Handbook of Burns Volume 2: Reconstruction and Rehabilitation

Preface
Contents
Part I: Psychological Aspects and Long Time Consequences
	1: Acute Stress Disorder and Post-traumatic Stress Disorder in Individuals Suffering from Burn Injury
		1.1	 Introduction
		1.2	 Definition and Symptoms
		1.3	 Prevalence
			1.3.1	 ASD
			1.3.2	 PTSD
		1.4	 Comorbidity
		1.5	 Risk Factors for the Development of Post-traumatic Stress
		1.6	 Assessment
			1.6.1	 ASD
			1.6.2	 PTSD
			1.6.3	 Assessment Considerations
				1.6.3.1	 Mental Status and Delirium
				1.6.3.2	 Pain
				1.6.3.3	 Time
		1.7	 Treatment
			1.7.1	 Initial Intervention
			1.7.2	 Cognitive-Behavioral Therapies
			1.7.3	 Other Psychosocial Interventions
			1.7.4	 Medication
		1.8	 Post-traumatic Growth
		1.9	 Summary and Conclusions
		References
	2: Long-Term Outcomes Following Burn Injuries
		2.1	 Introduction
		2.2	 The Biopsychosocial Model of Recovery
			2.2.1	 Pre-burn Emotional and Physical Health
			2.2.2	 Injury Characteristics
			2.2.3	 Coping
			2.2.4	 Emotional Distress
			2.2.5	 Post-traumatic Stress Disorder
			2.2.6	 Depression
			2.2.7	 Pain
			2.2.8	 Nonpharmacological Chronic Burn Pain Management
			2.2.9	 Sleep
			2.2.10	 Pruritus
			2.2.11	 Body Image
			2.2.12	 Return to Work
			2.2.13	 Return to School
		2.3	 Summary
		References
Part II: Skin Architecture and Burn Wound Healing
	3: Skin Architecture and Function
		3.1	 Skin Structure
		3.2	 Epidermis
		3.3	 Dermis
		3.4	 Hypodermis (Subcutaneous Fat, Panniculus Adiposus)
		3.5	 Skin (Stem) Cells: A Promising Source for Tissue Engineering and Regenerative Medicine?
		3.6	 Keratinocytes: Immune Competent Epithelial Cells
		3.7	 Melanocytes: Pigment Cells with Immune Properties
		3.8	 Merkel Cells: Essential for Light-Touch Responses
		3.9	 Dendritic Cells: Key Regulators of the Immune Response
		3.10	 Langerhans Cells: Required for Induction of Immunity and/or Tolerance?
		3.11	 Dermal Dendritic Cell Subsets: Possessors of Diverse Functions
		3.12	 Resident Skin T Cells: Important Mediators of Skin Homeostasis and Pathology
		3.13	 Dermal-Epidermal Junction: Laden with Multiple Functions
		References
	4: Burn Wound Healing: Pathophysiology
		4.1	 Introduction
		4.2	 Local Biological Events Occurring After Burns
			4.2.1	 Inflammation
			4.2.2	 Edema
			4.2.3	 Burn Wound Conversion
		4.3	 Evolution of the Burn Wound and Local Consequences of Burns
		4.4	 General Factors Influencing the Burn Wound Evolution
			4.4.1	 Types of Burns
			4.4.2	 The Systemic Response to Local Burns
			4.4.3	 Influence of Immediate Care on Burn Wounds
			4.4.4	 Pathophysiological Consequences of Choice of Strategies Concerning Burn Wound Healing
		4.5	 Conclusion
		References
Part III: Scar Assessment, Treatment and Rehabilitation
	5: Scar Assessment
		5.1	 Scar Assessment Tools
		5.2	 Scar Features
			5.2.1	 Clinimetrical Principles
		5.3	 Subjective Scar Assessment Scales
			5.3.1	 Importance of Different Scar Features on the General Impression
		5.4	 Objective Measurement Tools
			5.4.1	 Color
			5.4.2	 Thickness
			5.4.3	 Relief
			5.4.4	 Elasticity
		5.5	 Suction Methods
		5.6	 Pressure Methods
		5.7	 Torsion Methods
		5.8	 Tension Methods
			5.8.1	 Surface Area: Planimetry
		5.9	 Conclusion
