Pub Date : 2024-10-24DOI: 10.1016/j.burns.2024.107298
Norberto Navarrete, Juan David Rodriguez-Parra
{"title":"Correspondence: Electrical and thermal burns, An underestimated problem.","authors":"Norberto Navarrete, Juan David Rodriguez-Parra","doi":"10.1016/j.burns.2024.107298","DOIUrl":"10.1016/j.burns.2024.107298","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107298"},"PeriodicalIF":3.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.burns.2024.107290
Jamie Neelon , Irene Yau , Anders H. Carlsson , Steven Blake Smithson , David E. Varon , Christopher K. Chan , Rodney K. Chan , Kristo Nuutila
Advancements in the treatment of burns have considerably improved overall survival rates, but they have also highlighted several long-term sequelae related to the injury. Hypertrophic scars can impair function, reduce quality of life, and require multiple procedures as well as physical therapy. The purpose of this study was to investigate the effects of topical application of anti-inflammatory drugs in the treatment of burns. Up to 15 deep-partial thickness burns were created on the dorsum of four anesthetized swine. Subsequently, the burn wounds were randomized to receive amiloride, celecoxib, dexamethasone or minocycline mixed in a hydrogel. Silver sulfadiazine cream and blank hydrogel acted as controls. The animals were followed for 90 days and the wounds were assessed on days 3, 7, 14, 28 and 90 post-burn. Assessments were performed using photographs (macroscopic healing, contraction), laser-speckle imaging (blood perfusion), 3D camera (scarring, pigmentation), and histology (inflammation, burn depth, epidermal maturation). Inflammation was present in all burn wound histology specimens and peaked on day 7 in all groups. Regardless of the treatment the burns progressed and were deeper on day 7 in comparison to day 3. The burns were 50 – 80 % healed by day 14, but no significant differences were observed. No differences in epidermal thickness, rete ridges, contraction, hypopigmentation, or scar elevation were seen on day 90. Topical anti-inflammatories did not significantly decrease inflammation or mitigate burn wound progression in deep partial thickness burns in pigs. Also, no significant differences in wound healing or quality of healing were observed.
{"title":"Topical application of anti-inflammatory agents on burn wounds and their effect on healing","authors":"Jamie Neelon , Irene Yau , Anders H. Carlsson , Steven Blake Smithson , David E. Varon , Christopher K. Chan , Rodney K. Chan , Kristo Nuutila","doi":"10.1016/j.burns.2024.107290","DOIUrl":"10.1016/j.burns.2024.107290","url":null,"abstract":"<div><div>Advancements in the treatment of burns have considerably improved overall survival rates, but they have also highlighted several long-term sequelae related to the injury. Hypertrophic scars can impair function, reduce quality of life, and require multiple procedures as well as physical therapy. The purpose of this study was to investigate the effects of topical application of anti-inflammatory drugs in the treatment of burns. Up to 15 deep-partial thickness burns were created on the dorsum of four anesthetized swine. Subsequently, the burn wounds were randomized to receive amiloride, celecoxib, dexamethasone or minocycline mixed in a hydrogel. Silver sulfadiazine cream and blank hydrogel acted as controls. The animals were followed for 90 days and the wounds were assessed on days 3, 7, 14, 28 and 90 post-burn. Assessments were performed using photographs (macroscopic healing, contraction), laser-speckle imaging (blood perfusion), 3D camera (scarring, pigmentation), and histology (inflammation, burn depth, epidermal maturation). Inflammation was present in all burn wound histology specimens and peaked on day 7 in all groups. Regardless of the treatment the burns progressed and were deeper on day 7 in comparison to day 3. The burns were 50 – 80 % healed by day 14, but no significant differences were observed. No differences in epidermal thickness, rete ridges, contraction, hypopigmentation, or scar elevation were seen on day 90. Topical anti-inflammatories did not significantly decrease inflammation or mitigate burn wound progression in deep partial thickness burns in pigs. Also, no significant differences in wound healing or quality of healing were observed.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107290"},"PeriodicalIF":3.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.burns.2024.107291
Ronit Malka , David T. Silliman , Andrea Fourcaudot , Jesse Q. Nguyen , Kai P. Leung , John F. Decker , Gregory R. Dion
Introduction
Oral commissure stenosis and lower eyelid ectropion from burns are functionally impairing and challenging to treat. Evaluation of various treatment modalities is limited by a lack of preclinical models. Described is a method for inducing controlled, titratable oral commissure and lower eyelid burns in swine for future treatment research.
