![]() Fresh epithelialization appeared on the edge of the other wounds. Underneath, new epithelialized skin appeared. ![]() On the 24 th day of life, a black crust of 2×1.5 cm was removed at the lateral foot margin. The subsequent dressing changes were performed in an outpatient setting. Thanks to the resulting improvement of the local findings, the patient was discharged in good general condition from the inpatient care on the 22 nd day of life. Lateralization of the toenail and complete re-epithelialization Lateral foot margin three months after burn. To minimize scar contracture, the small toe was carefully placed in neutral-position during dressing changes and underlaid with Adaptic® at the flexion fold. Dressing changes with Adaptic® were carried out in 48-hour intervals. The parents were informed about the baby’s possible loss of the big and small toe. In addition, antibiotic prophylaxis with cefuroxime was initiated at the 7 th postnatal day. ![]() As a radical debridement would possibly have extended to the base joints of the toes and the heel bone, the necrosis plates were left in place. The extent of the necrosis in the depths of the small toe could not be estimated at this point. The tip of the big toe and the 3 rd toe, the lateral half of the small toe, the lateral foot margin and a region of 2×2 cm at the heel were necrotic. Dry necroses occurred in the burnt areas. Two days later, the wound had deteriorated. Since the debridement was already performed, we started a conservative treatment with Adaptic® (Systagenix Wound Management Limited, Gatwick, UK)- a small mesh sized non-adhering dressing made of cellulose acetate fabric and impregnated with petrolatum emulsion. The extent of the burn was about 1% of the body surface. We found superficial partial, deep partial and full thickness burning areas on the plantar forefoot, the toes, the lateral foot edge and on the heel. On the 4 th postnatal day, our division was consulted. The blisters were removed at the Department of Pediatrics and treated with Jelonet TM (Smith & Nephew plc, London, UK) a sterile Paraffin-impregnated gauze. Warming the heel for capillary blood gas control on the 2 nd postnatal day with a heat pad caused severe burns on the left foot. The patient was released by caesarian section and the postnatal adjustment went without problems. 3 We report our experience with a newborn child who was treated by us because of an iatrogenic second to third-degree burn on the left foot. Simple application and cost-effectiveness are also important factors. The task of wound dressings is to prevent transdermal fluid loss and infections and to enable re-epithelialization as well as possible pain-free dressing changes. 5 The local standard therapy for high-grade burns includes immediate debridement and coverage with suitable dressings. ![]() 2 Burns in newborns, however, are rare and occur mainly in hospital setting. Children aged 0 to 3 years is the group (69.4%) who is most likely to suffer burns. 4 The most common burned region in children is the trunk (23.4%), followed by the hand (18.8%). In 2013, the rate of burn mortality in children aged 1 to14 years was 2.5 per 100.000 worldwide, whereas in the high-income Organisation for Economic Co-operation and Development (OECD) area, it was only 0.4. In most cases high-grade burns affect relatively small percentages of the skin surface. In superficial burns, no marked scarring is to be expected. The healing of such wounds usually takes 2 to 3 weeks. 1 Depending on exposure time and intensity, the thermal damage can affect purely the superficial papillary as well as the deep reticular dermis. In order to eliminate a scar contracture, we carried out a Z-plasty one year later.īurns in children can have far more serious consequences than in adults, since even small burns already occupy a large percentage of the body surface. To our knowledge, this is the first case report dealing with initial non-surgical combustion therapy in a newborn. New findings in stem cell research indicate that the high proportion of mesenchymal stem cells (MSC) in postnatal blood is also involved in the regeneration and healing of burns. Modern wound treatment following the principle of less frequent dressing changes allows the burn wound to have better re-epithelialization. After an initial debridement and 32 days of non-surgical wound therapy with Adaptic® fat gauze dressings, we were able to achieve an aesthetically and functionally satisfactory result including the complete preservation of all toes. The burns covered an estimated 1% of the total body surface area (TBSA). This report examines a case of accidental second to third-degree burning of the heel and toes on the left foot in a new-born girl. Since these patients are rare, there is little experience and no existing standardized treatment. Burn injuries in newborns are particularly complex cases.
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