Scars, burns & healing最新文献

Introduction: Research highlights the complex psychological needs that patients and their families can face following a burn injury, regardless of the objective severity of the injury and often beyond the timeframe of physical healing. Identification of psychological needs at different stages post-burn recovery is therefore a key role of clinical psychologists working in burn care services.

Method: This paper presents audit data collected across a two-year period in routine paediatric and adult multidisciplinary team follow-up clinics in a UK burns service. 808 clinical contacts (331 adults, 477 paediatrics) were recorded. Data gathered related to the identification of patient and/or family psychological need and the level of psychology input within clinic.

Results: For 43% of adult patients and 46% of paediatric patients seen in clinic, some degree of psychological need for the patient and/or family was identified during the consultation. A large majority of concerns related directly to the burn injury. This is consistent with previous research into the psychological impact of burns. Even for patients with no identified psychological needs, psychology presence enabled the opportunity for brief screening, preventative advice or signposting to take place during clinic.

Discussion: A substantial number of individuals and families presented with some level of psychological concern in relation to a burn injury when attending burns multidisciplinary team follow-up clinics.

Conclusion: A substantial number of patients and families presented with psychological needs in relation to a burn injury when attending burns MDT follow-up clinics. The presence of Clinical Psychologists at burns MDT follow-up clinics is beneficial for the identification of burns and non-burns related psychological concerns and is a valuable use of psychological resources within a burns service.

Lay summary: The Regional Burns Centre holds regular outpatient scar clinics to monitor recovery and healing. As well as the medical professionals, the clinics are joined by Clinical Psychologists who can assess, refer, and support individuals struggling with their burn or scarring on a mental level. Over 15 months, data was collected about patients attending the clinics and the involvement of the psychologists. 43% of adult patients and 46% of paediatric patients were identified as having some psychological need, either related to their burn or to other aspects of their life. This demonstrates the benefits of having psychology presence within scar clinics, as nearly half of the patients seen in clinic received an assessment and further support (such as signposting and referrals to psychological support). Burns staff also felt that psychology presence enhanced conversations and increased collaboration with decision making around treatment.

Introduction: Surgical burn excision (along with skin grafting) carries the risk of blood loss. The use of enzymatic debridement agents such as Nexobrid® has gained increased popularity as an alternative to surgical debridement in the management of burns with its reported benefits of selective burn debridement, minimising blood loss and potentially reducing the need for skin grafting. However, there is limited evidence regarding its effects on bleeding. Currently, the manufacturer declares there is no evidence for increased risk of localised bleeding and its systemic effects upon coagulation are less clear.

Methods: We present two clinical cases demonstrating the possible effects of Nexobrid® on coagulation and bleeding at the debridement site. Comparisons are drawn with the manufacturers' guidance as well as evaluating the current recommendations of its use.

Discussion: Nexobrid® is a novel therapy and there are few adverse effects reported in the literature. The basis of its appeal is the reduced blood loss at the debridement site and the selectivity it possesses in preserving healthy dermis. However, our cases have demonstrated that haemorrhage can occur and that those using Nexobrid® should be mindful of the potential bleeding risk from varicosities within the burn wound. We have also illustrated that Nexobrid® can be used in patients with pre-existing clotting disorders without requiring the use of blood products. However, we emphasise the importance of haematological support for its safe administration.

Lay summary: Nexobrid®, a debriding agent that contains enzymes, has been developed as an alternative to surgery which for most surgeons is the traditional method of removing dead tissue following a burn injury. The active agent is bromelain and this is derived from the stems of pineapples. This novel treatment is increasingly being used in the management of middle to deep skin thickness burns and it seems to have a number of benefits such as reducing blood loss, reducing the need for skin grafting as well as being able to treat burns in certain areas of the body that would be technically challenging to remove in the standard fashion. It simply targets the dead tissue leaving viable remnants of the skin that would hopefully allow healing to occur without the need for surgical intervention. Being a relatively new concept, current evidence regarding the safety and value of Nexobrid® continues to develop. In 2020, an agreement guideline outlining best practice with the use of Nexobrid® was published. In this statement, it was advised that caution should be taken when using Nexobrid® in patients who have blood clotting disturbances as this could increase the likelihood of bleeding. However, they did not mention that excessive bleeding can potentially occur with this treatment.We present two clinical cases demonstrating the possible effects of Nexobrid® on th

Introduction: Reactivation of pulmonary tuberculosis is a prevalent concomitant infection and cause for mortality in burns patients in Sub-Saharan Africa. First line laboratory diagnostic studies for pulmonary tuberculosis are often negative in these patients and if relied on, result in high mortality. The purpose of this report is to share our experience with a novel protocol of empiric treatment of clinically suspected pulmonary tuberculosis in severely burned patients with negative GeneXpert tests in a tertiary burns centre and to present a brief literature review on the topic.

