Burn Scar Management and Reconstructive Surgery

Evaluating the Content and Quality of Videos Related to Hypertrophic Scarring on TikTok in China: Cross-Sectional Study

BACKGROUND

Hypertrophic scars (HTSs) are a predominant condition after burns and trauma, and it causes severe physiological and psychological problems. TikTok (Douyin in Chinese), a popular platform for sharing short videos, has shown the potential to spread health information, including information related to HTSs. Educating the public to obtain correct information is important to reduce the incidence of physiological and psychological problems caused by HTSs. However, the quality and reliability of HTS-related video content on TikTok in mainland China have not been thoroughly studied.

OBJECTIVE

This study aims to evaluate the content and quality of short videos related to HTSs on the Chinese version of TikTok (Douyin) and explore the factors related to their quality, providing valuable insights for health information dissemination.

METHODS

We collected a sample of 153 TikTok videos in Chinese related to HTSs and categorized them according to video source and content. We evaluated the video content using a coding schema, and a hexagonal radar schema was used to intuitively display the spotlight and weight of each aspect of the videos. We evaluated quality using 4 standardized tools: the modified DISCERN (mDISCERN) questionnaire, the Journal of the American Medical Association, the Global Quality Scale (GQS), and the Health on the Net Foundation Code of Conduct. We also explored the potential relationship between video quality and characteristics.

RESULTS

The analysis showed that health care professionals uploaded all videos about treating HTSs, which matched the hexagonal radar model analysis findings. The quality assessment scores for the Journal of the American Medical Association, GQS, mDISCERN, and the Health on the Net Foundation Code of Conduct had median values of 1 (IQR 1-2), 2 (IQR 2-3), 2 (IQR 2-3), and 3 (IQR 3-4), respectively, indicating a need to improve the quality and reliability of videos on HTSs. In addition, high-quality videos were more popular, based on metrics such as likes, comments, favorites, and shares (P<.001). Interestingly, the time when the videos were uploaded positively correlated with GQS and mDISCERN scores (r=0.393; P<.001 and r=0.273; P<.001), while the video length did not significantly correlate with evaluation scores (P=.78, P=.20, P=.07, and P=.04).

CONCLUSIONS

The quality of TikTok videos related to HTSs is generally moderate. Users should exercise caution when seeking information on HTSs from TikTok. It is advisable to choose videos uploaded by health care professionals from the burn department and the burn plastic surgery department, and in the Chinese context, those produced in first-tier cities and emerging first-tier cities.

Location, Payer Type, and Gender as Drivers of Burn Scar Reconstruction Utilization: A Burn Model Systems National Database Study

BACKGROUND

There are demographic and socioeconomic disparities in physical and psychosocial outcomes after burn injury. Here, we assess the demographic and geographic variation in utilization of burn scar reconstruction to assess if such barriers to these procedures may be contributing to disparities in outcomes.

METHODS

We performed a retrospective cohort study using prospectively collected data from adults enrolled in the Burn Model System National Database between 2015 and 2022. Undergoing burn scar reconstruction, defined as surgery for burn scars or laser scar revision, by 24 months after discharge was compared across age group (18-64 vs 65+ years), gender, race/ethnicity, payer type, and enrollment site. Multiple logistic regression was used to assess use of burn scar reconstruction by demographic characteristics while adjusting for presence of range of motion deficits at discharge, hand burn, head/neck burn, and upper arm/shoulder burn.

RESULTS

In the unadjusted analysis (N = 836), burn scar reconstruction use by 24 months differed by age group (<0.001), race/ethnicity (P = 0.014), payer type (P < 0.001), and enrollment site (P < 0.001). By multiple logistic regression (n = 717), burn scar reconstruction was associated with female sex (odds ratio [OR] 1.89, P = 0.002), workers' compensation (OR 3.41, P < 0.001), enrollment at site 1 or site 2 (OR 6.02, P < 0.001; OR 4.09, P < 0.001), hand burns (OR 2.35, P < 0.001), and upper arm/shoulder burns (OR 2.34, <0.001).

CONCLUSIONS

Location, payer type, and gender were primary drivers of burn scar reconstruction use after adjusting for burn characteristics. Geographic variability in burn scar reconstruction use may reflect less dependence on surgery to achieve favorable functional outcomes; however, these differences may represent barriers requiring further evaluation.