Methods
Burn wounds 3 cm in diameter were applied to the lower eyelid and oral commissure of seven anesthetized Yorkshire swine for 10, 15, 20, or 30 s at 100 °C with a custom designed thermocouple-controlled burn device and observed for 3, 30, or 90 days. Tissue underwent laser speckle imaging (LSI) to assess vascular perfusion and histologic analysis after harvest. Statistical comparisons were calculated using Wilcoxon rank-sum tests.
Results
Subdermal extension was noted in oral commissure and lower eyelid burns with contact time of 20 s or greater. Wound area progressively contracted from post-operative day (POD) 0 to 90 in both sites, but this was not statistically significant based on contact time or burn site (p > 0.20). Burns of 20–30 s demonstrated increased neutrophil influx for oral commissure injuries (p < 0.01) and leukocyte and macrophage influx for lower eyelid injuries (p = 0.02). Degree of vascular congestion increased with 20–30 second burns in both the oral commissure (p = 0.015) and lower eyelid (p = 0.04). Normalized LSI readings showed increased speckle size in both oral commissure (4.0-fold increase, p < 0.01) and lower eyelid (3.2-fold increase, p < 0.01) burns on POD 90 compared to pre-injury. No change in oral or ocular function was noted in any of the groups (p = 0.96).
Conclusion
Oral commissure and lower eyelid burns create scars which may be modified by burn duration. This model may evaluate a therapeutic’s ability to limit functional impairment from burns.
{"title":"Design and validation of a preclinical model for oral commissure and lower eyelid thermal injury","authors":"Ronit Malka , David T. Silliman , Andrea Fourcaudot , Jesse Q. Nguyen , Kai P. Leung , John F. Decker , Gregory R. Dion","doi":"10.1016/j.burns.2024.107291","DOIUrl":"10.1016/j.burns.2024.107291","url":null,"abstract":"<div><h3>Introduction</h3><div>Oral commissure stenosis and lower eyelid ectropion from burns are functionally impairing and challenging to treat. Evaluation of various treatment modalities is limited by a lack of preclinical models. Described is a method for inducing controlled, titratable oral commissure and lower eyelid burns in swine for future treatment research.</div></div><div><h3>Methods</h3><div>Burn wounds 3 cm in diameter were applied to the lower eyelid and oral commissure of seven anesthetized Yorkshire swine for 10, 15, 20, or 30 s at 100 °C with a custom designed thermocouple-controlled burn device and observed for 3, 30, or 90 days. Tissue underwent laser speckle imaging (LSI) to assess vascular perfusion and histologic analysis after harvest. Statistical comparisons were calculated using Wilcoxon rank-sum tests.</div></div><div><h3>Results</h3><div>Subdermal extension was noted in oral commissure and lower eyelid burns with contact time of 20 s or greater. Wound area progressively contracted from post-operative day (POD) 0 to 90 in both sites, but this was not statistically significant based on contact time or burn site (p > 0.20). Burns of 20–30 s demonstrated increased neutrophil influx for oral commissure injuries (p < 0.01) and leukocyte and macrophage influx for lower eyelid injuries (p = 0.02). Degree of vascular congestion increased with 20–30 second burns in both the oral commissure (p = 0.015) and lower eyelid (p = 0.04). Normalized LSI readings showed increased speckle size in both oral commissure (4.0-fold increase, p < 0.01) and lower eyelid (3.2-fold increase, p < 0.01) burns on POD 90 compared to pre-injury. No change in oral or ocular function was noted in any of the groups (p = 0.96).</div></div><div><h3>Conclusion</h3><div>Oral commissure and lower eyelid burns create scars which may be modified by burn duration. This model may evaluate a therapeutic’s ability to limit functional impairment from burns.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 1","pages":"Article 107291"},"PeriodicalIF":3.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.burns.2024.10.004
N. Dastagir, D. Kijas, D. Obed, M. Tamulevicius, PM Vogt , K. Dastagir
