Journal of Burn Care & Research最新文献

CO2 ablative fractional laser (CO2 AFL) therapy is a safe and effective procedure when used in the treatment of hypertrophic scars for burn patients. It has a high patient satisfaction rate and a minimal side effect profile, typically consisting of postoperative pain, irritation, surgical site inflammation, and, in rare cases, infection. Although prophylactic antibiotics have historically been recommended, there is a paucity of literature on the topic and recent studies indicate that they may be unnecessary in routine cases. In this retrospective, single-center descriptive study, 230 cases in patients with hypertrophic burn scars treated with CO2 AFL therapy were compared. 28 cases were with the use of prophylactic antibiotics and 201 cases were without the use of prophylactic antibiotics. We found that there was no significant association between the use of antibiotics and the prevention of topical skin infection in cases treated with CO2 AFL therapy (P = 1). Therefore, we conclude that the omission of prophylactic antibiotics is not associated with an increased risk of infection and recommend that prophylactic antibiotics should not be indicated in the setting of routine CO2 AFL therapy for patients with hypertrophic burn scars.

Appropriate identification of burn depth and size is paramount. Despite the development of burn depth assessment aids [eg, laser Doppler imaging (LDI)], clinical assessment, which assesses partial-thickness burn depth with 67% accuracy, currently remains the most consistent standard of practice. We sought to develop an image-based artificial intelligence system that predicts burn severity and wound margins for use as a triaging tool in thermal injury management. Modified EfficientNet architecture trained by 1684 mobile-device-captured images of different burn depths was previously used to create a convoluted neural network (CNN). The CNN was modified to a novel boundary attention mapping (BAM) algorithm using elements of saliency mapping, which was used to recognize the boundaries of burns. For validation, 144 patient charts that included clinical assessment, burn location, total body surface area, and LDI assessment were retrieved for a retrospective study. The clinical images underwent CNN-BAM assessment and were directly compared with the LDI assessment. CNN using a 4-level burn severity classification achieved an accuracy of 85% (micro/macro-averaged receiver operating characteristic scores). The CNN-BAM system can successfully highlight burns from surrounding tissue with high confidence. CNN-BAM burn area segmentations attained a 91.6% accuracy, 78.2% sensitivity, and 93.4% specificity, when compared to LDI methodology. Results comparing the CNN-BAM outputs to clinical and LDI assessments have shown a high degree of correlation between the CNN-BAM burn severity predictions to those extrapolated from LDI healing potential (66% agreement). CNN-BAM algorithm gives equivalent burn-depth detection accuracy as LDI with a more economical and accessible application when embedded in a mobile device.

Biodegradable Temporizing Matrix (BTM) is a synthetic dermal template recently developed to reconstruct complex wounds. Current literature describes BTM outcomes in the presence of infection and other comorbidities but is limited by small sample sizes. The purpose of this systemic review and meta-analysis was to determine the current breadth and success of BTM use for complex wound closure. Databases were searched to identify previously published studies describing BTM use in human wounds. Studies were excluded if conducted in vitro, using nonhuman animals, or for procedures irrelevant to wound care. A total of 24 studies met the inclusion criteria, representing 202 patients. The most common injury treated with BTM was burns (68 cases, 33.7%) followed by acute surgical wounds (59 cases, 29.2%). The large majority of patients did not experience any postoperative infections (76.6%). Infected wounds were associated with a 7.5-day delay from BTM to grafting. Univariate regression analyses showed a negative association between time to BTM implantation and age, exposed muscle, and exposed tendon (p < 0.001). In total 92% of patients received BTM implantation less than 2 weeks from admission. A total of 84% of patients had a greater than 95% BTM take. The median time to split-thickness skin graft (STSG) was 34 days, and 92% of patients experienced a greater than 95% STSG survival. To our knowledge, this is the first reported systemic review on the application of BTM for wound reconstruction. According to the published data, BTM is a versatile dermal template for complex wounds coverage with a low risk of infection, high template take rate, and excellent autograft survival.

