Introduction:
Superficial-partial paediatric scalds are usually managed with dressings; wound size determines dressing number, frequency, type (simple/biosynthetic) and location (clinic/ward/theatre).
Deeper burns are debrided and grafted early; meaning rapid wound closure but inevitable scarring.
In mid-to-deep-dermal or mixed-depth burns, traditional methods include waiting for a period of healing before grafting remaining wounds within 2-3 weeks.
In Western Australia, early dermabrasion and ReCell has offered us an alternative management pathway.
We reviewed 5 years of electronic data for paediatric scald injuries >5% treated with ReCell, examining demographics, LOS, number of operations/dressing changes and follow-up.
Results:
We report 106 paediatric scalds; mean age of 3y, mean TBSA 9% and mean LOS 9.6 days. When split into %TBSA ranges results were:
|
|
Mean Age(years) |
Mean TBSA(%) |
LOS(days) |
|
TBSA 5-10% |
3.1 |
6.5 |
6.8 |
|
TBSA 11-15% |
2.4 |
12.2 |
10.2 |
|
TBSA 16-20% |
1.7 |
17.1 |
16.3 |
|
TBSA 21-25% |
7.2 |
23 |
42 |
|
TBSA 25% + |
2.6 |
35 |
71 |
Discussion:
Early dermabrasion and ReCell allows removal of the burn load earlier, avoids over-debridement and grafting areas which would have healed (a.k.a. the perfect crime).
Review of wounds at 1 week (no planned dressing changes in-between) allows earlier discharge, less operations, dressings and discomfort whilst allowing us to graft deeper areas in a timely fashion.
This is supported by our LOS data; for injuries between 5-20% we are at or under 1 day stay per % burn.
In younger patients especially, areas which we expected to graft are frequently almost healed at one-week, reducing unnecessary grafts and examples are shown.