Toxic epidermal necrolysis (TEN) is a life-threatening condition with a mortality rate of approximately 25 % to 30 %. Early and adequate wound coverage is necessary due to large skin defects. Suprathel® is a modern wound dressing that shows promising results when treating superficial wounds such as scalds, burns and abrasions. Previous reports on wound care in TEN patients using Suprathel® have described radical debridement of the entire affected body surface prior to the application of Suprathel®. However, heavy wound secretion in TEN may result in the loss of a significant portion of Suprathel® over time. Prolonged operation time increases the risk of hypothermia. In addition, the large open wound areas result in an increased risk for hypovolemic shock, wound infection, and subsequent sepsis. This study presents a new strategy that involves serial hydrotherapeutic wound debridement and the stepwise application of Suprathel® to the affected areas. Water-filtered infrared A light (wIRA) was used to keep the Suprathel®-covered areas dry. Retrospective data from patients who received polyhexanide gel treatment (control group 1) and those who only received Suprathel® (control group 2) were collected for matched-pair analysis. The length of stay in the intensive care unit (ICU) and the need for catecholamines were compared among the three groups. By using serial debridement and combining wIRA treatment with Suprathel® dressings, we were able to significantly reduce the need for catecholamines, lower the risk of hypothermia and infection, and shorten ICU stay compared to the two control groups. We propose incorporating this methodology into the standard of care to promote wound closure and healing when treating TEN patients.
{"title":"Suprathel® and water-filtered infrared-A radiation (wIRA) as a new treatment strategy for toxic epidermal necrolysis (TEN): A prospective study","authors":"N. Dastagir, D. Kijas, D. Obed, M. Tamulevicius, PM Vogt , K. Dastagir","doi":"10.1016/j.burns.2024.10.004","DOIUrl":"10.1016/j.burns.2024.10.004","url":null,"abstract":"<div><div>Toxic epidermal necrolysis (TEN) is a life-threatening condition with a mortality rate of approximately 25 % to 30 %. Early and adequate wound coverage is necessary due to large skin defects. Suprathel® is a modern wound dressing that shows promising results when treating superficial wounds such as scalds, burns and abrasions. Previous reports on wound care in TEN patients using Suprathel® have described radical debridement of the entire affected body surface prior to the application of Suprathel®. However, heavy wound secretion in TEN may result in the loss of a significant portion of Suprathel® over time. Prolonged operation time increases the risk of hypothermia. In addition, the large open wound areas result in an increased risk for hypovolemic shock, wound infection, and subsequent sepsis. This study presents a new strategy that involves serial hydrotherapeutic wound debridement and the stepwise application of Suprathel® to the affected areas. Water-filtered infrared A light (wIRA) was used to keep the Suprathel®-covered areas dry. Retrospective data from patients who received polyhexanide gel treatment (control group 1) and those who only received Suprathel® (control group 2) were collected for matched-pair analysis. The length of stay in the intensive care unit (ICU) and the need for catecholamines were compared among the three groups. By using serial debridement and combining wIRA treatment with Suprathel® dressings, we were able to significantly reduce the need for catecholamines, lower the risk of hypothermia and infection, and shorten ICU stay compared to the two control groups. We propose incorporating this methodology into the standard of care to promote wound closure and healing when treating TEN patients.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107283"},"PeriodicalIF":3.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.burns.2024.107294
Lauren L. Agoubi , Scha’Chia Murphy , Kara McMullen , Gretchen J. Carrougher , Stephanie A. Mason , Damien W. Carter , Callie M. Thompson , Karen Kowalske , John W. Scott , Barclay T. Stewart
Introduction
Community-level disadvantage is associated with reduced quality of life after burn injury. We evaluated the association between community-level disadvantage and return to work after burn injury.