		References
	6: Burn Scar Treatment
		6.1	 Physiological Scarring
		6.2	 Pathological Scarring
		6.3	 Scar Classification and Grading
		6.4	 Scar Treatment
			6.4.1	 Scar Prevention
			6.4.2	 Surgical Treatment Options
				6.4.2.1	 Surgery: Prevention
				6.4.2.2	 Surgery: Treatment
		6.5	 Dermal Substitutes
			6.5.1	 Bilayer Non-cellularized Dermal Regeneration Templates
			6.5.2	 Single-Layer Cellularized Dermal Regeneration Templates
		6.6	 Non-surgical Treatment Options
			6.6.1	 Adhesive Tapes
			6.6.2	 Pressure Garments
			6.6.3	 Silicone Gel Sheeting
			6.6.4	 Corticosteroids
			6.6.5	 Radiotherapy
			6.6.6	 Laser Therapy
			6.6.7	 Cryotherapy
			6.6.8	 5-Fluorouracil
			6.6.9	 Interferon
			6.6.10	 Avotermin (TGF-β3)
		6.7	 Conclusion
		References
	7: The Future of Wound Documentation: Three-Dimensional, Evidence-Based, Intuitive, and Thorough
		7.1	 Medical Documentation
		7.2	 Electronic Documentation
		7.3	 Structured Data
		7.4	 Wound Management
		7.5	 Photo Documentation
		7.6	 Data Standards
		7.7	 Existing Documentation Systems
		7.8	 Documentation for Burn Injuries
		7.9	 Research for Documentation Systems
		7.10	 Data Quality and Data Completeness
		7.11	 Virtual Patients
		7.12	 Data Acquisition on Virtual Patients
		7.13	 Photo Documentation on Virtual Patients
		7.14	 Data Analysis Beyond Single Institutions
		7.15	 Including Evidence
		7.16	 Mobile Documentation
		References
	8: Evaluation of Mimic Function in Patients with Facial Burns by Use of the Three-Dimensional Video-Analysis
		References
	9: Rehabilitation and Scar Management
		9.1	 Introduction
		9.2	 Rehabilitation in the Critically Ill Burn Patient
		9.3	 Rehabilitation in the Recovering Burn Patient
		9.4	 Non-surgical Scar Management
			9.4.1	 Compression Therapy
			9.4.2	 Pressure Pads
			9.4.3	 Hydration and Silicone
			9.4.4	 Lubricants and Solar Exposition
			9.4.5	 Creams/Salves
			9.4.6	 Scar Massage
			9.4.7	 Cortisone Treatment
			9.4.8	 Antimitotic Drugs
			9.4.9	 Verapamil
			9.4.10	 Laser
			9.4.11	 Radiotherapy
			9.4.12	 Soft Tissue Augmentation
		9.5	 Conclusions
		References
	10: Laser Treatment of Scars
		10.1	 Introduction
		10.2	 Laser Technologies for Scar Treatment
			10.2.1	 Ablative Lasers
			10.2.2	 Nonablative Lasers
		10.3	 Laser Treatment Options for Different Scar Types
			10.3.1	 Linear Scars
			10.3.2	 Linear Hypertrophic Scars
			10.3.3	 Widespread Hypertrophic Scars
			10.3.4	 Keloids
		10.4	 Summary
		References
	11: The Value of Medical Needling in Burn Scars
		11.1	 Introduction
		11.2	 Science
			11.2.1 How It Works
			11.2.2 Induction of the Wound Healing Cascade
			11.2.3 TGF and the Induction of Collagen I
			11.2.4 Dermal Remodelling
			11.2.5 Increase in Skin Elasticity
			11.2.6 Normalized Perfusion
			11.2.7 Increase in Skin Moisture Content
			11.2.8 Increase of Epidermal Thickness
			11.2.9 Role of Vitamins in Wound Healing
			11.2.10 No Dyspigmentation After Medical Needling
			11.2.11 Repigmentation of Hypopigmented Burn Scars with Medical Needling and Non-cultured Autologous Skin Cell Suspension (NCASCS)
		11.3	 Clinical Results
			11.3.1 Medical Needling
			11.3.2 Medical Needling and NCASCS
		11.4	 Conclusion
		References
