Clinics in Plastic Surgery

Burn injuries pose one of the greatest challenges to health care professionals worldwide, requiring a multidisciplinary approach for optimal patient care. We are constantly reminded of the sheer resilience of the human spirit in the face of unimaginable pain and adversity experienced by these patients. It is with great passion and dedication that health care professionals strive to make a difference in the lives of those who have faced the inferno of acute burn injuries. This issue is dedicated to all the exceptional members of the burn team that deliver such incredible care with empathy, compassion, and unwavering commitment to our patients' well-being...

No abstract text is available yet for this article.

Large burns provoke profound pathophysiological changes. Survival rates of patients with large burns have improved significantly with the advancement of critical care and adaptation of early excision protocols. Nevertheless, care of large burn wounds remains challenging secondary to limited donor sites, prolonged time to wound closure, and immunosuppression. The development of skin substitutes and new grafting techniques decreased time to wound closure. Individually, these methods have limited success, but a combination of them may yield more successful outcomes...

Burns in the elderly are a significant cause of morbidity and mortality. Frailty is an important indicator of patient health and physiologic reserve. Comorbidities and typical age-related changes significantly impact the outcomes of elderly burn patients and decisions made during their burn care. It is essential to have early and thorough discussions about the goals of care and rehabilitation plans. Physiologic changes that occur from aging cause slower wound healing and may make operative treatment more challenging, although techniques such as autographing, skin substitutes, and flaps may all play a role in treating this patient population...

Cold-induced injuries are a major challenge for burn surgeons, leading to significant sequelae for the patients including amputations, long-term disability, and death. Rapid assessment and diagnosis are essential for optimal outcomes. Various therapies have emerged to improve outcomes. Topical, oral, and intravenous agents have shown to minimize the impact of cold-induced injuries. Thrombolytics have shown the greatest promise in improving tissue perfusion outcomes in cold-induced injuries. This article provides an update on the evidence-based assessment and management of cold-induced injuries, as well as reviews outcomes and future directions of this challenging pathology...

Burn-related pain can contribute to decreased quality of life and long-term morbidity, limiting functional recovery. Burn-related pain should be assessed first by chronicity (acute or chronic), followed by type (nociceptive, neuropathic, nociplastic), to guide multimodal pharmacologic management in a stepwise algorithm approach. Combination therapies increase the efficacy and reduce toxicity by offering a multimodal approach that targets different receptors in the peripheral nervous system and central nervous system...

The leading cause of morbidity in burn patients is infection with pneumonia, urinary tract infection, cellulitis, and wound infection being the most common cause. High mortality is due to the immunocompromised status of patients and abundance of multidrug-resistant organisms in burn units. Despite the criteria set forth by American Association of Burn, the diagnosis and treatment of burn infections are not always straightforward. Topical antimicrobials, isolation, hygiene, and personal protective equipment are common preventive measures...

Coverage of burn wounds is crucial to prevent sequalae including dehydration, wound infection, sepsis, shock, scarring, and contracture. To this end, numerous temporary and permanent options for coverage of burn wounds have been described. Temporary options for burn coverage include synthetic dressings, allografts, and xenografts. Permanent burn coverage can be achieved through skin substitutes, cultured epithelial autograft, ReCell, amnion, and autografting. Here, we aim to summarize the available options for burn coverage, as well as important considerations that must be made when choosing the best reconstructive option for a particular patient...

Burn injuries affect patients of all ages, and timely surgical debridement and excision commence to protect dermal vascularity and integrity, improve healing, and minimize scarring. Several tools may be used for burn wound excision, which is performed either tangentially or down to muscular fascia. Once wounds are optimized from a tissue viability and healing standpoint, coverage may be obtained through grafts or secondary intention healing for more superficial injuries. A collaborative team of plastic and general surgeons, anesthesiologists, nutritionists, and therapists can provide improved patient care throughout the perioperative period, leading to improvements in overall patient morbidity and mortality...

Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.

