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Olutoye OO, Eriksson E, Menchaca AD, Kirsner RS, Tanaka R, Schultz G, Weir D, Wagner T, Renata F, Naik-Mathuria B, Liu P, Ead KJ, Adedayo T, Armstrong DG, McMullin N, Balch Samora J, Akingba AG. Management of Acute Wounds - Expert Panel Consensus Statement. Adv Wound Care (New Rochelle) 2024. [PMID: 38618741 DOI: 10.1089/wound.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
SIGNIFICANCE The Wound Healing Foundation recognized the need for consensus-based unbiased recommendations for the treatment of wounds. As a first step, a consensus on the treatment of chronic wounds was developed and published in 2022.(1) The current publication on acute wounds represents the second step in this process. Acute wounds may result from any number of conditions, including burns, military and combat operations, and trauma to specific areas of the body. The management of acute wounds requires timely and evidence-driven intervention to achieve optimal clinical outcomes. This consensus statement provides the clinician with the necessary foundational approaches to the causes, diagnosis and therapeutic management of acute wounds. Presented in a structured format, this is a useful guide for clinicians and learners in all patient care settings. RECENT ADVANCES Recent advances in the management of acute wounds have centered on stabilization and treatment in the military and combat environment, Specifically advancements in hemostasis, resuscitation, and the mitigation of infection risk through timely initiation of antibiotics and avoidance of high pressure irrigation in contaminated soft tissue injury. . CRITICAL ISSUES Critical issues include infection control, pain management and the unique considerations for the management of acute wounds in pediatric patients. FUTURE DIRECTIONS Future directions include new approaches to preventing the progression and conversion of burns through the use of the microcapillary gel, a topical gel embedded with the anti-inflammatory drug infliximab.(38) Additionally, the use of three-dimensional bioprinting and photo-modulation for skin reconstruction following burns is a promising area for continued discovery.
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Affiliation(s)
- Oluyinka O Olutoye
- Nationwide Children's Hospital, 2650, Surgery, 700 Children's Drive, T6 Administration, Columbus, Columbus, Ohio, United States, 43205
- The Ohio State University, 2647, Surgery, 700 Children's Drive, T6 Administration, Columbus, Ohio, United States, 43210-1132;
| | - Elof Eriksson
- Harvard Medical School, 1811, Plastic & Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Alicia D Menchaca
- Nationwide Children's Hospital, 2650, Pediatric Surgery, 575 Children's Crossroad, Rm 4143, Columbus, Ohio, United States, 43205-2664;
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, United States;
| | - Rica Tanaka
- Juntendo University School of Medicine Graduate School of Medicine, 73362, Regenerative Therapy, Department of Plastic & Reconstructive Surgery, Bunkyo-ku, Tokyo, Japan;
| | - Gregory Schultz
- Institute for Wound Research, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, United States, 32610-0294;
| | - Dot Weir
- Saratoga Hospital for Wound Healing and Hyperbaric Medicine, Saratoga Springs, United States;
| | - Tracey Wagner
- Nationwide Children's Hospital, 2650, Emergency Medicine, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Fabia Renata
- Nationwide Children's Hospital, 2650, Pediatric Surgery , Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Bindi Naik-Mathuria
- The University of Texas Medical Branch at Galveston, 12338, Pediatric Surgery, Galveston, Texas, United States;
| | - Paul Liu
- Brown University/Rhode Island Hospital, Plastic Surgery, 225 Plain Street, Providence, Rhode Island, United States, 02905;
| | - Karim J Ead
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Temitope Adedayo
- Temple University School of Podiatric Medicine, 70068, Philadelphia, Pennsylvania, United States;
| | - David G Armstrong
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Neil McMullin
- Evans Army Community Hospital, 19909, Plastic Surgery, Fort Carson, Colorado, United States;
| | - Julie Balch Samora
- Nationwide Children's Hospital, 2650, Orthopedic Surgery, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Ajibola G Akingba
- VA, 8267, Vascular Surgery , Washington, District of Columbia, United States;
