Journal of Burn Care & Research最新文献

Skin grafts are essential in reconstructive surgery, although complications such as hematomas, seromas, infections, and shear forces can compromise their success. This study evaluated the effectiveness of a hemostatic net fixation technique to improve graft integration and reduce complications. Fifteen patients treated with non-meshed split-thickness grafts fixed using continuous sutures forming a hemostatic net were compared to meshed grafts fixed with staples or sutures along the edges (traditional technique). Both treatments were applied to split wound areas in the same patient. Six months of follow-up, assessing graft integration, aesthetic appearance, and complications, were reported. No patients experienced hematomas, seromas, or infections, and all grafts integrated successfully. Additionally, a blinded panel of plastic surgeons rated the aesthetic appearance of the two techniques. The aesthetic appearance was evaluated with higher scores in the grafts fixed with a hemostatic net. In conclusion, the fixation of skin grafts using a hemostatic net improves integration and aesthetic outcomes while minimizing complications such as hematoma or seroma. Further studies with more surgical areas are needed to confirm these benefits. The technique could represent a significant advancement in reconstructive and aesthetic surgery, optimizing clinical and cosmetic outcomes.

After major burn injury, patients experience a hypermetabolic response leading to catabolic effects. Anabolic steroids have been investigated to combat these effects. Oxandrolone, the primary anabolic steroid used to combat burn hypermetabolism, was removed from the US market in June 2023, and our institution implemented testosterone as an alternative. A known side effect of anabolic steroid use is transaminitis. This study aims to compare the incidence of transaminitis between oxandrolone and testosterone in patients with major burn injury. A single-center, retrospective cohort study was conducted to evaluate adult patients with at least 20% BSA burn injury who received either testosterone or oxandrolone. The primary outcome evaluated was incidence of transaminitis. Secondary outcomes included the need for dose reduction or discontinuation of the steroid, length of stay (LOS), and mortality. Preliminary data were analyzed for significance. Seventy patients received either oxandrolone (n = 52) or testosterone (n = 18). Demographics were similar. The incidence of transaminitis was not statistically significant between oxandrolone and testosterone, 38% vs 28% (P = .596). The rate of dose decrease between the 2 groups was not significant, 17% vs 0% (P = .071). There was a statistically significant difference in early discontinuation of the drug between the groups, 33% oxandrolone vs 0% testosterone (P = .014). The median LOS was 28 and 36 days, respectively, with a mortality rate of 21% and 6% in each group. Preliminary data from this study demonstrate a trend to higher incidence of oxandrolone transaminitis in comparison to testosterone, without statistical significance.

Disasters often lead to increased generator use, resulting in carbon monoxide poisonings (COP) and burn injuries that can overwhelm regional burn centers. Following Hurricane Ida, emergency medical services (EMS) providers in southeastern Louisiana were empowered to treat minor COP and burn injuries on the scene without hospital transport. This study evaluated the impact of that policy. Using EMS and Louisiana Emergency Response Network (LERN) data, we analyzed EMS calls from 3 periods surrounding Hurricane Ida's landfall on August 29, 2021: pre-Ida (07/08-08/25), mid-Ida (08/26-09/08), and post-Ida (09/09-10/31). We tracked call volumes, transport rates, and EMS turnaround times. Weekly calls were compared using Kruskal-Wallis tests and negative binomial regression; transport rates were assessed using chi-squared tests. Emergency medical services received 1607 COP or burn-related calls during the study period. Pre-Ida, EMS averaged 15.3 calls/day (89% COP), with transport rates of 98% for COP and 61% for burns; turnaround time averaged 63 ± 36 min. Mid-Ida saw a rise to 20.9 calls/day (84% COP), with transport rates of 78% for COP and 73% for burns; turnaround was 64 ± 31 min. Post-Ida, calls declined to 10.6/day, with 97% of COP and 61% of burns transported; turnaround was 69 ± 49 min. No repeat EMS calls were made by patients treated on the scene. The study observed a significant increase in CO-related EMS dispatches during mid-Ida, with a concurrent decrease in hospital transports, indicating successful on-scene care. Emergency medical services turnaround times remained stable across all periods. These findings highlight effective collaboration between EMS and burn centers during disaster response.