To study the effect of parecoxib sodium in alleviating inflammation in burned rats and restoring cognitive function in burned rats. A total of 30 specific pathogen free grade Sprague-Dawley rats were randomly divided into 6 groups: (1) blank control group (group C), (2) Sham surgery group (group Sham), (3) second-degree burn model (group B), (4) low-dose (1 mg/kg/d) parecoxib sodium (group L + B), (5) medium-dose (10 mg/kg/d) parecoxib sodium (group M + B), and (6) high-dose (20 mg/kg/d) parecoxib sodium (group H + B). ELISA measures inflammatory factors interleukin (IL)-2, IL-6, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ), and cognitive function factors neuron-specific enolase (NSE), cortisol, and S-100β. Combined with water maze and dark-avoidance experiments to further verify the recovery of cognitive function in rats. The contents of IL-2, TNF-α, and IL-6 in group M + B were significantly lower than those in group Sham (P < .05), and the content of IFN-γ was significantly lower than that in group Sham (P < .05). The cognitive markers NSE, S-100β, and cortisol levels in group M + B were significantly higher than those in group Sham at 2 h, 1 d, 5 d, and 10 d after operation (P < .05). In the group M + B dark-avoidance experiment, the number of probes and errors was not significantly different than those in group Sham and group C (P > .05), and the number of times group M + B found a platform in the water maze experiment and crossed the platform was second only to group B and group C. Parecoxib sodium can effectively reduce inflammation in burn rats and promote cognitive recovery in burn rats, and the optimal dose of parecoxib sodium for burn rats is 10 mg/kg.

In pediatric patients, frostbite is a well-documented cause of epiphyseal cartilage destruction and subsequent growth deformity of the affected phalanges. Cases of full acroosteolysis also referred to as phalangeal osteolysis, of distal phalanges as soon as 3 months after cold exposure have yet to be reported. We describe a complicated case of frostbite-associated phalangeal osteolysis in the dominant hand of a 9-year-old patient, in the context of post-traumatic insensate hand after sustaining prior electrical burn injuries. This case demonstrates the unique sequela of pediatric frostbite injury involving early loss of the distal phalanx through resorption of the bone and parallel soft tissue retraction, rendering early plastic surgery reconstruction impractical. Reconstructive strategies for frostbite injury in pediatric patients will need to account for the individualized dynamic tissue changes that develop in the months after cold exposure.

Unhoused burn patients (UBPs) have historically been more likely to leave against medical advice (AMA) and suffer worse health outcomes than the general population. The coronavirus disease 2019 (COVID-19) pandemic created a major strain on the health care system, resulting in worse overall health outcomes for burn patients. We sought to investigate how COVID-19 impacted treatment for UBP, specifically the rate of leaving AMA. We conducted a retrospective chart analysis of patients admitted to a regional burn center between June 2015 and January 2023. March 1, 2020 was used as a cut point to separate the cohorts into patients seen pre-COVID-19 (p-CV) and during COVID-19 (CV). Outcomes included leaving treatment AMA and readmission within 30 days. In total, 385 patients met criteria for being unhoused and were included in our analytic sample, of which 199 were in the p-CV cohort and 186 in the CV cohort. UBP were significantly more likely to leave AMA during CV compared to p-CV (22.6% vs 7.5%, P < .001). Housed burn patients did not experience an increase in discharges AMA during this time period. The COVID-19 pandemic resulted in an increase in discharges AMA among unhoused patients only. While the etiology is unclear, our findings suggest that this vulnerable patient population is receiving inadequate care post-COVID. Future research should determine the driving force behind these increases and identify early interventions to mitigate them.