A Systematic Review of Simulation in Burn Care: Education, Assessment, and Management

Assessment and management of burns require nuanced, timely interventions in high-stake settings, creating challenges for trainees. Simulation-based education has become increasingly popular in surgical and nonsurgical subspecialties to supplement training without compromising patient safety. This study aimed to systematically review the literature on existing burn management-related simulations. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing burn-specific surgical and nonsurgical simulation models were included. The model type, study description, simulated skills, assessment methods, fidelity, cost, and outcomes were collected. Of 3472 articles, 31 met the inclusion criteria. The majority of simulations were high-fidelity (n = 17, 54.8%). Most were immersive (n = 17, 54.8%) and used synthetic benchtop models (n = 13, 41.9%), whereas none were augmented reality (AR)/virtual reality (VR). Simulations of acute and early surgical intervention techniques (n = 16, 51.6%) and burn wound assessments (n = 15, 48.4%) were the most common, whereas burn reconstruction was the least common (n = 3, 9.7%). Technical skills were taught more often (n = 29, 93.5%) than nontechnical skills (n = 15, 48.4%). Subjective assessments (n = 18, 58.1%) were used more often than objective assessments (n = 23, 74.2%). Of the studies that reported costs, 91.7% (n = 11) reported low costs. This review identified the need to expand burn simulator options, especially for burn reconstruction, and highlighted the paucity of animal, cadavers, and AR/VR models. Developing validated, accessible burn simulations to supplement training may improve education, patient safety, and outcomes.

A Pilot Study to Evaluate the Minimally Invasive Burn Care for Small, Deep Partial-Thickness Burns of the Hands and Feet Using Enzyme Debridement and Autologous Skin Cell Spray

Background/Objectives: We treated deep partial-thickness burns of the hands and feet in four cases using a combination of NexoBrid and ReCell autologous cell regeneration techniques, without conventional split-thickness skin graft, with good results following debridement of the eschar. Methods: We report cases of patients treated with a combination of the NexoBrid and ReCell techniques between 1 August 2023 and 31 July 2024. The degree of debridement and the time to complete wound closure were evaluated. Scar quality was assessed using the Vancouver Scar Scale (VSS). Results: Four patients aged 0-28 years with an average total burn surface area of 1.2% were treated on two hands and two feet, with an average follow-up of 12 months; no additional surgical treatment was needed. The mean VSS score was 0.25. The patients were satisfied with the aesthetic appearance of their hands and feet, and no complications, such as hypertrophic scars, were observed. We also developed separate algorithms for sedation and analgesia management for adults and children. Conclusions: Using ReCell alone following debridement of small burn wounds with NexoBrid resulted in early wound closure with good scar condition and cosmetic appearance.

NIR-II light based combinatorial management of hypertrophic scar by inducing autophagy in fibroblasts

The hypertrophic scar (HS) is a prevalent cutaneous fibrotic disorder that impacts both the aesthetic and functional aspects of the skin, there is an urgent need for a highly safe and effective approach to address the challenge of HS with thick and deep types. Inspired by the superior deep tissue penetrative ability of near-infrared-II (NIR-II) light and potential mitochondria ROS inducing effect of Chinese medicine lycorine (LYC), we fabricated a Cu2Se@LYC (CL) composite by encapsulating LYC on polyvinyl pyrrolidone (PVP) modified Cu2Se nanoparticles. After NIR-II irradiation, CL could induce the generation of reactive oxygen species (ROS) and mitochondrial damage in hypertrophic scar fibroblasts (HSFs). The subsequent release of cytochrome C (cyt-c) from mitochondria into the cytoplasm and upregulation of beclin1 leads to the activation of endogenous apoptosis and autophagy-mediated cell death. The CL + NIR-II treatment exhibited a pronounced anti-scarring effect in both in vitro and in vivo rabbit ear scar models, leading to a significant reduction in the fibrotic markers including Collagen I/III and α-smooth muscle actin (α-SMA). This study comprehensively investigated the crucial role of HSFs' autophagy in scar management and proposed a safe and effective therapy based on NIR-II laser for clinical application.

Betamethasone transdermal administration combined with fractional Er:YAG lasers or microplasma radiofrequency technology improved hypertrophic scars: A retrospective study

OBJECTIVE

This retrospective study aims to compare the efficacy rates in treating hypertrophic scars among four distinct groups of patients who either underwent fractional Erbium: yttrium-aluminum-garnet (Er:YAG) laser or microplasma radiofrequency technology as standalone treatments or in combination with compound betamethasone transdermal administration.