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Patterson KN, Beyene TJ, Lehman K, VerLee SN, Schwartz D, Fabia R, Thakkar RK. Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers. Burns 2023; 49:1311-1320. [PMID: 36764839 DOI: 10.1016/j.burns.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate pediatric burn patients' and caregivers' quality of life (QoL), while identifying clinical characteristics correlated with psychological stress. METHODS Pediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0-4 years completed the Infant's Dermatology QoL Index (IDQOL). Patients> 4-16 years completed the Children's Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers' stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics. RESULTS Overall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients' burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern. CONCLUSIONS QoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Veteran Affairs Palo Alto Health System (VAPAHCS), Palo Alto, CA, USA,; Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sarah N VerLee
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dana Schwartz
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Renata Fabia
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Rajan K Thakkar
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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Vasella M, Cirebea J, Gousopoulos E, Wang A, Schweizer R, Waldner M, Grieb G, Buehler P, Plock JA, Kim BS. Outcome of Facial Burn Injuries Treated by a Nanofibrous Temporary Epidermal Layer. J Clin Med 2023; 12:5273. [PMID: 37629315 PMCID: PMC10455532 DOI: 10.3390/jcm12165273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The face is commonly affected in thermal injuries, with a demand for proper recognition and the correct choice of treatment to guarantee optimal aesthetic and functional outcomes. It is highly vascularized and often heals conservatively, highlighting the particular relevance of conservative treatment modalities, many of which require daily re-applications or dressing changes, which can be painful and tedious for both the patient and the healthcare providers. Motivated by encouraging results of a novel temporary nanofibrous epidermal layer, we herein present a case series of this technology in a case series of patients suffering from facial burns and treated in our Burn Center. PATIENTS AND METHODS Patients with superficial partial-thickness facial burns and mixed pattern burns, which were treated with SpinCare™, an electrospun nanofibrous temporary epidermal layer, between 2019 and 2021, at our institution were analyzed retrospectively. The Manchester scar scale (MSS) and numeric rating scale (NRS) were used for scar, pain, and outcome evaluation at different time points by five independent board-certified plastic surgeons with profound experience in burn surgery. RESULTS Ten patients (m = 9; f = 1) were treated and evaluated retrospectively. The mean age was 38.8 ± years (SD ± 17.85). The mean healing time was 6.4 days (SD ± 1.56). The mean follow-up was 16.4 months (SD ± 11.33). The mean MSS score was 5.06 (SD ± 1.31), and the mean NRS Score for pain was significantly reduced from initially 7 to 0.875 upon application (mean (pre-application) 7 ± 0.7 and (application) 0.875 ± 1.26; p ≤ 0.0001). Patients reported a NRS score of 10 in terms of functional and cosmetic outcomes at their final follow-up appointment. No adverse effects were observed. CONCLUSIONS The application of a nanofibrous temporary epidermal layer such as SpinCare™ represents a relatively easy-to-use, well-tolerated, and effective alternative for the treatment of partial-thickness facial burns.
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Affiliation(s)
- Mauro Vasella
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
| | - Jan Cirebea
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
| | - Epameinondas Gousopoulos
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
| | - Anna Wang
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Riccardo Schweizer
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
- Department of Plastic, Reconstructive and Aesthetic Surgery, Regional Hospital Lugano, 6900 Lugano, Switzerland
| | - Matthias Waldner
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, 14089 Berlin, Germany;
- Department of Plastic Surgery & Hand Surgery, Burn Center, Medical Faculty, Hospital of the RWTH Aachen University, 52074 Aachen, Germany
| | - Philipp Buehler
- Center of Intensive Care Medicine, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Jan Alexander Plock
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (M.V.); (E.G.); (A.W.); (R.S.); (M.W.); (J.A.P.)