	12: Principles of Autologous Fat Grafting: Current Application in Burn Wounds and Scars
		12.1	 Definition
		12.2	 Indications and Contraindications
			12.2.1	 Fat Grafting in Burn Wounds and Scars
		12.3	 Technique
			12.3.1	 Harvesting
			12.3.2	 Preparation
			12.3.3	 Injection
			12.3.4	 Postoperative Care
		12.4	 Risks and Complications
		References
	13: Exercise
		13.1	 Acute Stage
			13.1.1	 Safety and Efficacy Considerations Prior to Beginning Exercise
			13.1.2	 Mobilization Protocol
			13.1.3	 Heterotopic Ossification
			13.1.4	 Positioning
		13.2	 Outpatient Stage
			13.2.1	 Exercise: Background
			13.2.2	 Exercise Prescription
			13.2.3	 Exercise Testing
				13.2.3.1	 Peak Oxygen Consumption or Aerobic Exercise Capacity
				13.2.3.2	 Strength Measurements
				13.2.3.3	 Three Repetition Maximum Test
				13.2.3.4	 Lean Body Mass Measurements
				13.2.3.5	 Additional Testing
			13.2.4	 Exercise Programs
				13.2.4.1	 Aerobic Training
					Intensity
					Duration
					Frequency
					Mode
					Progression of Exercise
				13.2.4.2	 Resistance or Strength Training
					Exercise Type and Order
					Frequency
					Number of Sets and Repetitions
					Training Load
					Rest Periods
					Progressive Overload
		13.3	 Special Considerations
		References
Part IV: Burn Reconstruction: Principles
	14: Principles of Burn Reconstruction
		14.1	 From the Reconstructive Ladder to the Reconstructive Elevator
		14.2	 The Reconstructive Clockwork
			14.2.1	 General Principles
		14.3	 Indication and Timing of Surgical Intervention
		14.4	 The Techniques of Reconstruction
		14.5	 Excision Techniques
			14.5.1	 W-Plasty and Geometric Broken Line Closure
		14.6	 Serial Excision and Tissue Expansion
		14.7	 Skin Grafting Techniques
		14.8	 Local Skin Flaps
			14.8.1	 Z-Plasty
			14.8.2	 Double-Opposing Z-Plasty
			14.8.3	 Musculocutaneous (MC) or Fasciocutaneous (FC) Flap Technique
		14.9	 Distant Flaps
			14.9.1	 Free Tissue Transfer
			14.9.2	 Perforator Flaps
		14.10	 Composite Tissue Allo-Transplantation
		14.11	 Regeneration: Tissue Engineering
		14.12	 Robotics/Prosthesis
		14.13	 Summary
		References
	15: Tissue Expanders in Burn Surgery
		15.1	 Introduction
		15.2	 Historical Aspects
		15.3	 Biology of Expanded Tissue
		15.4	 Basic Principles and Techniques
			15.4.1	 Indications, Patient Selection, and Compliance
			15.4.2	 Expanders
			15.4.3	 Aspects in Expander Volume and Shape Selection
			15.4.4	 Surgical Expander Placement and Expansion
			15.4.5	 Expander Explantation and Management of the Capsule
			15.4.6	 Pre-expanded Flaps
		15.5	 Complications
		15.6	 Clinical Applications of Tissue Expanders
			15.6.1	 Head and Neck Reconstruction
				15.6.1.1	 Alopecia Reconstruction of the Burned Scalp
				15.6.1.2	 Eyelid Reconstruction
				15.6.1.3	 Nose Reconstruction
				15.6.1.4	 Facial Reconstruction
				15.6.1.5	 Supraclavicular Island Flap (SIF-Flap)
		15.7	 Reconstruction of the Trunk and Extremities
		15.8	 Summary
		References
	16: Burn Reconstruction: Skin Substitutes and Tissue Engineering
		16.1	 Introduction
		16.2	 History of Skin Transplantation
		16.3	 Indications for Skin Grafting
		16.4	 Necrotomy
		16.5	 Methods of Skin Grafting
		16.6	 Split- and Full-Thickness Skin Grafts
		16.7	 Standard Methods
