A 33-year-old male was brought to the emergency department by ambulance having been exposed to an explosive flash burn from a nitrous compressor while welding. The patient sustained burns to the face, neck, hands, and arms. His immediate first aid was to jump into a swimming pool of cold water. His burns were clinically assessed as 5% TBSA and mainly of superficial partial thickness. The epidermal layer had blistered and been removed, but the underlying dermis remained sensate and with a brisk capillary refill. The patient was known to the VABS as he had sustained a 40% TBSA burn 12 years previously, following a fire while cooking with hot oil. Remarkably, all of the flash burns from the welding accident had affected previously grafted or scarred skin. The patient was admitted for 48 h for analgesia and to establish a dressing plan and face care protocol on the ward. Once comfortable, he was discharged home to have dressings in the community and for clinic follow-up; within an expectation, his wounds would heal within the 3-week target.
Five days later, the patient re-presented to the emergency department feeling feverish and complaining of general malaise. On examination, he had sloughy, infected burn wounds on the face, neck, hands, and arms. He was swabbed for microbiology, then commenced on intravenous antibiotics. Despite the wounds having been previously assessed as superficial partial thickness, it was apparent that the burns had failed to improve and would not heal without surgical intervention (see Figs. 1a, b and 2a, b). The burns were subsequently debrided in theatre with the Versajet II (hydrosurgery system), before being autografted. Split thickness thigh skin was used to sheet graft the dorsum of the hands with Artiss (fibrin sealant) to improve adhesion. Scalp skin was harvested to better match the skin of the face and neck. In addition due to the large amount of skin previously harvested from the patient's thighs in his previous burn surgery, it was thought that further use of these areas for grafting of the face would give suboptimal results. Scalp skin was inset on the face as sheet grafting with Artiss. Thigh skin meshed 2:1 was used to reconstruct the less cosmetically sensitive areas on the arms. Grafts were checked at 3 days and found to be intact and adhering well (see Figs. 1c, d and 2c, d). The patient was discharged home satisfied that his new grafts had improved the cosmesis of his previously scarred facial burns.  
Seven months following surgery, the patient continues to attend clinic for long-term follow-up of his wounds. As is the usual practice in our department, he is undergoing treatment with pressure garments and silicone in order to keep scarring to a minimum and prevent contractures (see Fig. 3).