Methods
A multicenter burn injury database was queried from 1998–2021. Participants 18–65 years old with documented employment status and ZIP codes were included. Exposures were community distress (Distressed Communities Index, DCI), patient demographics, and burn characteristics. The primary outcome was odds of employment 6 months after burn injury using stepwise logistic regression models, first with patient-level variables, then DCI. An interaction term was included to evaluate the modification of DCI and post-injury employment by race.
Results
1960 participants were included, with a median age of 39.2 years (IQR 29.2, 49.3); 81 % were White, 75 % male, and 74 % were working at the time of injury. Participants unemployed 6 months post-injury were more often older, female, non-White, and unemployed at injury, with larger burn sizes and longer hospitalizations. 59 % of participants unemployed at 6 months were employed at the time of injury. Residence in the highest distress ZIP codes was associated with 2.21 (95 % CI 1.39–3.52) odds of 6 month unemployment. Older age, larger burn size, more operations, Black race, and pre-injury unemployment were associated with the greatest odds of unemployment. The interaction between race and DCI was not statistically significant.
Conclusion
Patients from the highest distress communities have twice the odds of unemployment 6 months after injury. This association did not vary by race. Screening for DCI by ZIP code may be a useful tool to focus vocational rehabilitation resources.
{"title":"Association between community distress and return to work after burn injury","authors":"Lauren L. Agoubi , Scha’Chia Murphy , Kara McMullen , Gretchen J. Carrougher , Stephanie A. Mason , Damien W. Carter , Callie M. Thompson , Karen Kowalske , John W. Scott , Barclay T. Stewart","doi":"10.1016/j.burns.2024.107294","DOIUrl":"10.1016/j.burns.2024.107294","url":null,"abstract":"<div><h3>Introduction</h3><div>Community-level disadvantage is associated with reduced quality of life after burn injury. We evaluated the association between community-level disadvantage and return to work after burn injury.</div></div><div><h3>Methods</h3><div>A multicenter burn injury database was queried from 1998–2021. Participants 18–65 years old with documented employment status and ZIP codes were included. Exposures were community distress (Distressed Communities Index, DCI), patient demographics, and burn characteristics. The primary outcome was odds of employment 6 months after burn injury using stepwise logistic regression models, first with patient-level variables, then DCI. An interaction term was included to evaluate the modification of DCI and post-injury employment by race.</div></div><div><h3>Results</h3><div>1960 participants were included, with a median age of 39.2 years (IQR 29.2, 49.3); 81 % were White, 75 % male, and 74 % were working at the time of injury. Participants unemployed 6 months post-injury were more often older, female, non-White, and unemployed at injury, with larger burn sizes and longer hospitalizations. 59 % of participants unemployed at 6 months were employed at the time of injury. Residence in the highest distress ZIP codes was associated with 2.21 (95 % CI 1.39–3.52) odds of 6 month unemployment. Older age, larger burn size, more operations, Black race, and pre-injury unemployment were associated with the greatest odds of unemployment. The interaction between race and DCI was not statistically significant.</div></div><div><h3>Conclusion</h3><div>Patients from the highest distress communities have twice the odds of unemployment 6 months after injury. This association did not vary by race. Screening for DCI by ZIP code may be a useful tool to focus vocational rehabilitation resources.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 1","pages":"Article 107294"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.burns.2024.107292
SiNing Zhao , Yongpei Yu , Katherine P. Frey , Stephen T. Wegener , Renan C. Castillo
Background
Burns carries a high risk of severe physical damage, prolonged recovery, and mental health implications for both patients and their caregivers. While distress among caregivers of burn patients has been studied, less attention has been given to potential positive psychological changes. This study focuses on the prevalence, temporal dynamics, and predictors of posttraumatic growth (PTG) among caregivers.
Methods
A cross-sectional survey was conducted with 161 family caregivers from two Chinese burn units in 2016–2017. Participants completed a general information questionnaire and four measures: Posttraumatic Growth Inventory, Posttraumatic Stress Disorder Checklist, Depression, Anxiety, and Stress Scale-21, and Multidimensional Scale of Perceived Social Support.
Results
The PTG scores for caregivers, with an average of 59.8 (± 13.9), exhibited a curvilinear pattern over a period of 36 months, initially decreasing and then increasing. Multiple linear and quadratic regression analyses affirmed that heightened anxiety (p < 0.001), male gender (p < 0.05), college education (p < 0.05), and increased social support (p < 0.05) positively predicted family caregiver PTG.