			16.7.1	 Autologous Full-Thickness Skin Grafts
			16.7.2	 Autologous Meshed Split-Thickness Skin Grafts
			16.7.3	 Meek Technique
			16.7.4	 Stamp Technique
		16.8	 Alternative Methods
		16.9	 Temporary Allogenic and Xenogenic Skin Grafts
			16.9.1	 Allogenic Skin Grafts
			16.9.2	 Xenogenic Skin Grafts
		16.10	 Mixed Skin Grafts
			16.10.1 The Chinese Method: Intermingled Grafting
			16.10.2 Autologous Allogenic Intermingled Grafts
			16.10.3 Autologous Xenogenic Intermingled Grafts
			16.10.4 “Sandwich” Technique
			16.10.5 Microskin Grafts
			16.10.6 Buried Chip Graft Technique
			16.10.7 Purely Epithelial Skin Grafts
		16.11	 Cultured Epithelia and Tissue Engineering
			16.11.1 Requirements
			16.11.2 Historical Review
			16.11.3 Explant Cultures
			16.11.4 Dissociated Cultures
		16.12	 Cultured Skin Substitutes
			16.12.1 Cultured Epidermal Autografts (CEA)
			16.12.2 Cell Suspensions
			16.12.3 Membrane Cell Transplants
			16.12.4 Alloplastic and Synthetic Biological Carriers for Cultured Cells
				16.12.4.1	 Bioprinting and Biofabrication
		16.13	 Summary
		References
	17: Twelve-Year Follow-Up: A Clinical Study on Dermal Regeneration
		17.1	 Introduction
		17.2	 Clinical Trial
			17.2.1	 Scar Elasticity
			17.2.2	 Scar Erythema and Melanin
			17.2.3	 Scar Surface Roughness
			17.2.4	 Subjective Scar Evaluation
			17.2.5	 Substitution in Combination with Different Graft Expansions
		17.3	 Discussion
		17.4	 Conclusion
		References
Part V: Burn Reconstruction: Special Body Regions
	18: Burn Reconstruction: Neck Region
		18.1	 Part I: Basic Principles
			18.1.1	 Introduction
			18.1.2	 Pathogenesis and Associated Problems of Neck Contractures
			18.1.3	 Evaluation and Classification of Burn-Related Neck Deformities
			18.1.4	 Case Samples
			18.1.5	 Prevention, Nonsurgical Treatment Modalities, and Adjunct Surgical Procedures
		18.2	 Part II: Surgical Reconstruction of Neck Contractures
			18.2.1	 Indications
			18.2.2	 Reconstructive Options and Guidelines
				18.2.2.1	 Mild Defects
				18.2.2.2	 Moderate Defects
				18.2.2.3	 Severe and Extensive Defects
			18.2.3	 Skin Grafts
			18.2.4	 Dermal Regenerative Templates
			18.2.5	 Local Flaps
			18.2.6	 Tissue Expansion
			18.2.7	 Regional Flaps
				18.2.7.1	 Supraclavicular Island Flap (SIF)
				18.2.7.2	 Trapezius Muscle Flap
			18.2.8	 Free Flaps
			18.2.9	 Summary
		References
	19: Burn Reconstruction: Eye Region
		19.1	 Introduction
		19.2	 Reconstruction of the Eyelid Region
			19.2.1	 Upper Eyelid and Anterior Lamella of Lower Eyelid
			19.2.2	 Reconstructive Skin Grafting (Split-Thickness or Full-Thickness Skin Graft) in the Eyelid Region
			19.2.3	 Reconstructive Local Flaps in the Eyelid Region
			19.2.4	 Reconstructive Free Flaps in the Eyelid Region
		19.3	 Posterior Lamella
		19.4	 Scar Management
			19.4.1	 Retraction of Upper Eyelid and Ectropion of Lower Eyelid
			19.4.2	 Surgical Tarsorrhaphy
			19.4.3	 Masquerade Procedure
			19.4.4	 Tenonplasty
		19.5	 Deformities of the Eyebrows
		19.6	 Horizontal Eyelid Shortening
			19.6.1	 Lower Eyelid Sling
			19.6.2	 Obstruction of Canaliculi
		References
	20: Ear Reconstruction in Post-burn Ear Deformity
		20.1	 Introduction
		20.2	 Basic Anatomy and the Appearance of a Natural Ear
