Elizabeth Concannon

Background: Cement is widely used in the construction industry by professionals and in domestic do‐it‐yourself (DIY) settings. As a highly alkaline substance, prolonged skin contact can result in chemical burns. Although relatively uncommon, cement burns often cause small but deep injuries that require operative management. Methods: A retrospective case review was performed of patients admitted to the Adult Burns Unit at The Royal Adelaide Hospital with cement burns between 2020 and 2025. Incidence and injury characteristics were compared with those reported in a previous case series published by the same unit in 2014, after which public awareness initiatives were undertaken. Results: Thirty‐three patients with cement burns were admitted over this 5 year period. This is a significant increase compared with the previous 10‐year audit. All patients were male and the median age was 45 years. The median delay in seeking medical treatment was 4 days. 60% of these injuries were sustained in a DIY setting, most commonly from kneeling in wet cement. The mean burn size was 2% TBSA and 79% of patients required operative management. The median length of inpatient stay was 5 days. Conclusion: Admissions for cement‐related burn injuries are increasing despite previous public awareness efforts. While further media initiatives have been undertaken by our Burns Unit, enhanced public education, workplace safety measures, and product labeling is urgently needed to reduce the burden of these injuries.

Objective: The objective of this systematic review will be to evaluate the effectiveness of the bilayered dermal substitute, Biodegradable Temporising Matrix (BTM), compared with other wound management options in improving clinical outcomes for adults with wounds requiring surgical intervention. Introduction: Dermal substitutes provide physiological wound cover for major burns, traumatic wounds, necrotizing fasciitis, diabetes, oncological resections, and previously non-graftable wound beds. Bilayered dermal substitutes such as BTM are designed to provide immediate coverage to an area of skin loss, with subsequent skin grafting to restore structure and function. Eligibility criteria: This review will consider studies on adult patients (18 years or older) with wounds of any etiology or severity requiring surgical intervention. Studies will be considered if they evaluate surgical treatment for wounds using BTM, with or without negative pressure wound therapy, compared with any other surgical technique. Methods: This review will adhere to the JBI methodology for systematic reviews of effectiveness. The following databases will be searched for published studies: PubMed, Embase (Ovid), and CINAHL Ultimate (EBSCOhost). Unpublished studies, gray literature, conference presentations, and posters will also be considered. The searches will be conducted from database inception till the present, with no language limitations. Two reviewers will independently screen titles and abstracts against the eligibility criteria, followed by full-text screening. Eligible studies will be critically appraised at the outcome/result level for methodological quality using JBI’s standardized critical appraisal instruments. Data will be extracted and pooled in statistical meta-analysis. The results will be reported in tables, visual format, and narrative format. Review registration: PROSPERO CRD42024595778

By Lauren Middleton, Elizabeth Concannon & 2 more. The authors describe a case of extensive facial burn scar reconstruction in two stages (biodegradable temporising matrix implantation followed by a split thickness skin graft), and discuss the results.

By Brett Sacks, Elizabeth Concannon & 1 more. The authors describe an alternative option for reconstructing an eyebrow defect following excision of a squamous cell carcinoma using a single-stage, double opposing forehead flap.

Background: Non‐graftable or composite defect reconstruction represents a major challenge to the reconstructive surgeon, with many wounds requiring local flap or free microvascular tissue transfer approaches. The recent advent of synthetic skin substitutes such as Biodegradable Temporizing Matrix (BTM) have revolutionized the management of complex defects including those caused by burns, trauma and infection, with low‐morbidity and low‐complexity surgery. However, limited data exist supporting their use in cancer reconstruction in Australia. Methods: We performed a prospective cohort study of patients undergoing cancer resection and reconstruction with BTM between February 2021 and February 2023 in our institution. Reported outcomes included matrix integration, infection, and return to theatre. Results: Twelve patients underwent reconstruction of primary or secondary defects following cancer resection during this period. Eight patients were male, four female, mean age at surgery was 70 years. Pathology resected included squamous cell carcinoma (SCC) and melanoma of the head and neck, sarcoma resection of the lower limb, and osteoradionecrosis (ORN) of the scalp. T‐stage of primary tumours ranged from T2 to T4 and one in‐transit metastasis of melanoma. Four patients were treated with radiotherapy, two of whom received postoperative radiotherapy (PORT) and two who received neoadjuvant radiotherapy, three additional patients had an intervention to a previously irradiated wound bed for recurrence or ORN. Overall matrix integration was 83% (10/12), with a 50% integration rate (2/4) observed in the post‐radiotherapy group, requiring return to theatre for alternative reconstructive approaches. Conclusion: We report our experience with a synthetic dermal matrix (BTM) in cancer reconstruction, the largest cohort of this type in the Australian literature. BTM represents an exciting reconstructive tool for the cancer reconstructive surgeon, with a high rate of success and low morbidity.

Skin substitutes have modernised burn wound reconstruction since their use was first pioneered by Burke and Yannas in the 1980s. Skin substitutes offer a solution to the problem of insufficient autologous skin graft availability in major burn wound closure. A growing body of evidence supports the role of skin substitutes in both acute major burns and secondary burn scar resurfacing. Classification of skin substitutes has become increasingly complex given the large variety of synthetic and biologic dermal matrices now available as the result of ongoing advances in regenerative medicine techniques. Classification systems are required to assist clinicians with selection and comparison of outcomes across a wide diversity of skin substitutes. Professor John Greenwood, invented, designed and developed one such dermal substitute, \'Biodegradable Temporising Matrix\', which is approved for use across the globe for reconstruction of major burns and complex wounds. This chapter provides a review of available classification systems for skin substitutes with a summary of the latest evidence in relation to their role and impact on burn wound outcomes. Future developments toward the elusive ‘ideal’ skin substitute may be possible through ongoing research efforts focused on clinical translation of modern skin tissue engineering techniques for burn wound reconstruction.

Inhalation injury is a major contributor to mortality following burn injury. Despite recognised clinical criteria to guide the intubation of burn patients, concerns remain regarding overutilisation of intubation. Complications can arise as a result of intubation, including ventilator-associated pneumonia (VAP). This study reviews the indications for intubation against the internationally accepted criteria (American Burns Association (ABA) and Denver criteria) for burn patients treated at the Royal Adelaide Hospital (RAH) burns unit between 2017 and 2020. Burn patients who were intubated on arrival to the RAH or in a pre-hospital setting were identified using the BRANZ database. Indications for intubation were compared to the ABA and Denver criteria. A total of 61 patients were identified with a mean total body surface area of 17.8%. A total of 95% of patients met one of the ABA and Denver criteria. The most common ABA and Denver criteria for intubation was deep facial burns or singed facial hair, respectively. Most adult patients with burns admitted to the RAH are intubated per published criteria. Early nasoendoscopy/bronchoscopy may be useful in determining patients who can be safely extubated within 48 h.