Conclusions
This is the first study of burn injury caregiver PTG. The study indicates caregivers of burn patients may undergo positive psychological transformation. Variations in predictive factors necessitate validation through longitudinal research. The dynamic interplay of psychological outcomes between patients and caregivers requires further exploration.
{"title":"Posttraumatic growth among burn patient family caregivers in China","authors":"SiNing Zhao , Yongpei Yu , Katherine P. Frey , Stephen T. Wegener , Renan C. Castillo","doi":"10.1016/j.burns.2024.107292","DOIUrl":"10.1016/j.burns.2024.107292","url":null,"abstract":"<div><h3>Background</h3><div>Burns carries a high risk of severe physical damage, prolonged recovery, and mental health implications for both patients and their caregivers. While distress among caregivers of burn patients has been studied, less attention has been given to potential positive psychological changes. This study focuses on the prevalence, temporal dynamics, and predictors of posttraumatic growth (PTG) among caregivers.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted with 161 family caregivers from two Chinese burn units in 2016–2017. Participants completed a general information questionnaire and four measures: Posttraumatic Growth Inventory, Posttraumatic Stress Disorder Checklist, Depression, Anxiety, and Stress Scale-21, and Multidimensional Scale of Perceived Social Support.</div></div><div><h3>Results</h3><div>The PTG scores for caregivers, with an average of 59.8 (± 13.9), exhibited a curvilinear pattern over a period of 36 months, initially decreasing and then increasing. Multiple linear and quadratic regression analyses affirmed that heightened anxiety (<em>p</em> < 0.001), male gender (<em>p</em> < 0.05), college education (<em>p</em> < 0.05), and increased social support (<em>p</em> < 0.05) positively predicted family caregiver PTG.</div></div><div><h3>Conclusions</h3><div>This is the first study of burn injury caregiver PTG. The study indicates caregivers of burn patients may undergo positive psychological transformation. Variations in predictive factors necessitate validation through longitudinal research. The dynamic interplay of psychological outcomes between patients and caregivers requires further exploration.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107292"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To share our 20-year experience in major burn management and the impact of a newly implemented burn protocol since 2015 at Tri-Service General Hospital (TSGH).
Materials and methods
We performed a retrospective cohort study of severely burned patients who were admitted to the intensive care unit (ICU) at TSGH from January 2003 to September 2023. Data regarding demographics, complications, and mortality were collected and analyzed. We compared the patient data before (pre-implementation) and after 2015 (post-implementation), when the new major burn management protocol was introduced.
Results
No statistically significant differences were observed in the mean total body surface area of the burns between the groups. The post-implementation group had younger age (34.62 vs 45.06, P < 0.001) and lower rate of inhalation injury (60.8 % vs 82.5 %, P = 0.005). No statistically significant difference was observed in the ICU stays between the groups. The post-implementation group had a statistically significant lower all-cause mortality (8.1 % vs 47.6 %, P < 0.0001) and lower rate of renal replacement therapy (RRT) (20.3 % vs 42.9 %, P = 0.004) but earlier initiation of RRT.
Conclusion
The new TSGH Burns Protocol revolutionized the care of major burns by introducing tailored, multidisciplinary burn management and improved patient outcomes.