		20.3	 The Position of the External Ear
		20.4	 Initial Management of the Burned Ear
		20.5	 History of Ear Reconstruction
		20.6	 Post-burn Reconstruction
			20.6.1	 Impaired Hearing
			20.6.2	 Abnormal Scarring
			20.6.3	 Loss of Function
			20.6.4	 Deformity of the Ear Without Loss of Tissue
			20.6.5	 Displacement of the Ear Due to Surrounding Scarring
			20.6.6	 Loss of Part or Whole of the External Ear
				20.6.6.1	 The Temporoparietal Flap
				20.6.6.2	 The Subcutaneous Pocket Technique
				20.6.6.3	 Pre- and Post-auricular Skin Healing Flaps
		20.7	 Total Ear Reconstruction
		20.8	 Summary
		References
	21: Reconstruction of the Perioral Region After Facial Burns
		21.1	 Introduction
			21.1.1	 Aetiology and Pathophysiology
			21.1.2	 Relevant Anatomy
			21.1.3	 Presentation and Classification
			21.1.4	 General Considerations and Indications
		21.2	 Treatment of Facial Burns
			21.2.1	 Microstomia: Acute and Non-surgical Treatment
			21.2.2	 Microstomia: Reconstruction of the Oral Commissure
			21.2.3	 Reconstruction on the Upper and Lower Lips
				21.2.3.1	 Flowchart for Surgical Planning (Table 21.2)
				21.2.3.2	 The Upper Lip
				21.2.3.3	 The Lower Lip
		21.3	 Summary and Conclusion
		References
	22: Nasal Reconstruction
		22.1	 Principles of Nasal Reconstruction
		22.2	 Summary
		References
	23: Reconstruction/Correction of Burn Alopecia
		23.1	 Hair Grafting
		23.2	 Scalp Reduction (Serial Excision and Local Scalp Flap)
		23.3	 Scalp Extension
		23.4	 Scalp Expansion
		23.5	 Conclusions
		References
	24: Burn Reconstruction: Breast
		24.1	 Introduction
			24.1.1	 Reconstructive Principles
		24.2	 Scar Release
		24.3	 Split-Thickness Skin Graft
		24.4	 Full-Thickness Skin Grafts
		24.5	 Combination of Split- or Full-Thickness Grafts with Dermal Substitutes (Matriderm®, Integra®)
		24.6	 Local Flaps
			24.6.1	 Z-plasties
			24.6.2	 Transposition Flaps
		24.7	 Pedicled Flaps
			24.7.1	 Transverse Rectus Abdominis Muscle (TRAM)
			24.7.2	 Myocutaneous Latissimus Dorsi Flap (LD)
		24.8	 Free Flaps
			24.8.1	 Deep Inferior Epigastric Artery Perforator Flap (DIEP)/Superior
			24.8.2	 Anterior Lateral Thigh Flap
		24.9	 Nipple-Areola Complex Reconstruction
			24.9.1	 Tattoo
			24.9.2	 Local Flaps
		24.10	 Tissue Expanders
		24.11	 Reduction and Augmentation Mammaplasty/Mastopexy
		24.12	 Conclusion
		References
	25: Reconstruction of Burn Deformities of the Lower Extremity
		25.1	 Introduction
		25.2	 Reconstructive Ladder Stage 1: Z-Plasty
		25.3	 Reconstructive Ladder Stage 2: Skin Graft Transplantation
		25.4	 Reconstructive Ladder Stage 3: Pedicle Flaps
			25.4.1	 Tensor Fascia Lata Flap (TFL)
			25.4.2	 Anterolateral Thigh Flap (ALT)
			25.4.3	 Gracilis Flap
			25.4.4	 Vastus Lateralis Flap
			25.4.5	 Soleus Muscle Flap
			25.4.6	 Gastrocnemius Muscle Flap
			25.4.7	 Saphenous Flap
			25.4.8	 Sural Flap
			25.4.9	 Dorsalis Pedis Flap
		25.5	 Reconstructive Ladder Stage 4: Free Flaps
			25.5.1	 Latissimus Dorsi Flap
			25.5.2	 Scapular and Parascapular Flap
			25.5.3	 Lateral Arm Flap
			25.5.4	 Radial Artery Flap
		25.6	 Reconstructive Ladder Stage 5: Perforator Flap
		25.7	 Discussion
		25.8	 Summary
		References
	26: Thermal Injuries to the Foot
		26.1	 Introduction
		26.2	 Anatomy
		26.3	 Burn Therapy
