Cornelis J. Hoogewerf

Impact of facial burns: relationship between depressive symptoms, self-esteem and scar severity ☆ ☆☆

OBJECTIVE This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. METHOD A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale, the Rosenberg Self-esteem Scale and the Hospital Anxiety and Depression Scale. Structural Equation Modeling was used to assess the relations between depressive symptoms, self-esteem and scar severity. RESULTS The model showed that patient-rated facial scar severity was not predictive for self-esteem and depressive symptoms six months post-burn. There was, however, a significant relationship between early depressive symptoms and both patient-rated facial scar severity and subsequent self-esteem. The variables in the model accounted for 37% of the variance in depressive symptoms six months post-burn and the model provided a moderately well-fitting representation of the data. CONCLUSION The study suggests that self-esteem and depressive symptoms were not affected by self-reported facial scar severity but that earlier depressive symptoms were indicative for a more severe self-reported facial scar rating. Therefore, routine psychological screening during hospitalisation is recommended in order to identify patients at risk and to optimise their treatment.

Burns to the head and neck: Epidemiology and predictors of surgery

BACKGROUND The face is a frequent site of burn, but prevalence rates vary and reports are often limited to one healthcare setting. We examined the incidence of facial burns in the Netherlands in Emergency Departments (ED), hospitals and burn centres. Additionally, we identified which patient, injury and burn-related characteristics were predictors of facial burns, facial surgery and facial reconstruction in burn centres. METHODS A retrospective, observational study was conducted including data from the Dutch Injury Surveillance System, the National Hospital Discharge Register and burn centres in a 5-year period (2003-2007). RESULTS Facial burn incidences per 100,000 were 15.1 for ED visits, 1.3 for hospital admissions and 1.4 for burn centre admissions. A total of 2691 patients were admitted to Dutch burn centres; 47.5% (n=1277) had facial burns of which 20.5% received primary facial surgery and 5.3% received facial reconstruction in follow-up. Predictors of facial burns and facial surgery were identified. Predictors of facial reconstructive surgery were burns to the neck (ventral), fire/flame burns and number of facial surgeries in the acute phase of the burn. CONCLUSIONS One in five patients with facial burns admitted to a Dutch burn centre received primary facial surgery and 1 in 20 received facial reconstructive surgery within a follow-up of minimum 2 years.

Reconstructive surgery after burns: a 10-year follow-up study.

BACKGROUND There is minimal insight into the prevalence of reconstructive surgery after burns. The objective of this study was to analyse the prevalence, predictors, indications, techniques and medical costs of reconstructive surgery after burns. METHODS A retrospective cohort study was conducted in the three Dutch burn centres. Patients with acute burns, admitted from January 1998 until December 2001, were included. Data on patient and injury characteristics and reconstructive surgery details were collected in a 10-year follow-up period. RESULTS In 13.0% (n=229/1768) of the patients with burns, reconstructive surgery was performed during the 10-year follow-up period. Mean number of reconstructive procedure per patient were 3.6 (range 1-25). Frequently reconstructed locations were hands and head/neck. The most important indication was scar contracture and the most applied technique was release plus random flaps/skin grafting. Mean medical costs of reconstructive surgery per patient over 10-years were €8342. CONCLUSIONS With this study we elucidated the reconstructive needs of patients after burns. The data presented can be used as reference in future studies that aim to improve scar quality of burns and decrease the need for reconstructive surgery.

Early excision and grafting for burns

Background: Burn injuries are an important health problem. The functional and cosmetic

The official update of the POSAS: An invitation to share experiences to improve the POSAS in ‘Project POSAS 3.0’

available at the referring country are all considerations that need to be thoroughly acknowledged. For instance, we found useful to know that the cabin cruising altitude, of between 4000 and 8000ft., leads to a reduction in ambient pressure with a resulting reduction in blood oxygen saturation of about 10% that creates mild hypoxia [2]. Additionally, the low relative humidity (RH) in the cabin, between 10 and 20% (ideal RH: 50%). While is not an issue in healthy passengers, where no central dehydration or changes in plasma osmolality have been reported, in our burn population instead this could be a potential negative contributor, leading to a greater demand for fluids. Moreover, it has been shown that in a long-haul flight (over 4h), the risk of venous thrombosis is doubled [3]. This could be significant for our patients, as it is well known that they are more prone to the development of venous thrombosis. If concerns arise in respect of their contagiousness, although the airflow in the cabin is filtered and laminar; however, cross infection is possible. Therefore, we should carefully consider the infectious status of our patients.

O19.5 Epidemiology of facial burns in the Netherlands

Methods: Consecutive patients admitted to five burn centres completed the Burns Itch Questionnaire (BIQ) at 3 months post burn. This is a 20-item questionnaire inquiring after intensity and occurrence of itching complaints, and impact on daily life. Items are scored on a 10-point Likert scale (0 = “no itch” to 9 = “most severe itch”). We collected additional data regarding demographic and injury characteristics. Results: We obtained data for 167 persons. Patients were on average 40 years old, 19% was female. Mean TBSA was 13%. Eighty-eight patients (53%) had itch complaints. Ninety percent of the patients with itch complaints reported itch in superficial burn surface areas, 47% of the patients had (also) itching in grafted areas, and 33% reported itching of donor sites. Itching had the highest intensity in grafted burns. Overall itch and itch frequency were negatively correlated with age. Conclusion: Itching complaints are most frequent in superficial burn injury, but the highest intensity of itching is reported in grafted areas.