, such as debridement and reconstruction with grafts and flaps, were identified. Up to a third of patients died from complications directly related to the disease. There was 40% complication rate. The average hospital stay was 34.5 days. Plastic surgeons often collaborate in the management of these patients and must recognize the clinical signs early. Early multidisciplinary collaboration is important. The establishment of supportive measures, antibiotics and early surgical debridements are the key to the treatment of this disease.