Patients with severe burns are more vulnerable to infection, sepsis, and death. With heavy use of antimicrobials, changes in burn wound microbial and antibiotic resistance patterns have been reported; however, the literature remains scarce. This study assessed wound colonization trends in first positive cultures in our burn unit over the last decade. This is a retrospective cohort study including all patients admitted to our burn unit from July 2013 to June 2023. Demographics, TBSA, injury mechanism and admission information were obtained. Wound culture information including date of positive cultures, type of organisms, and antibiotic susceptibility data was also collected. Patients were stratified based on TBSA as small (<10%), moderate (10%-19.9%), and severe burns (≥20%). Descriptive statistics were obtained. Generalized linear models were fit to assess the trends of positive cultures over time for the 3 TBSA strata. A total of 2755 patients were included; median age was 38 years, 72.2% were male; 74.1%, 15.9%, and 10.1% presented with small, moderate, and severe burns, respectively. Wound cultures on initial presentation were performed in 40.3% of our population with 600 cases having positive first cultures; 84.7% grew Gram-positive, 35.7% Gram-negative, and 9.7% fungal organisms. Data showed an increase in Gram-positive and fungal species over the study period in first positive cultures of severe burn patients. We also found increasing rates of resistance for several antibiotics, including erythromycin, oxacillin, and vancomycin. Future studies are warranted to evaluate changes in microorganism growth throughout the hospital course of severe burn patients.

Psychosocialsequelae from burn injuries may be significant for both patients and caregivers, affecting functional recovery. Narrative medicine, one aspect of medical humanities, uses guided reading, discussion, and writing to allow persons to feel seen and heard, and to reflect and express themselves. This low-cost, non-pharmacological intervention may benefit persons recovering from a burn injury, as well as caregivers. A prospective, uncontrolled, feasibility and acceptability trial was carried out in a 12-bed regional burn center with 6 patients and 6 caregivers (not dyadic pairs). Feasibility was defined as a minimum threshold of 85% completed intervention sessions; acceptability was defined as a minimum enrollment rate of 35%. Anticipating a subsequent quasi-experimental design, candidate outcome variables (anxiety and emotional regulation) were measured for potential use. Participants' written texts were collected and analyzed using thematic analysis. The study was acceptable (35%) and feasible to deliver to patients with burns (100%). Caregiver acceptability was low (under 35%), although it was feasible to deliver to caregivers (86%). Two candidate outcome variables (anxiety and emotional regulation) showed measurable change in the expected direction in both patients and caregivers. Thematic analysis yielded 4 themes: out-of-hospital stressors, hope and compassion, medical updates, and emotions. Meaningful contributions may be made by narrative medicine interventions, offering a low-cost, non-pharmacological option to reduce anxiety and regulate emotions. Results warrant revising the study design and proceeding with further development of this behavioral intervention.

Pediatric thermal injury induces immune dysfunction, which is associated with adverse clinical outcomes (eg, nosocomial infections [NIs]). As such, it is crucial to identify those most at risk for developing NI and determine immunomodulating therapeutics to augment the immune response. Our hypothesis was that immune suppression after pediatric thermal injury is reversible ex-vivo using the immunomodulators recombinant human granulocyte macrophage-colony stimulating factor (GM-CSF) and varlilumab (CD27-agonist). We enrolled 141 pediatric patients with acute thermal injuries from a single burn center. Blood samples were taken within the first week after injury to analyze immune function and ex-vivo reversibility. Pediatric patients with burn injuries who went on to develop an NI displayed a decrease in innate (ex-vivo lipopolysaccharide [LPS]-induced tumor necrosis factor alpha [TNFα] production capacity) and adaptive immune function (ex-vivo phytohemagglutinin [PHA]-induced interleukin [IL]-10 production capacity) compared to patients with burn injuries who recovered without infection. After correcting immune function measurements by the total number of cells, the ratio of LPS-induced TNFα/CD14+ monocytes decreased within the first 72 h for patients with burn injuries who developed an NI, whereas PHA-induced IL-10/CD4+ lymphocytes was significantly decreased at days 4-7. Samples co-incubated with GM-CSF significantly increased ex-vivo LPS-induced TNFα, while samples containing CD27 increased PHA-induced IL-10 production capacity, in the first 72 h, compared to samples that did not receive immunomodulators. The results of our study identified key markers to discover who is most at risk for developing NI, and provided early evidence of immunomodulators that may enhance immune function early after pediatric burn injury.

Pediatric patients with burn injuries in the intensive care unit require the care of a multidisciplinary team. Occupational and physical therapists play a vital role in edema management, positioning, orthoses fabrication, and advancement of functional and developmental activities. Early mobilization in the intensive care unit is increasingly recognized as the standard of care for pediatric patients. However, outcomes and barriers specific to the pediatric burn population have not been evaluated. This study aimed to describe early mobilization practices in pediatric patients with burn injuries, identify the barriers to their participation, evaluate changes in mobility levels throughout intensive care unit admission, and examine the impact of total body surface area burn on mobility progression. We retrospectively reviewed 108 children with burns who were admitted to the intensive care unit at a pediatric burn center. Patient demographics and therapy visit-level data within the first 14 days of intensive care unit admission, which included level of activity performed and barriers to participation, were analyzed. Children with higher total body surface area burns had significantly lower levels of activity (P = .002). Barriers to therapy participation were common with 66% of children missing at least 1 physical therapy session and 55% missing at least 1 occupational therapy session within the first 14 days of intensive care unit admission. The most common barriers included patient involvement in testing or procedures (54%) and nursing concern about medical status (12%). Future research and quality improvement initiatives should prioritize interventions that address and mitigate barriers to implementation of early mobilization in this patient population.