			26.3.1	 General Assessment
			26.3.2	 Goal of Therapy
			26.3.3	 Primary Treatment
			26.3.4	 Bridging the Time to Final Reconstruction
		26.4	 Skin Grafting
		26.5	 Postoperative Care
			26.5.1	 Secondary Reconstruction
		26.6	 Defects of the Dorsum of the Foot and Ankle
		26.7	 Defects of the Sole
		26.8	 Local Flaps
		26.9	 Local Flaps from the Dorsalis Pedis Artery
		26.10	 Local Flaps from the Posterior Tibial Artery
			26.10.1	 Regional Flaps from the Lower Leg
			26.10.2	 Regional Flaps from the Peroneal Artery
			26.10.3	 Regional Flaps from the Tibialis Anterior Artery
			26.10.4	 Regional Flaps from the Tibialis Posterior Artery
			26.10.5	 Cross-Leg Flaps
			26.10.6	 Free Flaps
			26.10.7	 Long-Time Sequelae
			26.10.8	 Thermal Injuries of Feet in Children
		26.11	 Summary and Conclusion
		References
	27: Burn Reconstruction: Hand
		27.1	 Introduction
		27.2	 Mechanisms of the Injury and Anatomic Characteristics
		27.3	 Aims and Principles of Treatment
		27.4	 Determination of Burn Depth
		27.5	 Escharotomy
			27.5.1	 Indication for Escharotomy
		27.6	 Treatment of Edema
		27.7	 Splinting
		27.8	 Wound Management
		27.9	 Surgical Treatment
		27.10	 Methods of Coverage
			27.10.1 Skin Grafting
			27.10.2 Skin Substitutes
			27.10.3 Skin Substitutes for Superficial Burn Injuries
			27.10.4 Acellular Dermal Substitutes for Deep Burn Injuries
			27.10.5 Allografts
		27.11	 Palm Burns
		27.12	 Exposed Joints
		27.13	 Reconstruction
			27.13.1 Claw Deformity
			27.13.2 Palmar Contractures
			27.13.3 Web Space Deformities
			27.13.4 Hypertrophic Scars
			27.13.5 Amputation Deformity
			27.13.6 Nail Bed Deformity
		27.14	 Rehabilitation
		27.15	 Summary
		References
	28: Burn Reconstruction: Future Perspectives—Facial Transplantation
		28.1	 Introduction
		28.2	 Burn Injury in the Twenty-First Century
		28.3	 Evaluation of Facial Burn Deformities
		28.4	 Conventional Reconstructive Methods
		28.5	 Vascularized Composite Allotransplantation and Face Transplantation
		28.6	 Face Transplantation in Facial Burn Reconstruction
			28.6.1	 Indications for Burned Face Reconstruction
			28.6.2	 Timing of Burned Face Reconstruction
			28.6.3	 Reconstruction of Specific Facial Regions
		28.7	 Burned Patient and Immunology
		28.8	 Conclusions
		References
	29: Modern Myoprostheses in Electric Burn Injuries of the Upper Extremity
		29.1	 Introduction
		29.2	 Standard Myoelectric Fittings
		29.3	 Targeted Muscle Reinnervation
		29.4	 Pattern Recognition for Prosthetic Control
		29.5	 Osseointegration
		29.6	 Bionic Reconstruction in Patients Left with a Functionless Hand
		29.7	 Outlook
		References
Part VI: Simulation and Training
	30: Simulation and Training
		30.1	 Introduction
		30.2	 Different Levels of Simulation
			30.2.1	 Low-Fidelity Training
			30.2.2	 Mid-Fidelity Training
			30.2.3	 High-Fidelity Training
			30.2.4	 It Is All About the Right Blend
		30.3	 Training Modalities in Simulation-Based Medical Education
			30.3.1	 Part-Task Training
			30.3.2	 Algorithm Training (AT)
			30.3.3	 Scenario Training
			30.3.4	 Full-Scale Care Process Simulation Training
		30.4	 SBME in the Emergency Management of Burns
			30.4.1	 Burn Care-Specific Technical Skills and Tools
		References
Index