Journal of Burn Care & Research最新文献

The Posttraumatic Growth Inventory (PTGI) was developed to measure positive psychological changes individuals can experience after trauma. While the 10-item form (PTGI-10) is relatively brief, an even shorter version would be valuable in situations where participant response burden is of particular concern. The PTGI-10 was administered to 1076 adults recovering from moderate to severe burn injury between 6 months and 20 years after injury as part of an ongoing longitudinal study. Analyses completed to inform item selection included classical test theory analyses of reliability (ie, Cronbach's alpha) and item performance, item response theory analyses, and qualitative item review. A focus group selected items for a new short form while considering results of the analyses as well as item content and acceptability. Score agreement between the PTGI-10 and the newly created short form was examined. A confirmatory factor analysis supported unidimensionality; however, reliability (α = 0.94) and results of local dependency indicated items were highly redundant. A new 3-item short form (PTGI-3) was created and includes 1 item from each of the 3 categories of perceived benefits identified in posttraumatic growth theory. Reliability of the new short form is moderate (>0.8) for scores ±1 SD around the mean. Scores on the PTGI-3 correlate highly (r = 0.94) with scores on the PTGI-10. The PTGI-3 has sufficient reliability for group comparisons, balances item content, and includes items that are acceptable to people with burn injury.

Burn injuries among migrants crossing the Mediterranean increasingly represent a serious health issue, particularly in southern Europe. We retrospectively reviewed 91 migrant patients admitted to the Burn Center of ARNAS Civico Hospital in Palermo between 2015 and 2025: 65 (71.4%) had chemical burns from seawater-fuel mixtures, 25 (27.5%) had flame burns due to vessel explosions or torture, and 1 (1.1%) had a burn injury of other etiology. Mean age was 25 ± 9.84 years, and mean TBSA was 16.09% ± 11.06%. Chemical burns healed faster than flame burns (P = .0043). Split-thickness grafting was required in 40.0% of flame burns versus 3.07% of chemical burns (P = .000026). Inhalation pneumonia occurred in 20% of flame burns versus 3.07% of chemical burns (P = .0164), and sepsis developed in 28.0% of flame burns versus 0% of chemical burns (P = .000064). Among the 7 septic patients, mean burn surface area was 32.14% ± 16.54% TBSA, and 2 patients (28.57%) died. Predominant isolates included Acinetobacter baumannii and Klebsiella pneumoniae. These findings highlight the elevated risk of surgical, pulmonary, and infectious complications following flame burns in resource-limited maritime settings. Optimized burn care protocols, rapid microbiological diagnostics, and improved postrescue coordination are critical to reducing morbidity and mortality in this high-risk group.

Pediatric burn injuries remain a leading cause of global morbidity, with complications such as delayed healing, infection, and hypertrophic scarring contributing to long-term functional and psychosocial burden. Polylactic acid skin substitutes have gained traction as a synthetic dressing option in pediatric burn care, yet outcome variability across studies necessitates a formal synthesis. Our objective was to evaluate the efficacy of polylactic acid skin substitutes in pediatric burn management by assessing healing time, infection rates, hypertrophic scarring, and pain scores through a systematic review and meta-analysis. A systematic search of PubMed, Scopus, and Embase identified studies reporting outcomes of pediatric burn patients treated with polylactic acid membranes. Nine studies (n = 811 pediatric patients) met inclusion criteria. Meta-analyses were conducted for healing time, infection rate, and hypertrophic scarring. Four additional studies were analyzed qualitatively due to heterogeneity in outcome reporting or study design. The pooled weighted mean healing time across 3 studies was 14.0 days (95% CI, 9.7-18.4), with moderate heterogeneity (I2 = 48.9%). The pooled infection rate across 4 studies was 5% (95% CI, 0%-66%), and the pooled hypertrophic scarring rate from 2 studies was 12% (95% CI, 1%-73%). Narrative synthesis revealed additional benefits, including systemic antioxidant effects, though challenges such as premature detachment were noted. In conclusion, polylactic acid skin substitutes demonstrate favorable performance in pediatric burn management, promoting timely reepithelialization, reducing infection, and mitigating scarring risk. While overall findings support its utility, variability in outcome definitions and moderate heterogeneity highlight the need for standardized protocols.

