Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. A literature search was conducted with priority given to review articles, meta-analyses and well-designed large trials; paediatric studies were included where adult studies were lacking with the aim to review the advances in adult intensive care burn management and place them in the general context of day-to-day practical burn management.

Introduction ‘Mersey Burns App’ is a smartphone/tablet application that aids in the assessment of total burn surface area (TBSA) and calculation of fluid resuscitation protocols in burns. This paper presents two studies assessing the speed and accuracy of calculations using Mersey Burns (App) in comparison with a Lund and Browder chart (paper) when a burn is assessed by medical students and clinicians. Methods The first study compared the speed and accuracy of TBSA and resuscitation calculation for a photograph of a burn with App and paper using burns and plastics and emergency medicine trainees and consultants. Developing on some of the feedback and results of that study, a second study was then carried out using burns-naive medical students assessing a fully simulated burn with both modalities. Preference and ease of use of each modality were assessed anonymously. Results The clinician study showed a lower variance in TBSA and fluid calculations using the App (p<0.05). The student study showed no difference in mean TBSA estimations (p=0.7). Mean time to completion of calculations was faster and calculations were more likely to be correct with the App (p<0.001). Students favoured the App in the following categories: preference in emergency setting, confidence in output, accuracy, speed, ease of calculation, overall use and shading (p<0.0001). Conclusions Mersey Burns App can facilitate quicker and more accurate calculations than Lund and Browder charts. Students also preferred the App. This suggests a useful role for the App in the care of patients with burns by inexperienced staff.

Many decellularized dermal matrices are available with various applications, all with slight differences. AlloDerm appears to have the greatest presence in the literature. The purpose of this systematic review is to provide an overview of the experience with AlloDerm, stratified by clinical indication. A literature search was performed across Medline, EMBASE, and the Cochrane Collaboration using the search terms "AlloDerm" and "acellular dermal matrix." Two independent authors applied a priori inclusion and exclusion criteria. Relevant articles were categorized by application, type of study, and evidence level. A total of 753 articles met the initial inclusion criteria, and 311 remained after discarding irrelevant articles: skin (25), head and neck (82), breast (34), trunk (66), pelvis (10), extremities (8), and basic science (86). Non-basic science study designs included 32 analytic articles (3 randomized controlled trials and 29 observational studies including 11 cohort studies, 1 cross-sectional study, and 17 case-controlled studies), 192 descriptive articles (106 case series, 51 case reports, 2 cross-sectional studies, and 33 qualitative studies), and 1 systematic review. More than 85% of articles had a level of evidence of 4 or 5. Articles showed outcomes that were 70% positive, 23% neutral, and 7% negative. AlloDerm has many clinical uses with promising results. Most evidence lies in descriptive and nonrandomized studies, but randomized trials are emerging. Cost and logistics of large trials with these products make large-scale trials challenging but necessary. Emphasis needs to shift to randomized controlled trials focusing on areas where most clinical benefit can be realized.

Significant controversy surrounds the effectiveness of negative pressure wound therapy although it has been in use for decades. Although many clinicians favor this modality in relation to its practicality, ease of use especially in complex wounds, it has faced the same challenges as other dressings in relation to evidence base of efficacy in relation to a number of outcome measures. In view of the current financial pressures on health care systems worldwide, this structured review systematically challenges the evidence for perioperative application of topical negative pressure (TNP) to split-thickness skin grafts (STSGs) through evidence-based critical appraisal, and extrapolate the mechanisms of action on the mechanisms through which TNP may aid wound healing. Weighted evidence-based recommendations regarding the impact of TNP on split skin graft quality and quantity of take as outcomes. Phase 1: Structured literature search. Phase 2: Retrieved articles were critically appraised for rigor and methodological validity by 3 independent authors, then stratified according to a validated "levels of evidence" framework. Graded "current best evidence" recommendations could therefore be proposed. Of the 220 studies retrieved in the initial search, 38 studies satisfied our quality of evidence criteria. Current best evidence supports 2 complementary trends explaining the mechanisms whereby STSG benefits from TNP. Active stimulation of epithelial mitosis: TNP creates mechanical stretch which stimulates multiple signaling pathways up-regulating growth- and mitosis-associated epithelial transcription factors. Topical negative pressure also promotes microcirculatory flow (graft and wound edge), stimulates angiogenesis and basement membrane integrity (grade C). Prevention of complications: significant reduction of graft lift-off by edema, exudates, subgraft hematoma, and reduction of shear when compared to traditional dressings (grade B). Topical negative pressure promotes significant qualitative improvement in the final STSG result studies (level 1B). The role of TNP in prevention of infection is, however, equivocal and further research is required. No evidence of harm from TNP application was reported. Topical negative pressure increases quantity and quality of split skin graft take compared to traditional bolster dressings. The advantages are increased in irregularly contoured, technically difficult wounds and suboptimal recipient wound beds where it seems to be the best modality currently available. Large-scale randomized clinical controlled trials remain scanty in all areas of wound dressing research including negative pressure therapy.

Objective: To investigate the accuracy of assessment of burn surface area and depth using a basic camera-equipped mobile phone. Methods: 31 patients with minor burns were assessed at the Welsh Centre for Burns & Plastic Surgery. Results: A high correlation was found between assessment of burn surface area and burn depth using a camera mobile phone compared with a live assessment. Conclusion: There are a number of implications for the use of mobile phone technology in hospitals and its potential use in the management of major in addition to minor burns, as well as other forms of trauma. The untapped potential for this technology in a hospital environment is highlighted.