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Escharotomy is a core emergency procedure in burn surgery, but the same decompressive principle may be crucial in other diseases causing ischemic constriction. Harlequin ichthyosis as a rare life threatening disease can cause circumferential hyperkeratotic constriction with rapidly progressive acral ischemia, digital necrosis, and limb loss. Reports of escharotomy-like release in this setting are rare. We present a very early-life, comprehensively documented case to emphasize the importance of escharotomy expertise in plastic surgery beyond burns.

A preterm female neonate (35+6/7 weeks, birth weight 2500 g) with severe Harlequin ichthyosis due to a homozygous ABCA12 mutation was transferred to the ICU at the University Children’s Hospital Zurich. Clinical findings included plate-like hyperkeratosis, deep fissures, and severe acral perfusion compromise of all extremities caused by constrictive keratinized bands. Within 24 hours of birth, escharotomy-like releases were performed on all distal extremities. Plastic surgery provided staged wound adaptation and serial reassessment within a multidisciplinary neonatal treatment pathway led by the pediatric dermatologist with intensive topical therapy and systemic acitretin.

After decompression, acral perfusion improved markedly and spontaneous motor activity of all four extremities was preserved. No digital autoamputation occurred. With serial dressings and staged plastic surgical wound management, all release sites healed progressively, and the infant was discharged after 5 weeks in improved general condition. The case allowed excellent longitudinal documentation of indication, operative timing, wound evolution, and functional limb preservation in a neonate.

This case highlights the rare scenario of escharotomy-like decompression in a neonatal non-burn patient and demonstrates that timely release can be limb-saving and potentially life-saving. Escharotomy is not limited to burns: correct indication, safe execution, and structured postoperative care are fundamental skills for managing ischemic constriction syndromes, including very rare pediatric dermatoses such as Harlequin ichthyosis.

Burns to critical anatomical areas such as the hand, the finger, and the face are challenging due to their functional and aesthetic significance. Both hands and face are almost always exposed and therefore burn sequela may stigmatize. Surgical management of deep partial- and full-thickness burns often includes escharotomies and almost always surgical debridement, and some form of skin coverage. This study explores the treatment of five patients who suffered severe burns to the hands and face during a disaster in Crans-Montana on January 1st, 2026.

Burns (2nd and 3rd degree deep) to the hands and fingers were treated by means of minimal surgical debridement and split-thickness skin grafting. In certain cases, well-demarcated, non-infected eschars of the fingertips were preserved to promote healing and maintain length. Five patients needed skin grafts on hands and fingers (total: hands: n=9; fingers: n=45).
Regarding facial injury, three patients suffered deep partial- and full-thickness burns, and two patients had superficial partial-thickness burns. Deep facial burns were surgically debrided up to punctate bleeding of the underlying dermis. Exposed nasal cartilage or muscle layer were covered by mobilization of local tissue. Autologous cells (keratinocytes, fibroblasts and melanocytes) were applied intraoperatively (RECELL® Spray-On Skin™), followed by topical treatment. Superficial dermal burns were treated with epidermal substitutes.
Clinical outcomes and complications were documented.

Eschar preservation helped the tissue to regenerate, especially at the fingertips and ears, while reducing the need for extensive excision. Early hand mobilization compromised graft adherence, and late tendon ruptures occurred in three patients. Revisional procedures for the hands were needed in four cases, and delayed facial reconstruction was satisfactorily achieved using the application of autologous cells in spray form in three patients, two of whom required a second application.

This series demonstrates that established surgical principles and structured rehabilitation are the backbone of burn treatment in critical anatomical areas such as the hands, the fingers and the face. Selective eschar preservation associated with innovative regenerative technologies can achieve functional and aesthetic outcomes, particularly when the treatment is tailored to the patients.

To study the predictors of limb loss in electric burn injuries and functional outcomes in patients in a tertiary care center.

Sixty individuals with electrical burn injuries participated in a prospective cohort study. Voltage, total body surface area (TBSA), time to presentation, and compartment syndrome were among the variables. Limb salvage as opposed to amputation was the main result. The Short Form-36 (SF-36), Lower Extremity Functional Scale (LEFS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score were used to measure functional outcomes. The status of returning to work was noted.

All injuries were high-voltage, with delayed presentation (>6 hours) in all patients. Compartment syndrome was present in 90%. Amputation was required in 50% of patients. Mean DASH, LEFS and SF-36 scores suggest a moderate to severe physical disability. Return-to-work rates were low (10%). Delayed intervention was associated with poorer functional outcomes and increased surgical burden. Prosthetic usage was negligible despite encouragement and support, due to social taboo, financial constraints and lack of access to devices.

