Prevalence of post major burn complications, posttraumatic stress disorder and depression among HUSM patients treated for major burn between 2006 and 2016

Introduction The goal of this study is to identify early and late burn complications among major burn patients. This study also evaluated the effect of total body surface area (TBSA) of burn towards posttraumatic stress disorder (PTSD) and depression. Association between TBSA and quality of life (QoL) was also identified. Methods This study was a cross-sectional study involving adult major burn patients from 2006 until 2016. Validated psychometric questionnaires that were used to screen for PTSD and depression in post major burn patients are, Malay PTSD Checklist for Civilians (MPCL-C), Trauma Symptom Inventory-2 (TSITM-2), Beck Depression Inventory- Malay (BDI-Malay) and Center for Epidemiological Study – Depression scale (CES-D). A Malay translated Burn Specific Health Scale – B was used to evaluate post major burn QoL. The difference of mean TBSA and PTSD as well as TBSA and depression were addressed using Independent t-test. The association between TBSA and QoL was addressed using simple linear regression. Results A total number of 55 patients voluntarily participated in answering the psychometric battery. Early complications that were identified among the major burn patients were acute stress disorder (0.72%), renal failure (0.72%), heart failure (1.08%), respiratory failure and infection (1.44%), Systemic Inflammatory Response Syndrome (2.16%), sepsis (2.52%) and infected wound (2.88%). Late complications that were identified include, corneal defect (0.36%), alopecia (0.72%), keloid (0.72%), ear deformity (1.08%), contracture (5.04%) and hypertrophic scar (10.1%). Results based on the MPCL-C and TSI-2, indicated that there were no significant difference of mean TBSAbetween patients who has PTSD and no PTSD, MPCL-C, p > 0.05 and TSI-2, p > 0.05. However, when the results of BDI and CES-D were compared, there were significant difference of mean TBSA between patient who has depression and those who dont have depression. Based on BDI, for patients with depression; the average mean TBSA is 17.1%, p < 0.05. Based on CES-D, for patients with depression; the average mean TBSA is 14.7%, p < 0.05. There is a significant association between major burns TBSA and QoL with p<0.05. Based on the model summary output, the variable TBSA explains 37.2% of the variability in QoL. This indicates, the higher level of TBSA leads to poor quality of life. For TBSA more than 25% it was reported that the QoL was 45.67 lesser when compared with TBSA less than 15%. Conclusion This study identified early and late burn complications among major burn patient through a burn database and burn proforma from 2006 until 2016. This study has found significant effect of TBSA towards depression, while no significant effect towards PTSD. Findings provide some evidence for poor QoL post major burn in a negative direction. It is suggested all major burn patients be screened for PTSD and depression as original sample size was small and it carries a significant impact towards patient’s well being beyond physical recovery from burn. All major burn patients’ quality of life should be evaluated as well, as it reflects the final outcome of healing holistically

Nasal Reconstruction Using Tissue Expander and Modified Paramedian Forehead Flap Supported by Cartilage Graft

This is an interesting case of a male patient with traumatic nasal injury with partial nasal amputation who was referred to our centre 3 months after the initial trauma. The wound was complicated with necrosis, the amputated nose had fallen off and a scar had formed at the wound bed. The nasal defect was greater than 2.5cm in length. More than 50% of the nose had fallen off including the bilateral alar lobule, the tip and the dorsal part of the nose. We utilized a tissue expander to create more tissue on the forehead in view of the patient’s short forehead, for donor site closure and to lengthen our flap. We performed a modified paramedian forehead flap with a widened distal portion of flap, in a two-staged nasal reconstruction surgery supported by L-strut cartilage graft harvested from the 7th rib. In this report we provide an illustrative description of the procedure, its cosmetic and functional outcome and we also share the challenges we faced

Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template

BACKGROUND: Myelomeningocele is one of the most complex congenital malformations of the central nervous system. It is one of the most common types of spina bifida which involves a failure of neural tube closure. Reconstruction surgery for myelomeningocele had always been challenging for plastic and neurosurgeons. CLINICAL CASE: We report a case of a new-born with lumbosacral myelomeningocele who received treatment in the Hospital Universiti Sains Malaysia. The myelomeningocele was repaired by the neurosurgery team and subsequently, the child was left with huge lumbosacral skin defect. The large defect was successfully covered by using a combined method of bilateral bipedicle flap with lateral releasing incision and remaining lumbosacral and secondary defect resurfaced using Integra® dermal regeneration template (DRT). We used ACTICOAT interfaced negative pressure wound therapy (NPWT) as our main dressing in preparing the wound bed for autologous epidermal graft. The result of our closure technique provides tension free closure. DISCUSSION: We incorporated bilateral bipedicle fasciocutaneous flap technique together with DRT for closure of the lumbosacral defect. The bilateral bipedicle flap with lateral releasing incision served to reduce tension on the skin at bilateral lumbar region. The DRT downsized the lumbosacral defect and NPWT dressing provided an optimal sterile environment in giving time for neodermis generation. The remaining secondary defect were also resurfaced utilizing DRT and autologous skin grafting. CONCLUSIONS: The outcome of surgery demonstrated that the combined use of bilateral bipedicle fasciocutaneous flap with lateral releasing incision and DRT with delayed skin grafting is safe, effective and provide long term stable and supple scar for large, exposed dura defect

A complex scalp resurfacing utilizing Integra® as temporary dressing in aplasia cutis congenita

BACKGROUND: Aplasia cutis congenita is a rare newborn malformation characterized by focal absence of skin. It possesses difficulty in reconstruction surgery for neurosurgeons and plastic surgeons. We report a challenging case of aplasia cutis congenita who received treatment in our center. CLINICAL CASE: A 2-year-old boy, presented to Plastic and Reconstructive Surgery, Hospital USM, with bilateral vertex defect with encephalocele who received a series of surgical interventions since 1 month old. Unfortunately, he returned after 2 years with a chronic nonhealing scalp wound associated with dura defect and cerebral spinal fluid leakage. The wound was debrided and the swab culture result showed no organism growth. Part of the wound bed with dura defect was repaired using a small piece of transplanted fascia lata and Integra® was applied. DISCUSSION: There is scarcity in the medical literature on the reconstructive technique of aplasia cutis congenita. In the case we described here, we successfully managed the wound with multiple application of dermal substitute (Integra®) dressing with negative pressure wound therapy and split-thickness skin graft. CONCLUSIONS: Management of aplasia cutis congenita with skull defect remains a controversy. Its management varies depends on its pattern and underlying condition. We successfully develop a new simple method in treating scalp accutilizing Integra®