Pediatric patients with larger TBSA burns have a high surface area to volume ratio and are at risk of over-resuscitation. In 2015, our burn center revised our resuscitation algorithm for "difficult to resuscitate" patients with >15% TBSA burn to substitute albumin for a portion of crystalloid volume, hoping to reduce negative effects of volume overload while preserving resuscitation goals. We retrospectively reviewed patients <18 years of age treated between 2008 and 2024 who required burn resuscitation. Patients who had ≥15% TBSA burn and required >40% of baseline fluids in the first 24 h were defined as "difficult to resuscitate." Patients who died in <48 h were excluded. Patient demographics, burn characteristics, treatment details, and patient outcomes were collected. Patients were compared using Fisher's exact and Wilcoxon rank sum tests. Thirty-four patients were "difficult to resuscitate," with 8 patients admitted prior to substitution of albumin and 26 patients treated after. Demographic characteristics did not vary between groups. Patients in the albumin group received less total intravenous fluid volume within 48 h (12.4 [IQR: 8.6-13.8] vs 7.8 [IQR 6.3-9.3] mL/kg/TBSA P = .037) and had lower serum lactate at 48 h (1.7 [IQR 1.7-2.2] vs 1.0 [IQR 0.8-1.3] mmol/L P = .018). Length-of-hospital-stay normalized to TBSA burn was shorter among those who received albumin (1.2 [IQR: 0.8-1.6] vs 1.9 [IQR:1.3-2.4] days P = .027). The substitution of albumin for pediatric burn patients who are difficult to resuscitate reduced total intravenous volume and length-of-stay per TBSA, while preserving chemical markers of adequate resuscitation.

Axillary burn contractures impair upper limb function and can recur after initial reconstruction. The risk factors for recurrence remain unclear. This study aims to evaluate the recurrence rate of axillary burn contractures and identify associated risk factors. A retrospective chart review was conducted on patients who underwent reconstructive surgery for axillary burn contracture at a single institution between 2009 and 2022. Data collected included demographic information, injury details, reconstruction type, follow-up, reoperations, and complications. There were 30 axillary burn scar contractures in 27 patients (74.1% male, 25.9% female; mean age of 36.8 ± 15.2 years). Almost all burns were thermal (n = 24; 88.9%) and partial thickness (n = 22; 81.5%). The mean time between injury and reconstructive surgery was 10.3 ± 8.5 months, and the mean follow-up period was 18.1 ± 26.4 months. Z-plasty was the most frequently employed reconstructive procedure (n = 12; 40%), followed by split-thickness skin graft (STSG) only (n = 5; 16.7%), and a 2-stage procedure with the application of a dermal substitute followed by STSG in 2 weeks (n = 4; 13.3%). The overall recurrence rate was 30.0% (n = 9). The Z-plasty group (n = 2; 16.7%) demonstrated relatively low rates of contracture recurrence. In contrast, the STSG only (n = 3; 60%) and latissimus dorsi flap with STSG (n = 2; 66.7%) groups had the highest rates of recurrence. Reoperation was performed in 77.8% of recurrent contractures (n = 7). The recurrence rate following axillary burn reconstruction is high, often requiring multiple reoperations. Given how procedure type affects contracture recurrence rate, reconstructive surgeons should consider using local flaps over skin grafts to release axillary burn contractures.

Childhood burn injuries can lead to physical and psychosocial challenges that linger well beyond the initial phases of the trauma. This study explores the interrelated roles of pain, body image, and physical function in children living with burn injuries using data from the Burn Model System National Longitudinal Database. A cohort of 110 children aged 8-17 was assessed 6 months postinjury. Descriptive and regression analyses revealed that, on average, pediatric burn survivors reported significantly lower pain interference compared with the general pediatric population. However, higher pain interference and number of surgical operations were negatively associated with physical function. Body image was not significantly associated with clinical variables, thus suggesting a more multifaceted nature of psychosocial recovery. These findings underscore the importance of comprehensive pain management and family-centered rehabilitation to foster resilience and enhance functional and emotional outcomes in pediatric burn survivors.