Electrical burn injuries carry a high risk of limb loss, poor functional recovery and return to work rates. Early recognition and timely intervention is needed to improve functional outcomes and should be prioritized.

Scald injuries are a leading cause of severe burn trauma in older adults, particularly those with cognitive or physical impairment in long-term care. Risk factors include excessive water temperatures, insufficient staff training, and inadequate technical safeguards. In Switzerland, high domestic water temperatures may further increase this risk. This study analyzes incidence, injury patterns, clinical course, and outcomes of ICU-treated scald injuries and compares prevention strategies with international standards

In this retrospective single-centre cohort study (2019–2025), adult ICU-treated scald patients at a tertiary burn centre were stratified into bathwater-related injuries versus other mechanisms. Nursing home residents were analyzed as a predefined subgroup. Data included demographics, comorbidities, burn severity, operations, complications, mortality, and length of stay. Prevention regulations were reviewed. Statistical analysis included descriptive measures and logistic regression for mortality predictors.

Twenty-four bathwater-related scalds accounted for 47.1% of ICU-treated adult scald injuries. Mean age was 58.2±21.4 years; 75% were male. Mean TBSA was 22.1±13.2, mainly affecting back, buttocks, and lower extremities. Mean ICU stay was 20.6±17.6 days, with 3.1±2.9 surgeries and a total hospital stay of 35.1±20.0 days. Mortality was 21%. Major complications included wound infection (50%), pneumonia (50%), and sepsis (45.8%). Compared with 27 other scald cases-primarily resulting from occupational (44.4%) and domestic cooking-related accidents (40.7%)- no significant differences were observed in age, comorbidities, burn size, or overall injury severity. However, bathwater injuries showed significantly higher rates of sepsis, coagulopathy, pneumonia, and refeeding syndrome. Mortality was numerically higher but not statistically significant. Non-bathwater cases were more frequently discharged home.

Bathwater scalds represent nearly half of ICU-treated scald cases. Clinical severity and outcomes were comparable to other scald mechanisms, underscoring the significant morbidity associated with an apparently low-threshold environmental hazard. Standardized prevention strategies—including thermostatic mixing valves, routine temperature control, and structured staff training—should be implemented nationwide.

This study presents the clinical course of train surfing (TS) high-voltage (HV) injuries versus other HV burn victims (non-TS, NT) in Switzerland and explores the potential role of social media in promoting this risky behavior.

HV accidents involving unauthorized individuals on railroad tracks from 2016 to 2023 were retrospectively collected from the Federal Office of Transport (FOT) and the Swiss Transportation Safety Investigation Board (STSB). Additionally, clinical data of TS and NT patients treated at a specialized burn center during 2016 to 2024 were retrospectively analyzed to compare injury severity, clinical course, and healthcare costs. An exploratory social media content analysis was also conducted to assess the potential influence of TS trends on TikTok and Instagram on the behavior’s popularity and perception.

The FOT and STSB recorded 29 HV accidents. 41 HV patients were treated at a specialized burn center, including 12 TS patients. TS were younger (43.6 vs. 20.3 years) and suffered more severe injuries (18.5% vs. 44.3% burned total body surface area, TBSA), higher rates secondary injuries (100% vs. 31%), longer ICU stays (48.5 vs. 13.2 days), and more complications (100% vs. 58.6%) than NT patients. As a result, rehabilitation time and hospitalization costs increased for TS (109 vs. 73 days and CHF 503 152 vs. CHF 174 307). Social media analysis revealed that TS-related content was popular and often glamorized the activity, with safety warnings frequently bypassed, potentially contributing to increased engagement in this risky behavior.

TS causes worse outcomes and higher medical costs compared to NT. Review of social media posts suggested that TS-related content achieved high visibility (measured by views, likes, and shares) and was often portrayed in an appealing or thrill-seeking manner, hence ‘glamorized’ the activity. This underscores the urgent need for targeted prevention and awareness efforts to reduce these avoidable injuries.

Severe burn injuries require comprehensive and multidisciplinary care. Infections, especially those caused by multidrug-resistant bacteria such as Acinetobacter baumannii, can significantly delay wound healing, lengthen hospital stay and spread throughout entire hospital units. Understanding the exact circumstances of the burn trauma is crucial for initial, care as well as timely management of complications.

A 55-year-old man sustained deep burns of 73% of his total body surface area (2nd and 3rd degree) following the explosion of a generator in a closed space. To cool down, he jumped into a nearby public fountain before being transferred to a burn center. He presented with inhalation injuries and deep circumferential burns, requiring escharotomies and multiple surgeries, including coverage with cultured autologous epithelial grafts.