Methods: A retrospective chart review of all patients, who sustained thermal injury with an inhalation component, with negative GeneXpert tests who were treated empirically for pulmonary tuberculosis over a five-year period (2015-2020) was performed. Additionally, a literature search was performed on Medline (PubMed), Cochrane and Google Scholar databases.

Results: Over the five-year period, 20 patients with suspected pulmonary tuberculosis and severe burns requiring ventilation were managed according to the protocol and all survived to discharge. The literature search identified six factors that explain the consequence of pulmonary tuberculosis in severely burned patients and provide a hypothesis for the negative laboratory studies encountered.

Conclusion: There was an improved outcome for patients with the clinical diagnosis of reactivation of pulmonary tuberculosis when they were started on empirical pulmonary tuberculosis treatment. There are several potential mechanisms that can contribute to reactivation of pulmonary tuberculosis in susceptible severely burned patients. The GeneXpert test should not be relied upon in these patients for a diagnosis, but rather all other clinical evidence should inform management.

Lay summary: From the current literature evidence most patients who have severe burns complicated by a secondary infection known as pulmonary (lung) tuberculosis, die as a result. The purpose of this report is to share our experience with treatment of pulmonary tuberculosis during a five-year period, from 2015 to 2020, in a specialized adult tertiary burn center. Severely burned patients who were suspected of having pulmonary tuberculosis and received treatment despite having negative laboratory tests for pulmonary tuberculosis, had a better survival rate than expected. A brief literature review on the topic of pulmonary tuberculosis and severe burns was done to investigate causes for reactivation of pulmonary tuberculosis and negative laboratory studies in these patients.The literature search identified the following factors that can potentially affect the reactivation of pulmonary tuberculosis in severely burned patients: decreased immune system; secondary infections; low blood albumin(protein) levels; decreased clearance of bacteria from the a

Background: Treatment of wounds and burn injuries is very important. Nowadays, the tendency to research complementary medicine has increased.

Method: In this clinical trial, 60 patients hospitalized in the burn ward who met the inclusion criteria were randomly assigned to two groups: intervention (n = 30) and control (n = 30). In addition to treatments, the intervention group received one capsule (2 g) of Calendula officinalis daily, for two weeks, and the control group received the placebo. Wound status was assessed with the Bates-Jensen Wound Assessment Tool (BWAT) on the 1st, 7th, and 15th days of the study in both groups.

Results: The mean total score of wound status using BWAT at the 1st, 7th, and 14th days in the intervention group was 48.23, 35.93, and 22.97, respectively, and in the control group was 48.90, 42.57, and 37.8. Statistically, wound condition on the first day was at the same level for both groups. Wound healing scores in the two groups increased during the 1st to 15th days of the study (P <0.001). However, in the intervention group, the range of wound healing changed on days seven and 15 and was greater than in the control group.

Conclusion: Based on the results of this study, C. officinalis may have beneficial healing properties and be effective in accelerating the healing of second-degree burn wounds and can be used as a supplement to treat wounds.

Introduction: Venous leg ulcers are the most common cause of leg ulcers. The aim of this study is to assess the effect of Combined Ultrasound and Electric Field Stimulation therapies (CUSEFS) on wound surface area and pain level in patients with venous leg ulcers, utilizing a novel device (BRH-A2 from BRH Medical, Ltd).

Methods: This prospective case series study, conducted by the Department of Plastic Surgery at the Yitzhak Shamir Medical Center, Israel, collected data for subjects treated with CUSEFS with the BRH-A2 device, between April 2018 and September 2019. Measurements of wound area and assessment of pain intensity using a 10-point visual analog score were recorded. At the end of the four-week period, average wound area and pain scores were included for analysis.

