The Effect of Facial Burns on Long-Term Outcomes in Young Adults: A 5-Year Study

Burn injury and fear of rejection: A qualitative study

INTRODUCTION

One of the most important duties of the members of the treatment team is to pay attention to the mental, psychological, and social aspects of burn patients. One of the concerns of these patients during their stay in the hospital is the fear of rejection. The objective of this research is to examine the concept of 'fear of rejection' among patients hospitalized with burn injuries.

METHOD

This study was conducted between January 2023 and March 2024 in Hamadan, Iran, employing a qualitative content-analysis approach. The study enrolled sixteen patients, and data were collected through deep and semi-structured interviews. The data were then analyzed using the conventional content-analysis approach developed by Graneheim and Lundman.

RESULTS

A group of 16 patients, comprising an equal number of men and women, were interviewed for this study. Based on the data obtained from these interviews, negative brainstorming, frustration, fear of permanent physical disabilities, occupational and financial challenges were identified as categories; visualization of a foggy future and inability in performance of roles emerged as the two themes.

CONCLUSION

Based on the results of this study, it can be said that the fear of social rejection, characterized by an inability to perform roles and the visualization of a foggy future, significantly affects the psychological and physical health of burn patients, potentially delaying their recovery. Assisting these patients in reaching their fullest potential to contribute to society post-discharge, and fostering optimism for a promising future, constitute a paramount aspect of daily care and ongoing support.

Outcome of Facial Burn Injuries Treated by a Nanofibrous Temporary Epidermal Layer

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.

The Impact of Burn Size on Community Participation: A Life Impact Burn Recovery Evaluation (LIBRE) Study

OBJECTIVE

To assess the association of burn size and community participation as measured by the LIBRE Profile.

SUMMARY OF BACKGROUND DATA

Burn size is an established clinical predictor of survival after burn injury. It is often a factor in guiding decisions surrounding early medical interventions; however, literature is inconclusive on its relationship to quality of life outcomes.

METHODS

This is a secondary data analysis of a cross-sectional survey of adult burn survivors. Self-reported data were collected between October 2014 and December 2015 from 601 burn survivors aged ≥18 years with ≥5% total body surface area (TBSA) or burns to critical areas. Sociodemographic characteristics were compared between participants with small burns (≤40% TBSA burned) and large burns (>40% TBSA burned). Ordinary least squares regression models examined associations between burn size and LIBRE Profile scale scores with adjustments for sex, current work status, burns to critical areas, and time since burn injury.

RESULTS

The analytic sample comprised 562 participants with data available for burn size. 42% of respondents had large burns (>40% TBSA burned) and 58% reported smaller burns (TBSA ≤40%). In adjusted regression models, patients with large burns tended to score lower on the Social Activities and Work & Employment scales ( P < 0.05) and higher on the Family & Friends scale ( P < 0.05). Participants with burns >40% TBSA scored lower for several individual items in the Social Activities scale and one item in the Work & Employment scale ( P < 0.05).

CONCLUSIONS

Increasing burn size was found to be negatively associated with selected items of Work & Employment and Social Activities, but positively associated with aspects of Family & Friend Relationships. Future longitudinal studies are necessary to assess and understand the long-term social impact of burn injuries on adult populations.

Investigation of the relationship between social appearance anxiety and perceived social support in patients with burns

INTRODUCTION

Since burns affect body image, they cause appearance anxiety. Interventions designed to reduce appearance anxiety that can cause psychological problems such as depression are important. This study aimed to determine the social appearance anxiety of individuals following burns and the factors affecting it and to examine the relationship between social appearance anxiety and perceived social support.

METHODS

This descriptive study was conducted between November 2018 and November 2019 with 106 adult patients with burns. Data were collected using a Personal Information Form, the Social Appearance Anxiety Scale, and the Multidimensional Scale of Perceived Social Support. Shapiro-Wilk test, Independent Two Samples T-Test, One Way Analysis of Variance, Duncan's test, Pearson's correlation analysis, multiple linear regression analysis, the Q-Q plot, and the Durbin-Watson statistics were used in data analysis.

RESULTS

The social appearance anxiety scores were moderate (39.38 ± 17.71). Being single; having a high level of education; burns on the face, head, or neck; burn-related amputation; and passing the one-week after injury period were found to significantly increase social appearance anxiety (p < 0.05). Although the perceived social support scores of the individuals with burns were high (68.34 ± 18.08), they were found to have no correlation with social appearance anxiety (p > 0.05).

CONCLUSIONS

The results of this study show that social support does not affect social appearance anxiety. In this respect, we recommend that interventions such as reconstruction and professional psychological support initiatives be prioritized for individuals with burn trauma who are evaluated to have high social appearance anxiety by the appearance anxiety scales.