Very soon, the patient developed a severe infection with extensively drug-resistant (XDR) baumannii, affecting the skin and progressing to osteomyelitis. Despite intensive topic treatment with daily hydrotherapy and systemic antibiotics (colistin, meropenem, amikacin), sepsis recurred. Environmental investigation traced the strain to the fountain water; samples genetically matched the clinical isolate. Targeted treatment based on a similar strain's sensitivity, along with topical mafenide acetate (Sulfamylon) resulted in clinical improvement. The patient achieved not only eradication of the bacteria, but also satisfactory functional and aesthetic outcomes.

A thorough patient history may reveal unexpected infection sources. This case underscores the importance of considering environmental exposures in burn patients. Early recognition can support timely diagnosis and therapy, improving outcomes and limiting the spread of multi-resistant pathogens .

Burn injuries represent a significant global health burden, resulting in a statistically significant burn-related death rate. Despite the existence of standardized treatment protocols, major challenges persist regarding patients' susceptibility to burn-related complications and prolonged hospitalization. Hyperbaric Oxygen Therapy (HBOT) has recently gained attention for its role in tissue regeneration, with recent European consensus statements reinforcing its therapeutic value in several clinical conditions, especially burn management. This case series aims to provide practical insights into the therapeutic potential of Hyperbaric Oxygen Therapy (HBOT) for optimizing outcomes in burn wound care.

A retrospective case series of seven patients treated at the Hyperbaric and Subaquatic Medicine Center (CMSH – Hospital das Forças Armadas- Polo Lisboa) was conducted. Following institutional ethical and scientific approval, digital and physical medical records indexed under “Burn Wounds” were reviewed. Exclusion criteria comprised patients with insufficient clinical data and those who failed to initiate Hyperbaric Oxygen Therapy (HBOT) following their initial eligibility consultation.

These cases provide practical insight into the integration of Hyperbaric Oxygen Therapy in acute and chronic burn wound management protocols and local infection control. The evidence points to potential improvements in wound healing and reductions in complication and hospitalization rates, though challenges remain in uniformly implementing HBOT strategies and dealing with logistical incompatibilities between institutions.

This case series emphasizes the continuing challenges of burn wound management, exploring the application of Hyperbaric Oxygen and its potential benefit in enhancing clinical outcomes of the burnt patient. Further investigation is appropriate for the uniformization of treatment protocols and patient selection.

Post-burn scars can cause pigmentary changes, pruritus, pain, and contracture, and may lead to psychosocial distress due to functional impairment and disfigurement, particularly when involving visible areas. Accordingly, interest in aesthetic scar restoration has increased in recent years. Dermal overgrafting has been proposed as a technique to improve functional and aesthetic outcomes; however, evidence is limited and standardized recommendations are lacking. To our knowledge, pediatric-specific data on dermal overgrafting is not available.

We report four pediatric patients (Follow up 8 month to 4 years) with deep burn injuries who underwent dermal overgrafting following burn wound excision by tangential excision. Outcomes assessed included graft integration, scar appearance, functional outcome, complications, and need for secondary procedures. In addition, we reviewed the published literature on dermal overgrafting in burn reconstruction to summarize indications, techniques, and outcomes to position our pediatric cases within the existing evidence.

Dermal overgrafting achieved successful wound closure with satisfactory graft take in all four patients. Early postoperative healing was uneventful, with no major complications or graft loss. Follow-up demonstrated improved scar quality and preservation of function. The available literature, although heterogeneous and
limited in size, suggests that dermal overgrafting showed high patient-reported satisfaction with both aesthetic appearance and functional improvement, which was also clearly evident in our patients.

Dermal overgrafting appears to be a safe and feasible option for selected pediatric burn injuries, and our case series supports its clinical applicability while adding to the limited evidence base. In children, it is particularly attractive because the hair-bearing scalp offers a favorable donor site with an excellent surface-area yield and the potential for repeated harvests, enabling coverage of larger defects. Given the often predominantly aesthetic indication, the child’s developmental ability to participate in decision-making should be considered when balancing expected benefit against operative risk.

To report the functional and aesthetic outcomes of a staged reconstructive strategy combining trapeze flap reconstruction, serial excision, Z-plasty, and tissue expansion for severe recurrent post-burn neck contracture following previous surgical failure.

A single-patient case report of a 30-year-old female who sustained flame burns involving 18% total body surface area affecting the face, neck, chest, breasts, and hands, with predominantly full-thickness injury to the neck and upper chest. Acute management included debridement and split-thickness skin grafting. The patient later developed severe anterior and lateral cervical contracture with marked restriction of neck extension. Secondary reconstruction using full-thickness grafting after abdominoplasty was complicated by partial graft loss, infection, and recurrent contracture. Definitive management employed a staged reconstructive approach: complete contracture release with multiple trapeze flaps, lateral neck Z-plasty, serial excision of residual scars, and tissue expansion for further scar revision and neck release. Functional and aesthetic outcomes including cervical range of motion, scar quality, and recurrence were assessed clinically over one year.