METHOD

The study retrospectively examined 208 patients treated at our institution from April 2011 to December 2022 for hypertrophic scars, receiving no less than three treatments (with an interval of 8 weeks between each). The patients were categorized into four groups: the F group (treated with fractional Er:YAG laser), the F + B group (treated with fractional Er:YAG laser combined with compound betamethasone transdermal administration), the P group (treated with microplasma radiofrequency technology), and the P + B group (treated with microplasma radiofrequency technology combined with compound betamethasone transdermal administration). The therapeutic effects were evaluated based on the changes in the Vancouver Scar Scale (VSS) scores before and after treatment in these groups.

RESULTS

There was no statistically significant difference in the VSS scores among the four groups before treatment. After undergoing three sessions of the aforementioned four types of treatment, all groups showed a decrease in VSS scores, with average posttreatment VSS scores for the F group scored 5.15 ± 2.084, F + B group scored 3.7 ± 1.781, P group scored 4.41 ± 1.933, and P + B group scored 3.16 ± 1.775, respectively. With an increasing number of treatments, the total effective rate gradually increased in all four groups, and the combination treatment using compound betamethasone transdermal administration proved more effective than the standalone treatment.

CONCLUSION

All four treatments yielded favorable outcomes, with the combined therapy involving compound betamethasone transdermal administration proving more effective than the standalone treatments, meriting further clinical attention.

Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysis

Background

Free tissue transfer is often considered a last resort in burn reconstruction due to its complexity and associated risks. A comprehensive review on free flap outcomes in delayed burn reconstruction is currently lacking. The study aimed to evaluate the available evidence on the failure and contracture recurrence rates in free flap delayed burn reconstruction.

Methods

A systematic review and meta-analysis was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The protocol was registered on PROSPERO (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The measured outcomes were free flap loss and contracture recurrence rate.

Results

Of the 1262 retrieved articles, 40 qualified for inclusion, reporting on 1026 free flaps performed in 928 patients. The mean age was 29.25 years [95% confidence interval (CI), 24.63-33.88]. Delayed burn reconstruction was performed at an average of 94.68 months [95% CI, - 9.34 to 198.70] after initial injury, with a follow-up period of 23.02 months [95% CI, 4.46-41.58]. Total flap loss rate was 3.80% [95% CI, 2.79-5.16] and partial flap loss rate was 5.95% [95% CI, 4.65-7.57]. Interestingly, burn contracture recurrence rate was 0.62% [95% CI, 0.20-1.90].

Conclusions

This systematic review provides a comprehensive evaluation of the free flap outcomes in delayed burn reconstruction. The flap loss rate was relatively low, given the complexity of the procedure and potential risks. Furthermore, burn contracture rate was found to be extremely low. This study demonstrates that free flaps are a safe and effective option for delayed burn reconstruction.

Epidemiology and first aid measures in pediatric burn patients in northern China during 2016-2020: A single-center retrospective study

BACKGROUND AND AIMS

Burn and scald injuries are the fourth most common type of trauma. Pediatric burns account for a high proportion of the total number of burn patients and impose a high burden on public health. Understanding the epidemiology of pediatric burns can help improve science education and reduce the incidence of burn injuries.

METHODS

This study is a single-center retrospective study. One thousand five hundred and twenty-seven pediatric burn patients admitted to our burn center from January 2016 to December 2020 were included. Demographic and epidemiological data of included patients were extracted and analyzed. The correlations of categorical data were tested by the Chi-square tests, and differences of continuous data were tested by the Kruskal-Wallis tests. A p-value of less than 0.05 was considered to be statistically significant.

RESULTS

The results showed that children under 3 years of age were most susceptible to burn and scald injuries. Burn injuries were most likely to occur in the season of winter and at the place of home. 56.6% of included patients did receive first aid measures, while 1.8% received gold-standard first aid. Clinical variables related to the severity of injuries were statistically different between patients with and without cooling measures in first aid. Linear regression models showed that emergency treatment of burns in children and adolescents was associated with outcome indicators, including number of operations, total operation duration per total burn surface area (TBSA), cost per TBSA, and length of stay per TBSA.

CONCLUSIONS

This study summarized the epidemiology and outcomes of pediatric burn patients admitted to a burn center in northern China. Adopting cooling measures in first aid can reduce the severity of injuries and reduce the burden on the medical system. Education on burn prevention and first aid measures to caregivers of children, especially preschool children, should be strengthened.

Severe Burns of the Genital Area After Laser Hair Removal: A Case Report

Burn injuries are among the most commonly observed complications of laser hair removal. Here, we present a case, in which severe massive burns were caused in the genital and perineal areas during such a procedure. The consequent scar formation led not only to negative aesthetic effects but also affected the physical and psychological health of the patient.