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Papadopoulou S, Nikolaidou E, Joycey AP, Tzimorota Z, Karagergou E. Reconstruction of Bilateral Upper and Lower Eyelid Ectropion Caused by a Liquid Unblocker Chemical Burn. Cureus 2023; 15:e40880. [PMID: 37492843 PMCID: PMC10363769 DOI: 10.7759/cureus.40880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Liquid drain unblockers, although meant to be used by professionals with protective equipment, are sometimes used in the household without any precautions. This could lead to severe chemical burns, as in the case we present with severe eyelid ectropion. This study aims to stress the need for preventive measures regarding the use of chemicals and for close observation and timely surgical intervention in chemical burn patients to prevent and limit disfigurement. A 45-year-old woman was injured while using an unblocker (90% sulfuric acid) at home. Accidentally, a quantity of the liquid was spilled on her face. She was initially examined in ophthalmology emergencies because of the obvious ocular involvement, and the cutaneous component was underestimated. On the third post-burn day, she was referred as an outpatient to our clinic, and because of the soft consistency and patchy pattern of the burn, she was asked to revisit in a week. Unfortunately, she reappeared two months post-burn with severe ectropion of all four eyelids and a high risk of corneal abrasion, desiccation, and further damage to the already injured left eye as well as the right eye. She underwent three operations in six months and a fourth 15 months after the accident, with the release of the scarred eyelids with full-thickness skin grafts, Z-plasties, and V-Y plasties. After four operations and sessions of triamcinolone acetonide intralesional injection, the patient has a satisfactory eyelid position and function with adequate closure and scar maturation. Domestic use of strong industrial chemicals is dangerous, and public education for prevention is urgently needed. On the other hand, it is mandatory to follow up very closely with chemical burn patients to prevent severe sequelae, especially in the delicate and contraction-prone periocular and perioral areas. Reconstruction, in these cases, is a complex task. Often, several surgeries are needed to restore acceptable function and appearance. Burn disfigurement and self-stigma will follow the patients to some extent throughout their lives.
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Affiliation(s)
- Sophia Papadopoulou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Eirini Nikolaidou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Andrew P Joycey
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Zoi Tzimorota
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Eleni Karagergou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
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Sabapathy SR, Shanmugakrishnan RR, Ramkumar S, Muthukumar V, Senthilkumaran M, Bharathi RR. Postburn Reconstruction of the Face and Neck. Plast Reconstr Surg 2022; 150:1326e-1339e. [DOI: 10.1097/prs.0000000000009690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Management of Pediatric Facial Burns with Zinc-Hyaluronan Gel. CHILDREN 2022; 9:children9070976. [PMID: 35883959 PMCID: PMC9323794 DOI: 10.3390/children9070976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
Zinc-hyaluronan-containing burn dressings have been associated with enhanced reepithelialization and low infection rates, although their effectiveness has not yet been investigated in pediatric facial thermal injuries. This single-arm, retrospective cohort study assessed the characteristics of 23 children (≤17-year-old) with facial superficial partial-thickness burns and the wound closure capabilities of the applied zinc-hyaluronan gel. Patients were admitted consecutively to the Pediatric Surgery Division in Pécs, Hungary, between 1 January 2016 and 15 October 2021. The mean age of the children was 6.2 years; 30.4% of them were younger than 1 year. An average of 3% total body surface was injured in the facial region and 47.8% of the patients had other areas damaged as well, most frequently the left upper limb (30.4%). The mean time until complete reepithelialization was 7.9 days and the children spent 2 days in the hospital. Wound cultures revealed normal bacterial growth in all cases and follow-up examinations found no hypertrophic scarring. In conclusion, pediatric facial superficial partial-thickness burns are prevalent during infancy and coincide with left upper limb injuries. Rapid wound closure and low complication rates are accountable for the moderate amount of hospitalization. These benefits, along with the gel’s ease of applicability and spontaneous separation, are linked to child-friendly burn care.