Fires and burn injuries incurred from home oxygen therapy continue to pose a significant and escalating public health risk, particularly as the population of older adults ≥ 65 years exponentially grows during the next decades. In these oxygen-rich environments, common household ignition sources can trigger spontaneous fires that burn hotter and spread more rapidly. This endangers the patient, family members, neighbors, home healthcare workers, and first responders, potentially leading to property loss, injury, and/or death. A call to action was stimulated by a national review revealing a 14% per year increase in oxygen therapy injuries during a 10-year period. Similarly, the Veterans Health Administration issued a "Patient Safety Alert" due to the observed significant increase in oxygen therapy-related fires and injuries. To address this critical issue, professionals nationwide are seeking novel solutions to define the problem, raise awareness, and implement community-based risk reduction strategies. Hence, this article bridges an identified literature gap by providing a needed foundational overview of oxygen therapy-related fires and burn injuries, examining incidence data, illustrating current knowledge and data limitations, highlighting unique challenges, exploring opportunities for change, outlining ongoing national risk reduction efforts, and recommending specific evidence-informed strategic approaches for comprehensive prevention and mitigation interventions.

Hypertrophic scarring from burns can lead to sleep disturbances in children and significantly impact their quality of life and that of their caregivers. This study investigated the sleep quality of nine pediatric patients with hypertrophic scars who underwent CO2-AFL surgery. Electrocardiography was recorded before the first CO2-AFL treatment and after the final treatment. Cardio-pulmonary coupling software was used to automatically generate sleep reports, including total time in bed, total sleep time, sleep efficiency, sleep latency time, deep sleep time, light sleep time, rapid eye movement sleep time, wake time, and apnea-hypopnea index. This study found that pediatric patients with hypertrophic scars commonly experience sleep disorders, and CO2-AFL surgery could improve sleep quality, including sleep efficiency, deep sleep duration, awakening time, and apnea-hypopnea index. This study provides preliminary objective evidence that CO₂-AFL treatment is associated with improvements in sleep quality parameters in pediatric patients with hypertrophic scars.

Growing evidence supports the addition of fresh frozen plasma (FFP) to a standardized crystalloid-based burn resuscitation. FFP is thought to mitigate endotheliopathy, decrease total fluids and improve outcomes; however, when and how much FFP to give remains controversial. Here, we assessed the safety and efficacy of adding a non-titratable, 8-hour FFP infusion of 0.5 mL/kg/% total body surface area (TBSA) to a burn resuscitation. We performed an unmatched retrospective cohort review on all burn patients aged >18 years old with >20% TBSA burns who underwent our nursing-driven resuscitation protocol that included this early, standardized FFP infusion, from November 2016-May 2020. Fifty-three patients received FFP and met inclusion criteria. Patients were primarily male (85%), with a median age 36 years and a TBSA burn of 39% (range 24.5-94%). Median time to FFP administration was 7 hours from injury with a median of 1517 ml infused. Median input/output (I/O) ratio improved from 0.8 at FFP initiation to 0.4 at 3 hours post FFP, p<0.001. Median urine output (UOP) improved from 0.19 ml/kg/hr prior to FFP administration to 0.52 ml/kg/hr at 3 hours post FFP, p<0.001. No complications related to resuscitation such as abdominal compartment syndrome, acute respiratory distress syndrome, or transfusion reactions occurred. Therefore, adding a low-dose, standardized FFP infusion to burn resuscitations significantly improved UOP, normalized I/O ratios and did not cause any known complications. Standardizing a safe, effective, non-titratable FFP infusion provides the framework to systematically test how colloids can be optimized during burn resuscitations in the future.