Fear avoidance (FA) describes beliefs and behaviors related to avoiding movements or activities after a painful event. FA is a prevalent issue that limits the recovery outcomes and social reintegration of burn survivors. However, as current literature focuses on chronic conditions, understanding the impact and treatment of FA within sudden onset musculoskeletal (MSK) conditions, specifically in the burn survivor population, is lacking. The purpose of this scoping review is to synthesize evidence-based rehabilitation interventions aimed at improving FA behaviors and beliefs after sudden onset MSK conditions, and to provide suggestions for clinical application with the burn survivor population. Ovid Medline, Ovid EMBASE, CINAHL and PsycINFO were sourced from inception to May 2023. Monthly Google Scholar searches and hand searching of included articles' reference lists were done to add additional relevant publications. Eligibility criteria included: 1) adults with sudden onset MSK condition, 2) intervention from a rehabilitation professional, and 3) FA as primary outcome. Four authors performed data extraction using the TIDIER checklist. Seven intervention types were identified: 1) education; 2) exercise; 3) graded motor imagery; 4) manual therapy (MT); 5) multimodal - education with exercise; 6) multimodal - education with MT and exercise; and 7) multimodal - interactive gaming console with exercise. All intervention types, except MT, demonstrated significant decreases in FA. This review summarizes effective rehabilitation interventions to address FA while highlighting the role of rehabilitation professionals in improving function and alleviating potential disability stemming from FA despite physical recovery.

Electrical burns constitute a serious public health challenge. It is crucial to identify trends, advancements, and possible future research areas in this field. The aim is to analyze the scientific production on electrical burns using bibliometric methods. Eligible documents contained the MeSH descriptor "Burns, Electric" and were listed both in PubMed and in the Web of Science Core collection. The bibliometric analysis was based on several quantitative indicators. The analysis included 1456 articles from 455 journals. The annual average was 28.1 articles, with a growth rate of 2.08% from 1946 to 2024. The USA produced the most articles (n = 657), followed by China (n = 184). The USA also led in international collaboration, working with 26 countries. Harvard University was the leading institution (n = 85), and Burns the leading journal (n = 265). The most common subject category of the research was Surgery (31.97% of documents). Wang XW was the most prolific author (n = 21), while Lee RC had the most citations (n = 648). The main clinical MeSH descriptors were "Surgical flaps" (n = 233), "Skin transplantation" (n = 159), and "Electric injuries" (n = 136). The results show slight growth in scientific production on electrical burns. The USA is leading research in this field.

Cytokine storm can occur in many different clinical conditions and lack of recognition can lead to death. While cytokines have been measured and trended in burn patients, cytokine storm has not been widely discussed or its treatment reported. We present herein the diagnosis and the treatment of a 5-year-old, 91% burn patient, who developed cytokine storm three times during his hospital course. Aggressive treatment led to successful resolution. Cytokine storm should be entertained in patients who develop classic storm signs and symptoms, along with supporting laboratory. Treatment should be tailored to the patients' clinical picture. More study is warranted to define cytokine storm as well as its treatment in burn patients.

Two randomized controlled trials conducted in acutely burned patients found clinical benefits with higher carbohydrate (60-65% of total energy), lower fat (12-15%) nutrition, to include faster wound healing, fewer wound infections, decreased hospital stay, and less pneumonia. The primary purpose of this study was to assess whether our change in practice to a higher proportion of carbohydrates (60%) with 25% of energy from protein, and 15% of energy from fat was associated with improved wound healing rates. Secondary outcomes evaluated included invasive fungal wound infections, ischemic bowel, sepsis, and mortality. Before February 2022, the use of a high-protein, relatively low-fat enteral formula (52% carbohydrate, 23% fat, 25% protein) combined with a protein modular was the standard practice (PRE-group) in our burn center. After, we implemented a higher carbohydrate feeding protocol (POST-group). In this study, patients in the POST-group were matched 2:1 by age, burn size, burn depth, inhalation injury, and gender to those in the PRE-group. There were 66 patients evaluated: 18% female, 42±13 years of age, burn size of 38±21%TBSA. There was a statistically significant difference in wound healing rates (0.7%±0.5%TBSA/day PRE vs. 1.1%±0.5%TBSA/day POST, p=0.037). There was also significantly less sepsis (70%PRE vs. 41%POST, p=0.021). There were no statistically significant differences between groups in ischemic bowel (0%PRE vs. 4%POST, p=0.159), invasive fungal wound infection rates (14%PRE vs. 5%POST, p=0.245), or mortality (16%PRE, 9%POST; p=0.447). We found a statistically significant increase in wound healing rates when administering a higher proportion of carbohydrate to our patients with severe burns.