Acute burn injury creates a complex and multifactorial local response which may have systemic sequelae such as hypovolemia, hypothermia, cardiovascular collapse, hypercoagulability, and multi-system organ failure. Understanding the underlying pathophysiology of burn shock, the initial burn triage and assessment, calculation of fluid requirements, and the means of tailoring ongoing interventions to optimize resuscitation are critical for overcoming the wide spectrum of derangements which this condition creates...

Burn care evolved slowly from primitive treatments depicted in cave drawings 3500 years ago to a vibrant medical specialty which has made remarkable progress over the past 200 years. This evolution involved all areas of burn care including superficial dressings, wound assessment, fluid resuscitation, infection control, pathophysiology, nutritional support, burn surgery, and inhalation injury. Major advances that contributed to current standards of care and improved outcomes are highlighted in this article. New innovations are making possible a future where severe burn injuries will require less morbid interventions for acute care and outcomes will restore patients more closely to their pre-injury condition...

No abstract text is available yet for this article.

Body contouring surgeons encounter a wide range of deformities affecting multiple areas of the body. Combining and staging procedures can assist in optimizing outcomes, but there is no one-size-fits-all approach to surgical sequencing and timing. A meticulous, individualized approach to preoperative planning can lead to reliable, aesthetically pleasing results that align with the patient's goals and preferences. In this article, we present our latest ideas on circumferential body contouring surgery and discuss the integration of lower body lift procedures with those of the abdomen, upper body, breasts, back, and arms to create a comprehensive 360° transformation...

Body contouring for weight loss patients usually requires not only lifting but also some extent of central body tightening to achieve complete tissue readjustment. Fleur-de-lis abdominoplasty provides best vector correction with nice contouring results, especially for central body type patients, with superior waist definition with or without associated circumferential belt lipectomies. Special interest has been addressed on technical refinements to enhance vertical scar with neoumbilicoplasty as well as the mons pubis projection with marking and suturing refinements...

TULUA is an effective non-undermined lipoabdominoplasty with a low transverse wide plication of the rectus fascia that allows aggressive liposuction. For an esthetic 360° torso reshaping, oblique flankplasty, also without undermining, is added to correct sagging flanks, raise the lateral buttocks and thighs, and transversely tighten the abdomen. The indications, limitations, technique, and postoperative care are presented.

The present article discusses the evaluation and surgical planning of body contouring procedures for weight loss patients. These patients require thorough preoperative evaluation and patient education. Distinction should be made between massive weight loss and moderate medication-assisted weight loss (MMA) as these patient populations are managed differently and there are unique preoperative considerations with the MMA population. Given that weight loss patients often have multiple concerns, combination procedures are often utilized and must be planned with the patient's goals and safety in mind...

Abdominoplasty has evolved in the last few decades, especially the treatment of the myoaponeurotic deformities. Bulging, lack of definition of the abdominal contour, should be understood and treated according to the individual deformity. Many types of deformities have been recognized and treatment respects the local anatomy in most cases. Scientific basis that consolidate these treatments are discussed as well as possible recurrences and pitfalls of these techniques. The histological composition of muscles and fascia are also discussed and anatomical details help to enrich the knowledge of the correction of this layer...

There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons. LADE-lipoabdominoplasty (LAP) with anatomical definition-is a step ahead of the traditional LAP technique. This technique incorporated the principles of highlighting the definition of the abdominal musculature, achieving more natural results with fewer reminders of a surgical intervention. The esthetic results are much harmonious, with a true abdominal rejuvenated appearance...

The practice of large volume liposuction, when executed by board-certified plastic surgeons using a variety of energy-assisted liposuction devices, has been substantiated as a secure procedure, yielding enhanced aesthetic results and minimal complications. Techniques including the superwet technique and ultrasonic-assisted liposuction are utilized to diminish blood loss, while also maintaining a keen awareness of the maximum volume of infiltration fluid permissible for safe infusion. Adherence to evidence-based protocols is of paramount importance to reduce the risk of postoperative complications...