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Rasmussen SA, Romanowski KS, Sen S, Palmieri TL, Greenhalgh DG. Face Burns: A 4-Year Experience. J Burn Care Res 2021; 42:1076-1080. [PMID: 34136916 DOI: 10.1093/jbcr/irab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burns on the face pose unique management challenges because they are in a place that is constantly visible, so scars are hard to hide. The goal of this study was to review our experience of adult patients who had face burns. We performed a retrospective review of adult patients (≥18 years old) who were admitted to a regional burn center from July 2015 to June 2019 with face burns. Sex, age, ethnicity, burn etiology, burn size, and discharge status were collected from electronic medical records of the patients who met study criteria. Descriptive statistics, Student's t-tests, and chi-square tests were performed in Stata/SE 16.1. Significance was defined as a P-value < .05. In 4 years, 595/1705 patients (~35% of admissions) were admitted with face burns. The mean age was 44.9 ± 17.0 (mean ± SD) years, with the majority being men (475, 80%). The mean burn size was 19.8 ± 20.9% TBSA with 10.1 ± 19.8% TBSA being third degree. The mean head burn size for any face burn was 2.8 ± 1.8% TBSA. The majority of burns were due to flames (478, 80%) and of those 122 (21%) were from accelerant use and 43 (7%) resulted from propane or butane use. Scalds caused 53 (9%), electric 25 (4%), hot tar 5 (1%), and chemical 5 (1%). Overall, 208 (35%) patients had grafting of some portion of their body, but only 31 patients (5.2%) had face grafting. The mean age of those with face grafting compared with patients who did not need grafting was 45.9 ± 13.8 and 44.9 ± 17.2 years, respectively. Patients who needed grafting had a mean third-degree burn size of 31.7 ± 25.4% TBSA and a mean head (including face) burn size of 4.7 ± 2.0% TBSA, whereas patients who did not need grafting had a mean third-degree burn size of 8.9 ± 18.7% TBSA and a mean head burn size of 2.7 ± 1.8% head TBSA. Patients requiring face grafts had longer lengths of stay, intensive unit stays, ventilator days, and mortality than those whose face burns healed spontaneously. Overall, head burns in adults were common within the 4-year time span we studied, but only a small fraction (5%) had face grafts. The patients who needed grafting for their head burns had significantly larger total body and face burns and had a 2.4-fold higher mortality rate compared to patients who did not need grafting. Most face burns were caused by flame, especially the use of accelerants or flammable gases. Prevention efforts should focus on avoiding the use of accelerants and being careful with flammable gases.
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Affiliation(s)
| | - Kathleen S Romanowski
- Shriners Hospitals for Children Northern California and Firefighters Regional Burn Center at University of California, Davis, Sacramento, USA
| | - Soman Sen
- Shriners Hospitals for Children Northern California and Firefighters Regional Burn Center at University of California, Davis, Sacramento, USA
| | - Tina L Palmieri
- Shriners Hospitals for Children Northern California and Firefighters Regional Burn Center at University of California, Davis, Sacramento, USA
| | - David G Greenhalgh
- Shriners Hospitals for Children Northern California and Firefighters Regional Burn Center at University of California, Davis, Sacramento, USA
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Management of facial burns: an update. Curr Opin Otolaryngol Head Neck Surg 2021; 29:299-303. [PMID: 34183560 DOI: 10.1097/moo.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews literature on the recent progress made on management of facial burns. The discussion focuses on those aspects of the management in which recent studies brought new ideas, and reviews some that failed to change practices in the management of facial burns. RECENT FINDINGS Recent innovations and models have been proposed in an attempt to reduce the incidence of unnecessary intubations in patients with burns to the face and with suspected inhalational injury. However, the decision to secure the airway is still a challenging one. A new escharotomy method based on facial subunits principles has been described, while the practice of early tangential excision is still debated in the literature. Tarsorrhaphy without occluding the eyes has also been described in the management of peri-oral burns. Self-retaining and expandable stents for the nose have also been demonstrated to be effective in preventing nasal stenosis. 3D printed face masks have been more recently developed to improve the current wound-care methods used in facial scar management. SUMMARY This article highlights recent developments in the management of facial burns in areas such as acute facial burn care, subsequent wound care and facial scar management. It highlights areas wherein progress has been made, as well as the need for further studies in certain areas.
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