S156 Burns 33S ( 2 0 0 7 ) S1–S172 From 1993 to 1998, eight patients with TEN were admitted to our burn center. The mean age was 55.6 ± 16.1 years and the TBSA slough 72.5 ± 20.4%. Concerning systemic treatments six out of eight received corticosteroids, one low dose immunoglobulins and one corticosteroids and immunoglobulin. Local approach consisted in wide surgical epidermal debridement and coverage of the denuded dermis with artificial skin substitutes. The observed mortality rate was 75% (6/8), whereas the predicted one was 35.2% (2.82/8). In 1999, we adopted the IVIG treatment, in according with Viard’s protocol. Until the 2005, 23 TEN patients were treated with IVIG and conservative wound management. The mean age was 59.9 ± 17.7 years and the skin detachment 21 ± 14.1%. We recorded a mortality rate of 26% (6/23) with a cessation of further epidermal detachment occurred after an average of 5 days (range 3–10 days) from the onset of the therapy. The standardized mortality ratio analysis (SMR) ([observed deaths/expected deaths] × 100) showed a trend to lower actual mortality with high-dose IVIG treatment than the predicted mortality (SMR = 0.728; 95% CI, 0.327–1.620). doi:10.1016/j.burns.2006.10.363 The Western Australian experience of Integra ® use in paediatric patients 1996–2006 Falder S. a,b,c , Rea S. a,b,c,d , Wood F. a,b,c,d a Telstra Burn Outcome Centre, Australia b Royal Perth Hospital, Australia c Princess Margaret Hospital, Australia d McComb Foundation, Australia E-mail address: sianf@eftel.net.au (S. Falder). Introduction: Integra ® (Integra LifeSciences, New Jersey) is a well-known two-layer artificial dermis regeneration template. Indi- cations for its use have expanded from providing immediate temporary skin cover in acute burns with insufficient donor sites, to reconstruction, not only in the release of burn contractures, but also in selected non-burn cases, such as resurfacing defects after trauma or elective surgery. Integra ® use in children is complex due to their potential for growth and the effect that this may have on the reconstructed areas. Few series have reported specifically on Integra use in children. Aim: To describe the Western Australian experience with Integra ® in paediatric patients both for acute burns and reconstruction. Method: Study design: Retrospective review of all patients aged sixteen or under, treated with Integra ® at the Princess Margaret Hospital and the Royal Perth Hospitals, since 1996. Outcomes: Demographic data, surgical course, percentage Integra ® “take”, complications, cosmetic appearance, function and effects of growth. Results: Since 1996, Integra ® has been used for 25 patients (acute burns n = 13; burns reconstruction n = 15; non-burns reconstruc- tion n =2). We will report on the outcome variables for these three groups. Discussion: Integra ® is expensive and some centres have limited its use. We find Integra ® to be a safe and reliable means of reconstruction, both in acute and non-acute cases. However, the principles of Integra ® use in children are the same as for adults, with meticulous surgical technique and post-operative care being required to minimise Integra ® loss. We will discuss the lessons learned from almost a decade’s experience with its use in children and the long-term follow up of early patients in the series. Keywords: Integra ® ; Artificial dermis; Reconstruction; Children doi:10.1016/j.burns.2006.10.364 The effect of diet and wound closure on skeletal muscle loss and protein turnover in children with burns Prelack K., Yu Y.M., Lydon M., Petras L., Sheridan R.L. Shriners Burns Hospital, Boston, MA, USA E-mail address: kprelack@shrinenet.org (K. Prelack). Introduction: Recommendations for protein intake in pediatric burn patients are largely empirical. Kinetic studies have enhanced our understanding of protein metabolism following burn injury. However, the relative contribution of skeletal muscle to whole body protein breakdown in children is unknown. Given the potential for rapid muscle depletion in this population, we studied the effects of diet and wound closure on protein turnover and skeletal muscle breakdown. Methods: Seventeen children (mean age: 8.2 ± 4.6 years and burn size: 51.8 ± 24.0% total body surface area) were studied. Protein intakes (enteral and parenteral) ranged from 2.0 to 6.0 gram (g) per kilogram (kg). Upon hemodynamic stabilization (Phase A) and again at the time of wound closure (Phase B), protein synthesis and breakdown were determined using labeled N15 glycine. This method involves administration of 4mg/kg of N15 glycine, and a subsequent measure of N15 urea and ammonia in a 24-h urine sample. Simultaneously, skeletal muscle breakdown was quantified by measuring urinary 3 methyl-histidine (3MH) excretion. Protein turnover and 3MH according to diet and phase of injury were compared by Student’s t-test and multiple regression analysis.