The staged trapeze flap–based reconstruction achieved complete contracture release and restoration of full cervical extension and rotation despite prior failed procedures. Functional posture and daily activity improved substantially. Aesthetic results were satisfactory, with improved cervicomental angle, enhanced skin pliability, and reduced scar burden. Well-vascularized trapeze flap provided durable coverage resistant to recontracture, while serial excision enabled gradual scar reduction and contour refinement without excessive tension. Tissue expansion allowed additional scar removal and improved neck mobility and contour. No recurrence, flap complications, or significant donor-site morbidity occurred during one-year follow-up, supporting the effectiveness of flap-based staged reconstruction in complex recurrent cases.

A multi-staged reconstructive strategy combining trapeze flap, serial excision, Z-plasty, and tissue expansion provides durable functional restoration and favorable aesthetic outcomes in severe recurrent post-burn neck contracture. This approach should be considered in complex cases where graft-based techniques have failed.

Hypopigmented burn scars can be cosmetically distressing and difficult to treat, with current therapeutic options often involving invasive procedures. This report aims to demonstrate the potential of a bimatoprost-based, noninvasive approach for inducing repigmentation in hypopigmented burn scars. We describe a case of a 26-year-old female with hypopigmented burn scars of varying depth located inferior to the right breast and on the right thigh.

The scar inferior to the right breast, consistent with a second-degree burn with deep partial-thickness injury, was treated with microneedling at a depth of 1.0 mm combined with topical bimatoprost 0.03%, along with intradermal application of bimatoprost. The thigh scar, consistent with a second-degree burn with superficial partial-thickness injury, was treated with a single session of microneedling at a depth of 0.5 mm combined with topical bimatoprost 0.03%. Post-procedural care consisted of topical antibiotic ointment used only during the first 24 hours, and the patient did not apply topical bimatoprost at home. Topical corticosteroids were avoided to prevent suppression of local inflammatory and prostaglandin-mediated pathways that may contribute to bimatoprost-induced melanocyte activation. Clinical evaluation was performed at baseline and at a four-week follow-up.

At four-week follow-up, the patient demonstrated clinically appreciable repigmentation of both burn scars. No allergic reactions, adverse events, or treatment-related complications were reported. The patient tolerated the procedures well.

This case demonstrates satisfactory repigmentation of hypopigmented burn scars following a single treatment session using a bimatoprost-based, noninvasive approach. Careful, localized treatment limited to hypopigmented areas is essential to minimize the risk of unintended hyperpigmentation of the surrounding healthy skin. While the initial response was favorable, further studies with longer follow-up are needed to determine the durability of repigmentation, the potential for pigment fading, and whether additional treatment sessions may be required. Photoprotection, including consistent sunscreen use, is recommended to help maintain pigmentation and optimize long-term outcomes.

To assess the clinical effectiveness and safety of autologous dermal micrograft therapy, obtained using Rigenera® Technology, in the management of chronic ulcers and complex wounds that are refractory to conventional treatments. This study aims to analyze the regenerative potential, healing dynamics, and overall clinical outcomes in a series of seven representative cases.

Seven adult patients presenting with chronic, non-healing lesions of different etiologies—including post-traumatic, tumor-related, post-surgical, and vascular wounds—were enrolled. Autologous micrografts were harvested from a small dermal sample using the Rigenera® mechanical disaggregation system, generating a suspension rich in viable progenitor cells and extracellular matrix fragments. The suspension was applied directly to the wound bed, either as a stand-alone therapy or in combination with bioactive membranes or split-thickness skin grafts, depending on the clinical scenario. Patients were monitored for time to complete wound closure, pain evolution, local or systemic complications, and overall clinical response.

All seven patients achieved complete wound healing, with a mean closure time of 46 days (range: patient-specific variations). A consistent and clinically relevant reduction in pain levels was observed during the treatment course. No systemic adverse events occurred. Only a single patient reported mild, self-limiting discomfort at the donor site, without any functional or aesthetic impairment. The regenerative effect was evident even in challenging wound types, including those associated with previous tumor surgery or complex tissue damage.

Autologous micrograft therapy using Rigenera® Technology represents a highly promising regenerative approach for chronic, hard-to-heal, and complex wounds. The technique effectively stimulates reparative processes, shows excellent tolerability, and can be performed in an outpatient setting with minimal donor-site morbidity. Given its clinical efficacy, economic sustainability, and broad applicability, this method has strong potential for structured integration into standard hospital treatment pathways for difficult wounds.