Purpose: This study aimed to characterize the injuries involving periorbital region in our severely burned patients. Method: A 2 years retrospective study was conducted with a total of 210 severe burns admissions. Periorbital burn injuries (all produced in association with facial injuries) were encountered in 126 patients, representing the study group that was further analyzed for multiple parameters: demographics, mechanism of injury, TBSA (total body surface area), burn depth, inhalation injury, need for intubation and mechanical ventilation. The presence and severity of ocular injuries were also evaluated. Results: Analyzing our study group (n=126), we observed the presence of multiple negative prognosis factors: elderly patients, extensive burns, deep burns affecting functional areas, unfavorable mechanism (electric, chemical or explosions), inhalation injuries, need for intubation and mechanical ventilation, leading to severe morbidity and high mortality level. Ocular injuries were encountered in 37 patients (30 primary and 7 secondary lesions). The predominance of primary ocular lesions is explained trough high severity burns encountered in our patients with high mortality and lack of long-term clinical observations. Conclusion: The clinical outcome for periorbital burn injuries depends on patient characteristics, etiology, burn extension and depth, associated lesions, infectious risk and the quality of the treatment applied. Presence of ocular injuries in various severity degrees impose an adequate evaluation and specialized treatment, being associated with important morbidity. In severely burned patients, it is mandatory to apply preventive measures to avoid ocular complications. If exposure keratopathy is detected, prompt ophthalmologic treatment is essential to avoid functional impairment including loss of vision. Abbreviations: TBSA = total body surface area, MSOF = multisystem organ failure, OCS = orbital compartment syndrome, AION = anterior ischemic optic neuropathy

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Peripheral nerve lesions represent debilitating conditions that determine sensitive, motor and associated psychosocial losses, deeply and severely affecting the quality of life. Despite adequate microsurgical repair, functional results are variable and often dissatisfying. This study aimed to analyse and discuss peripheral nerve lesion cases from our clinic, involving the upper limb, an anatomical segment with impactful functional importance. We followed the distribution of nerve lesions throughout a three-year period, describing the patients’ characteristics and the therapeutic protocols. Furthermore, we reviewed the relevant literature to identify potential therapeutic strategies that may help optimize functional results. In the presented clinical study, most of the patients benefited from direct microsurgical repair of the nerve injury. However, we had a series of cases of nerve defects that could not be approached with primary repair. When a nerve cannot be repaired by direct neurorrhaphy, there are different options for bridging the nerve gap, each with its indications and advantages. Autografts still represent the gold standard in treating nerve gaps, but other procedures, such as vascularized nerve grafting, nerve conduits, allografts and nerve transfers, can be successfully used in some cases. The current focus in the field is the development of nerve conduits. Textile technologies represent a promising field in creating nerve conduits, given the ease of the manufacturing process, the affordable production cost and good mechanical properties.

Abrikossoff tumors, also known as granular cell tumors (GCT), originate from Schwann cells. The most common location is in the oral cavity, followed by the skin, but they can also be found in the breast, digestive tract, tracheobronchial tree, or central nervous system. They can affect both sexes at any age, with a higher incidence between 30 and 50 years and a slight predisposition for female sex. They are usually solitary tumors but may also be multifocal. Most of the time, they are benign, with malignancy being exceptional in <2% of cases. Clinically, they appear as solid, well-defined, painless tumors, located subcutaneously with dimensions that can reach up to 10 cm. The definitive diagnosis is based on the immunohistochemical examination, and the treatment for benign tumors consists of surgical excision. Chemotherapy or radiotherapy may be required for malignant lesions, but the treatment regimens and their benefits remain unclear. This manuscript presents the case of a 12-year-old girl with a benign GCT, located in the skin on the mandibular line.

Major burn is considered the most severe type of injury, with high mortality risk and poor quality of life prognosis for survivors. Appropriate burn wound management may require multiple treatment modalities, with specifi c sequencing particular to each patient, addressing every injured area depending on burn surface and depth, patient's general status and also available infrastructure and burn center resources. Early excision of burn eschar and grafting with autologous split-thickness skin grafts remains the universal standard of surgical burn care in acute phase. Ongoing research is conducted for developing new skin substitutes that meet the ethical, safety effi ciency and economical criteria in order to obtain adequate wound coverage when autologous skin grafts are not available. Each severe burned patient represents a complex case, requiring long-term multiple-stage and interdisciplinary treatment, adequate rehabilitation and follow-up program to obtain optimal functional results and socio-professional reinsertion. RezumatArsurile majore reprezintä cel mai grav tip de traumatism, cu risc mare de deces și prognostic rezervat în ceea ce privește calitatea vieţii supravieţuitorilor. Abordarea terapeuticä a leziunilor postcombustionale implicä un tratament multimodal, specifi c fi ecărui pacient, în funcţie de suprafaţa și profunzimea leziunilor, starea generală a pacientului cât și infrastructura și resursele existente în cadrul unităţii de îngrijire a pacientului ars. Excizia grefară precoce cu autogrefe de piele liberă despicată reprezintă standardul universal de tratament chirurgical în faza acută a arsurii. În prezent, continuă cercetările pentru dezvoltarea unor noi substituenţi de piele pentru acoperirea suprafeţelor arse excizate, când autogrefele nu sunt disponibile sau starea pacientului nu permite utilizarea acestora. Substituenţii tegumentari trebuie să întrunească criterii etice, de siguranţă, efi cienţă cât și economice pentru a putea fi utilizaţi pe scară largă pentru acoperirea defectelor postcombustionale. Fiecare pacient ars reprezintă un caz complex ce necesită tratament îndelungat, multistadial, impunând cooperare interdisciplinară. Urmărirea atentă a pacientului, reevaluarea periodică, efectuarea corecţiilor chirurgicale stadiale și încadrarea sa într-un program susţinut de recuperare medicală sunt elemente esenţiale pentru obţinerea unor rezultate optime funcţionale și estetice pentru o cât mai bună reinserţie socio-profesională. Cuvinte cheie: arsuri majore, faza acută, tratament chirurgical, grefe de piele, substituenţi tegumentari