Results: Ten consecutive patients met the inclusion criteria. During the study period, all patients exhibited a reduction in the wound surface area. The final average wound surface area was reduced by 53.52% following the combined treatment. Eight out of the ten patients (80%) reported a reduction in pain, with an average pain level reduction of 64% throughout eight consecutive treatments.

Conclusion: CUSEFS therapies with BRH-A2 technology is a promising treatment for venous leg ulcers. In accordance with our preliminary results, this treatment modality can aid in the reduction of wound surface area as well as reducing the pain suffered by patients from these chronic wounds. Larger multicenter studies are needed to further quantify and qualify the beneficial effect of CUSEFS in venous leg ulcers and other chronic wounds.

Lay summary: Venous leg ulcers (VLUs) are painful wounds occurring between the knee and ankle joint, that fail to heal for a period of at least two weeks and occur in the presence of venous disease. VLUs, are the most common cause of leg ulcers, affecting approximately 5% of the general population over the age of 65. Numerous non-invasive treatment modalities have been attempted for healing chronic wounds and ulceration, however, in some instances surgery, although invasive, is the preferred option. For many years, ultrasound (US) has been used therapeutically to treat chronic ulcers. US produces biophysical effects that are significantly beneficial to the wound healing process. Electrical stimulation therapy is another treatment option which contributes to wound healing by influencing the electrochemical wound process.Combined Modulated Ultrasound and Electric Field Stimulation (CUSEFS) have been shown to improve the healing of chronic wounds. However, research has focused predominantly on objective measures of healing, while less consideration has been given to researching the subjective discomfort and the negative impact that ulceration places on the patient. The aim of this study was to assess objective and subjective factors by measuring the short

Background: This case-report explores the effects of photobiomodulation therapy (PBMT) on the healing of scar tissue. The patient was a 32-year old female two years post cholecystectomy resulting in a 15 cm linear scar that was causing severe pain.

Methods: Treatment was initiated using the BIOFLEX® therapist device which consists of LED arrays and laser probes of a specific wavelength, power and frequency applied directly on the skin overlying the scar. The frequency and duration of treatment was every other day for six weeks in a clinic setting, followed by three times a week for two months at home. Then the patient continued to use the BIOFLEX® therapist home device on an as-needed basis.

Findings: The final result of this patient's treatment was significant flattening and decreased redness of her scar. Her self-reported pain decreased to a 6/10. At the one year follow up, the patient reported that she stopped taking her opioids, antidepressant and sleeping pills and that her pain decreased to a 4/10. At the last review her pain score was 1/10; and she had returned to work and took Tylenol (acetaminophen) occasionally for breakthrough pain.

Conclusions: We attribute the patient's improvement in scar appearance and pain symptoms to PBMT. Since pain is often associated with depressed mood and sleep disturbances, it cannot be determined whether PBMT was the direct or indirect cause of this patient's improved mood. For future studies, we propose the use of control subjects with similar scars treated with sham treatment compared to those who will receive the PBMT and observed for the same duration of time and compare the overall results.

Lay summary: Dermatological applications, especially wound healing; are accepted indications for photobiomodulation therapy (PBMT). The expansion into other clinical applications, particularly neurological ones show potential benefit. We present a case of a patient with a hypertrophic scar associated with severe neuropathic pain and concurrent depression, all of which improved directly or indirectly with PBMT. Although the original focus of treatment was dermatological the improvement in pain plus the discontinuation of therapy (opioids, antidepressants and benzodiazepines) were considered to be due to the PBMT.

Diabetes insipidus (DI) is characterized by polyuria and polydipsia. In most cases, the condition results from either an inadequate release or resistance to the activity of antidiuretic hormone in the renal collecting tubules. The underlying pathophysiology may be related to destruction the destruction or degeneration of neurons from inflammatory, autoimmune diseases, vascular diseases, Langerhans cell histiocytosis, sarcoidosis, or trauma. However, a large majority of diabetes insipidus cases (50%) are considered idiopathic. An exceedingly rare cause of idiopathic central DI occurs in burn injuries, which has only been reported in eight cases. We present an extremely rare case of idiopathic DI in a 15-year-old male with 76% total body surface area (TBSA) burns with the development of idiopathic central DI. An extensive literature review was accomplished to compare this case with the small number of previously reported case reports of idiopathic DI in burn patients.