Paraffin wax is applied to scar tissue for its proposed benefits of increasing skin pliability and relieving pain. However, limited studies have objectively assessed hypertrophic scar (HSc) response. This study examined immediate HSc changes after paraffin treatment compared with intra-individual controls. A quasi-experimental, within-subject, evaluator-blinded, pre-post design was used. Two homogeneous HSc were identified per participant: one treated with paraffin wax and one with mineral oil for 20 minutes. Normal skin also received paraffin to assess scar-specific effects. Objective measures included elasticity (Cutometer), erythema and melanin (Mexameter), transepidermal water loss (TEWL) (Tewameter), thickness (High-frequency Ultrasound), and self-reported pain, itch, stiffness, and overall scar impression. Thirty-nine burn survivors were recruited; 35 completed the study. Paired t-tests showed increased elasticity and erythema in paraffin-treated HSc and normal skin, decreased pigmentation in paraffin-treated normal skin, and decreased TEWL in the mineral oil-treated control scars. ANCOVA of post-treatment values, controlling for baseline, revealed significant increases in erythema and TEWL in paraffin-treated versus control scars. Participants perceived greater improvement in paraffin-treated HSc than controls, though controls improved across all items. Although paraffin significantly increased elasticity in both HSc and normal skin, it did not significantly differ from mineral oil-treated scars, suggesting that some of theeffect may be attributable to mineral oil, as there was a slight increase in skin elasticity within the mineral oil group. However, paraffin improved self-reported outcomes, highlighting its potential clinical value in relieving pain and itch rather than increasing scar elasticity. As mineral oil also improved self-reported items, its benefits need further investigation. Future studies should recruit participants with baseline pain and itch to ensure adequate power.

Despite improved safety standards, motor vehicle collisions remain a significant source of flame burn injury. The objective of this study is to characterize differences in demographics and outcomes between patients with burn injuries related to motor vehicle collisions and flame burn patients not involved in motor vehicle collisions. The analysis included participants enrolled in the Burn Model Systems from 2015-2023. Conveyance burn participants had more amputations than non-conveyance burn patients (15% vs. 4.9%, p < 0.001), with an increase in lower extremity amputations (2.5% vs. 0.7%, p = 0.027). Additionally, conveyance burns involved a greater total body surface area (TBSA) (26% vs. 23%, p < 0.034) and were associated with longer hospital stays (40 days vs. 33 days, p < 0.006). Participants who sustained injuries during conveyance demonstrated significantly lower global physical health t-scores (42.3 vs. 44.1, p = 0.037) and physical function t-scores (42.0 vs. 46.1, p = 0.002) at 6 months post-injury compared to those with non-conveyance flame burns. Additionally, conveyance burn participants reported significantly lower t-scores for their ability to participate in social roles at 6 months (48.8 vs. 50.8, p = 0.044) and 12 months post-injury (49.9 vs. 54.0, p = 0.015). This study highlights the significant impact of conveyance-related burn injuries, particularly with respect to higher amputation rates and poorer early physical outcomes, compared to non-conveyance flame burns. This supports the need for targeted preventive strategies, especially those focused on vehicle maintenance and safety among younger and underrepresented populations.

Background: Burn management in patients requiring pelvic external fixation is extremely challenging due to restricted positioning and difficulty maintaining airtight negative pressure wound therapy (NPWT). Practical techniques to secure NPWT in this setting are rarely described.

Case: A 53-year-old man sustained 26% TBSA deep burns and an unstable pelvic fracture treated with external fixation. Circumferential trunk eschar excision was achieved by alternating lateral positions, as prone positioning was not feasible. NPWT was applied for wound bed preparation and graft fixation. Airtight sealing was obtained using stoma paste around fixation pins and a belt-like silver-containing dressing on raw surfaces, reinforced with stoma paste to create a stable adhesion ridge. These methods enabled sustained negative pressure and stable graft take without regrafting.

Key technical points: (1) Safe circumferential debridement achieved via alternating lateral positions.(2) Stoma paste effectively sealed difficult contours.(3) Silver dressing under stoma paste created an antimicrobial, sealable ridge for film adhesion.(4) "Double-sided film sealing" around pins maintained airtight NPWT.

Conclusion: This case highlights practical NPWT sealing strategies enabling safe burn care under pelvic external fixation.