Management of third-degree facial burns remains one of the most difficult challenges in burn care. Patients with deep facial burns usually require gradual escharectomy, tangential excision of the wound, and resurfacing with full-thickness skin grafts or dermal substitutes associated with split-thickness skin grafts to provide better and superior cosmetic results. Immobilization of skin grafts and dermal substitutes by reducing shearing forces and hematoma formation underneath is paramount to improve success rates. Due to the irregular shape of the face, the proper immobilization of grafts with traditional methods is often difficult, especially over concave portions of the face. Herein, we report the original use of a custom three-dimensional printing facemask for securing dermal substitutes and skin grafts to difficult sites on the face.

Introduction Management of scalp pressure ulcers (SPU) in patients admitted to intensive care units (ICU) remains a challenge. The impossibility of freely moving the head due to different factors such as the intubation, enteral nutrition, dialysis and use of extracorporeal membrane oxygenation among others, makes the management of these wounds problematic. Herein, we present our early clinical experience in the treatment of SPU with a novel aerosol formulation of silver sulfadiazine. Methods A prospective study including all patients with SPU who were treated with an aerosol formula that includes silver sulfadiazine, lidocaine and vitamin A was carried out. Wound dressings were changed every 12h and consisted in wound cleansing, aerosol application and occlusion with sterile gauze. Evolution of each SPU was controlled with pictures and measures on the affected area every 48 hours. In order to determine the total wound area, pictures were analyzed using the Informatics Image System from the U.S National Institute of Health. Results Six patients were prospectively followed and were included in this study. There were 2 females and 4 males. Average age was 70.8 years (range 41–99), while average hospital stay in the ICU was 14 days (range 5–22). None of these patients experienced wound progression to a more critical stage. One patient had a favorable evolution from stage IV to stage II. Also, none of them showed clinical signs of a local infection of the SPU. The average quantity of aerosol used per dressing was 1.3 ml which represents 2,6 mm/day and a cost of A$106,16 (U$S 1,45). As the cost of hydrocolloid dressings, at our institution, is A$602 per dressing (U$S 8,24), this represented an important saving in costs. Conclusions In this case series, the use of this novel aerosol formulation of silver sulfadiazine has shown promising results in the treatment of SPU in patients admitted to ICU, facilitating the application and saving costs. Further and larger studies to confirm our encouraging preliminary results are warranted.

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