Adolescents with and without head and neck burns: comparison of long-term outcomes in the burn model system national database

INTRODUCTION

Facial burns account for persistent differences in psychosocial functioning in adult burn survivors. Although adolescent burn survivors experience myriad chronic sequelae, little is known about the effect of facial injuries. This study examines differences in long-term outcomes with and without head and neck involvement.

METHODS

Data collected for 392 burn survivors between 14-17.9 years of age from the Burn Model System National Database (2006-2015) were analyzed. Comparisons were made between two groups based on presence of a head and neck burn (H&N) using the following patient reported outcome measures: Satisfaction with Appearance Scale, Satisfaction with Life Scale, Community Integration Questionnaire, and Short Form-12 Health Survey at 6, 12, and 24 months after injury. Regression analyses were used to assess association between outcome measures and H&N group at 12-months.

RESULTS

The H&N group had more extensive burns, had longer hospital stays, were more likely to be burned by fire/flame and were more likely to be Hispanic compared to the non-H&N group. Regression analysis found that H&N burn status was associated with worse SWAP scores. No significant associations were found between H&N burn status and other outcome measures.

CONCLUSIONS

Adolescents with H&N burn status showed significantly worse satisfaction with appearance at 12-months after injury. Future research should examine interventions to help improve body image and coping for adolescent burn survivors with head and neck burns.

Management of facial burns: an update

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.

Appearance Concerns, Psychosocial Outcomes, and the Feasibility of Implementing an Online Intervention for Adolescents Receiving Outpatient Burn Care

The current study assessed the prevalence of appearance concerns, psychosocial difficulty, and use of an appearance-focused social and psychological support resource (Young Person's Face IT; YPF) within a population of teens (12-17 year-olds) receiving outpatient burn care with the goal to assess the feasibility of routine use of the resource in outpatient burn care. The study sample included 78 patients ages 12 to 17 receiving outpatient care for burns at one hospital. Appearance concerns were measured via the Burn Outcomes Questionnaire Appearance Subscale, the Appearance Subscale of the Body Esteem Scale for Adolescents, and a 2-part question which asked participants directly about appearance concerns related to the burn injury. A large majority (70.0%) of study participants reported appearance concerns on at least one appearance measure and girls reported more burn-related appearance concerns compared with boys. Psychosocial difficulty was measured via the Pediatric Symptom Checklist-17 (PSC-17) and measures of social functioning were collected and compared within the sample by burn size, burn location, sex, and appearance concerns. Internalizing symptoms were prevalent on the PSC-17 (18.6% risk) and decreased self-worth and increased social anxiety symptoms were significantly associated with having appearance concerns. Although interest in YPF was high (78.3%), actual use of the resource among those who signed up to pilot it (n = 46 participants) was low (19.4% use). Results indicate that there is a need for and interest in appearance-focused social anxiety resources for adolescents with burn injuries such as YPF, but more research is needed to understand its feasibility in clinical practice.

Management of facial burns

Burns to the face affect a part of the body that cannot be hidden and thus exposes potentially major changes in appearance to society. Therefore, it is incumbent upon the caregiver to optimize healing and minimize scarring. The goal for partial-thickness burns is to have them heal within 2-3 weeks to minimize healing time. For full-thickness burns there needs to be strategies to optimize the outcomes for skin grafting and minimize scarring. The goal of this review is to discuss the best way to improve the outcomes of these devastating injuries.

Introduction to the NIDILRR Burn Model System (BMS) Program: Selected Findings II

A special supplement to the Archives of Physical Medicine and Rehabilitation in 2007 reported selected findings of research from the first 13 years of the BMS Centers and Database Coordinating Center. This special supplement is the second such effort and reports on the growth of the BMS National Longitudinal Database (BMS NDB) since that time and select new research findings from the BMS centers.

The Associations of Gender With Social Participation of Burn Survivors: A Life Impact Burn Recovery Evaluation Profile Study

Burn injury can be debilitating and affect survivors' quality of life in a profound fashion. Burn injury may also lead to serious psychosocial challenges that have not been adequately studied and addressed. Specifically, there has been limited research into the associations of burn injury on community reintegration based on gender. This work analyzed data from 601 burn survivors who completed field testing of a new measure of social participation for burn survivors, the Life Impact Burn Recovery Evaluation (LIBRE) Profile. Differences in item responses between men and women were examined. Scores on the six LIBRE Profile scales were then compared between men and women using analysis of variance and adjusted linear multivariate regression modeling. Overall, men scored significantly better than women on four of the six LIBRE Profile scales: Sexual Relationships, Social Interactions, Work & Employment, and Romantic Relationships. Differences were not substantially reduced after adjustment for demographic characteristics and burn size. Men scored better than women in most of the areas measured by the LIBRE Profile. These gender differences are potentially important for managing burn patients during the post-injury recovery period.