Lay summary: Diabetes insipidus (DI) is a rare complication of burn injuries that results from the destruction of neurons involved in the secretion of antidiuretic hormone from the pituitary gland. Only eight cases of DI have been reported in the literature in association to burn injuries. The patient in this case report received immediate fluid resuscitation, burn treatment, and intensive observation after the initial burn injury. The rapid response was likely the main reason for the absence of neurological damage as reported in the CT image. Therefore, the treatment of burn injuries remains an important step for reducing neurological damage and hormonal dysregulation leading to diabetes insipidus.

Introduction: Silver hydrogel dressings are antimicrobial dressings with the potential to aid post-surgical healing. The purpose of this study is to evaluate the effects of a silver hydrogel dressing on postoperative scarring and complications.

Methods: 40 foot and ankle patients (48.43 ± 16.82 years) were included in the study with 20 patients in each group. Postoperatively, the treatment group was treated with a silver hydrogel sheet dressing, and the control group was treated with a standard petroleum-based dressing. Follow-up was performed at two, six, and 12 weeks. Postoperative scarring and complications were evaluated and compared between groups. Scarring was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Scar length and width were measured using digital calipers and used to compute scar area.

Results: The treatment group demonstrated statistically significant improvements in the POSAS observer score and observer opinion at six and 12 weeks (p < 0.001). Additionally, patient reported pain was significantly lower for the treatment group than the control group at 12 weeks (p < 0.001). Patient reported itch declined across time for both groups (p < 0.001) with significantly less itching reported by the treatment group (p = 0.027). Scar area was also significantly lower for the treatment group than the control group at six weeks and 12 weeks (p ≤ 0.002). Neither group experienced any postoperative complications.

Conclusion: These results suggest that the inherent properties of the silver hydrogel dressing may improve postsurgical scarring.

Lay summary: Surgical incisions result in scar, which can present both cosmetic and rehabilitation concerns after foot or ankle surgery. It is standard to use a petroleum-based dressing on incisions after surgery, however, advancements in incisional dressings have been made over the past 20 years. One such advancement is silver-impregnated hydrogel sheet dressings which have been shown to maintain a moist wound environment conducive to healing, while decreasing the chance of infection through its antimicrobial properties. This paper evaluates scar healing after foot or ankle surgery in patients treated with either the standard petroleum-based dressing, or the silver hydrogel sheet dressing. Patients who were treated with the silver hydrogel dressing had less itching and pain, as well as a smaller scar area than patients in the standard dressing group. Therefore, our results suggest that the silver hydrogel dressing may improve scarring after surgery.

Background: Surgical decompression of the carpal tunnel is considered the method of choice for its treatment with satisfactory results documented. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared interrupted mattress closure by means of nylon suture to running subcuticular closure with vicryl rapide suture. As far as we know, there is no similar study in the literature.

Methods: A total of twenty patients were included in the study. Ten of them had their surgical wound closed with 3.0 nylon suture in an interrupted fashion and for the rest, a running subcuticular 3.0 vicryl rapide was used. All patients filled in a questionnaire about VAS perceived pain and a Quick DASH score sheet, preoperatively, at two and six weeks postoperatively. The cosmesis of the scar was assessed using the POSAS v2.0 system at two and six weeks after surgery and overall incidence of infections was noted as well.

Results: There was no statistically important difference between the two groups of patients in regards to postoperative VAS pain levels at two and six weeks. Likewise, no statistically significant difference was evident as far as Quick DASH score, POSAS score and infections were concerned.

Conclusions: Our results suggest that the use of running subcuticular vicryl rapide suture is an attractive alternative to interrupted nylon sutures for closure after open carpal tunnel decompression, lacking any significant drawbacks.

Lay summary: Surgery for carpal tunnel decompression is considered the method of choice for its treatment with documented satisfactory results. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared the use of a non-absorbable suture, placed intermittently to an absorbable continuous intradermal suture. A total of twenty patients were included in the study. Half of them had their wound closed with the absorbable suture and the other half with the non-absorbable suture, as described above. All patients were evaluated as far as pain, scar characteristics, functional outcomes of the operated hand and incidence of infection, at two and six weeks after surgery. After analysis of the data, no significant differences were found between the two groups, suggesting that both of these techniques are equally safe and efficacious.