Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.
Biodegradable Temporising Matrix (BTM), a skin substitute, has been recently developed as a novel adjunct to the plastic surgeon’s reconstructive repertoire. Its use has been described in literature in a variety of settings and complex wounds, including those that previously would have been described as “non-graftable”, with favourable outcomes. We present the case of a patient with a wound to the right foot and ankle following extravasation injury. Following surgical debridement, this injury was managed with BTM, which allowed granulation and production of a “neo-dermis”. A split-thickness skin graft was subsequently applied. The characteristics of the BTM allowed the resulting skin graft and scar to be pliable, avoiding tendon tethering and joint contracture. To the authors’ knowledge, this skin substitute has not been reported in a wound of this aetiology before. It is our hope that this report will provide evidence to colleagues that this is a valuable adjunct that may be used in complex wounds.
Level of evidence: Level V, therapeutic study.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00238-022-01964-z.
Background
There were 142,101 new cases of non-melanomatous skin cancers reported by the UK National Cancer Statistics in 2015. The UK statistics published that the incidence is highest in the 90+ population and that this represented an overall 61% increase in skin cancer incidence in the UK in the last decade. This article aims to first provide an understanding of the change in service requirement over the last 25 years for skin cancer management in nonagenarians, and second, understand the subtypes of skin cancer and possible differences in the management for this cohort.
Methods
All skin cancer biopsies received by a UK university teaching hospital dermato-histopathology department were analysed over a five-year period spanning 2013–2017. This was compared with snap shot data at five-year intervals dating back to 1993. The patient demographics including age, sex and anatomical region were seen along with the types of skin cancers and histological subtypes.
Results
A total of 1050 skin cancers were managed with surgical input between January 2013 and December 2017 in 733 patients. The number of biopsies/year has increased 7-fold from 1993 (33) to 2017 (231). The annual cost of the surgical element to this service has dramatically increased, and in 2017, it was £220k compared to £33k in 1993.
Conclusion
Partly because of the ageing UK population, there has been a dramatic increase in the demand on the surgical service regarding managing skin cancers in those over the age of 90. There is a higher rate of incomplete excision in this population than that reported in the national British Association of Dermatologists (BAD) guidelines. Despite higher incomplete excision rates, there is a low re-operation rate in this population probably due to patient comorbidities affecting reconstructive options, patient preference and clinical decisions on surgical morbidity versus benefit.
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