Editorial

Current Standards of Burns Treatment

In accordance with a long-anticipated publishing plan, the editorial board has dedicated Issue 1 of Volume 59 to the vastly extensive topic of burn treatment. We do so in the spirit of tradition and the legacy of Professor František Burian, founder of this very journal and world renown pioneer of plastic surgery. As a plastic surgeon who routinely encountered the severe functional and cosmetic consequences suffered by burn survivors, Burian defined burns as trauma and advocated for an active surgical approach to their treatment. His meritorious efforts resulted in the first specialized burn center in Continental Europe, which he established in Prague in 1953. A disciple of Prof. Burian, Professor Radana Königová served as his successor by further developing a separate field of burn medicine, and contributing significantly to national policy on burn treatment, in the former Czechoslovakia. Since that time, the quality of our comprehensive and continuous approach to burn treatment has consistently remained comparable to leading burn centers around the world.

The contributions included in this issue were selected in an effort to present a conspectus of some of the major phases of burn injury treatment. One of the initial steps is the removal of all non-vital tissues that have been destroyed by burn trauma. Necrectomy of extensive burns is a demanding treatment phase not only for patients but also for surgeons. Seeking out the least invasive and most expedient method, e.g. chemical or enzymatic necrectomy, is one of several possible approaches. The next step toward full body surface restoration is skin grafting, which may prove to be highly complicated in cases with insufficient donor site availability. Thus, any improvement in the ability to use smaller donor sites to restore larger necrectomized areas is absolutely invaluable, as has been described in a contribution on Meek micrografting from Ostrava. A modern cutting-edge approach, which enables survival even in critical burn patients, employs the use of permanent dermal substitutes, i.e. artificial skin that can be used in patients undergoing treatment for acute conditions or reconstructive surgery. Authors from the Prague Burn Center present a contribution that documents their experience with roughly 50 patients who were treated with Integra^® permanent dermal regeneration templates. The most serious complication (and one of the most common) that burn survivors face throughout the course of treatment is infection. Another contribution from Brno addresses this topic in detail with a particular focus on yeast and fungal infections, which occur relatively less frequently. Thanks to the advances in medicine and technical equipment over the last few decades, the goal of burn treatment has shifted from the primary struggle for survival, to achieving the best possible quality of life with full somatic and psychosocial rehabilitation. Much attention has been devoted to the healing process, especially scar formation and the factors that influence it. One contribution discusses the new micro-needling method used in the treatment of scarred areas.

All of the papers presented in this issue are based upon the authors’ own clinical practice and scientific research conducted at their specialized institutions. Despite significant technical and instrumental improvements, particularly those in intensive care units, the long-term conditions under which clinicians have worked have not been ideal due to e.g. unclear funding rules for this demanding form of medical care, rather frequent changes in the legislative conditions for specialized medical training, etc., as Prof. Brychta, Chairman of the Czech Society of Burn Medicine, reports in this issue. Ensuring proper staffing and recruiting young physicians is crucial to the security and future of the entire field. At the same time, we appreciate the current opportunities for young physicians to participate in foreign internships and fellowships, which enable them to acquire, and return home with, valuable experience from prestigious institutions. In stark contrast to this, from time to time we must face terribly sad news when a prominent figure leaves the ranks of plastic or burn surgeons, such as the eminent Associate Professor Konstantin Troshev who, among many other things, was a long-time member of this journal’s editorial board (contributions from Hradec Králové).

During the last 2–3 decades, we have seen great improvements in burn prevention, significantly improved prognoses after severe burn trauma, reduced lethality, and increased quality of life of burn survivors. This characterization, however, is marked by tremendous variation across continents and throughout different world regions. During its 2012 Congress in Edinburgh, the International Society for Burn Injuries (ISBI) announced its motto for the then-upcoming period: “One world, one standard of burn care.” One of the concrete outcomes of that multi-year endeavor is the recently published worldwide guideline entitled, “ISBI Practice Guidelines for Burn Care” (Burns, 42, 2016, 5, pp. 951–1021). The Czech Republic’s consistently high level of burn care management is well documented by the papers published in this topic-oriented and specially dedicated issue; a level of care that was also acknowledged by the ISBI when they requested our active participation in the creation of their latest directives. During the creation process, we felt an enormous and legitimate sense of pride knowing that, in many ways, the world recommendations would be based upon guidelines that have long been well-established procedures in our own country. I trust that, as the reader becomes familiar with the papers published in this issue of Acta Chirurgiae Plasticae, they, too, will be convinced of that reality.

Assoc. Prof. Leo Klein, MD, CSc.

Division of Plastic Surgery and Burns

Charles University Teaching Hospital Hradec Králové, Czech Republic