目的：分享三军总医院（TSGH）20年来在重度烧伤管理方面的经验以及2015年以来新实施的烧伤治疗方案的影响：我们对2003年1月至2023年9月期间入住三军总医院重症监护室（ICU）的严重烧伤患者进行了一项回顾性队列研究。我们收集并分析了有关人口统计学、并发症和死亡率的数据。我们比较了新的大面积烧伤管理方案实施前（实施前）和2015年（实施后）的患者数据：两组烧伤患者的平均体表总面积无明显统计学差异。实施后组的年龄更小（34.62 岁 vs 45.06 岁，P 结论：实施后组的年龄更小（34.62 岁 vs 45.06 岁，P 结论：实施后组的年龄更小：新的 TSGH 烧伤治疗方案通过引入量身定制的多学科烧伤管理，彻底改变了重度烧伤的治疗方法，并改善了患者的预后。
{"title":"Impact of a newly implemented burn protocol at Tri-Service General Hospital: Outcome analysis of 20-year experience","authors":"Yu-Tse Weng , Yu-Chi Tsai , Juin-Hong Cherng , Chih-Hsing Wang , Yuan-sheng Tzeng , Kuang Ling Ou , Tim-Mo Chen , Hao-Yu Chiao","doi":"10.1016/j.burns.2024.107293","DOIUrl":"10.1016/j.burns.2024.107293","url":null,"abstract":"<div><h3>Purpose</h3><div>To share our 20-year experience in major burn management and the impact of a newly implemented burn protocol since 2015 at Tri-Service General Hospital (TSGH).</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective cohort study of severely burned patients who were admitted to the intensive care unit (ICU) at TSGH from January 2003 to September 2023. Data regarding demographics, complications, and mortality were collected and analyzed. We compared the patient data before (pre-implementation) and after 2015 (post-implementation), when the new major burn management protocol was introduced.</div></div><div><h3>Results</h3><div>No statistically significant differences were observed in the mean total body surface area of the burns between the groups. The post-implementation group had younger age (34.62 vs 45.06, <em>P</em> < 0.001) and lower rate of inhalation injury (60.8 % vs 82.5 %, <em>P</em> = 0.005). No statistically significant difference was observed in the ICU stays between the groups. The post-implementation group had a statistically significant lower all-cause mortality (8.1 % vs 47.6 %, <em>P</em> < 0.0001) and lower rate of renal replacement therapy (RRT) (20.3 % vs 42.9 %, <em>P</em> = 0.004) but earlier initiation of RRT.</div></div><div><h3>Conclusion</h3><div>The new TSGH Burns Protocol revolutionized the care of major burns by introducing tailored, multidisciplinary burn management and improved patient outcomes.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 1","pages":"Article 107293"},"PeriodicalIF":3.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.burns.2024.107289
Sinan Dogan , Folke Sjöberg , Ahmed T. El-Serafi , Zacharias Sjöberg , Islam Abdelrahman , Ingrid Steinvall , Matilda Karlsson , Pia Olofsson , Andrew Lindford , Jyrki Vuola , Moustafa Elmasry
This investigation delineates the evolution and prospective utilisation of an innovative two-blade dermatome, designed for the concurrent harvesting of a conventional split-thickness skin graft (STSG) and an additional dermal graft within the same surgical harvest. Historically, the extraction of dermal grafts has encountered substantial technical impediments, contributing to its limited acceptance and utilisation in clinical practice. The prototype dermatome, introduced in this technical note, offers a solution that could facilitate the more extensive adoption of dermal grafting techniques.
The dermal segment of an STSG, obtained as a second graft, confers four notable advancements: First, employing solely the dermal component for grafting and repositioning the uppermost skin flap to the donor site, markedly diminishes donor site morbidity. Second, owing to its elasticity, the dermal graft reduces the need for meshing, thereby enhancing cosmetic outcomes. Third, utilising both the uppermost skin layer and a deeper dermal layer for the recipient site can reduce donor site areas. Fourth, the dermal segment of the graft can serve as a dermal matrix in reconstructive procedures, potentially reducing the need for an allogenic dermal matrix and obviating the subsequent STSG; the dermal graft may heal independently, eliminating the need for an additional conventional STSG.
The findings of this study, predicated on the application of a first-generation two-blade dermatome on four cadavers, demonstrate the feasibility of extracting at least two distinct grafts with pre-determined thicknesses in a single, technically less challenging, surgical harvest procedure.
In conclusion, this proof-of-concept research elucidates the feasibility of a two-blade dermatome, capable of simultaneously yielding at least one conventional STSG and one dermal graft, thereby simplifying skin graft harvesting. Although these preliminary investigations were conducted on human cadavers, the results hold promise for the development of two-blade dermatomes and represent a significant advancement in skin graft harvesting. Further research is imperative to refine the prototype and to broaden our comprehension of the potential applications of dermal grafting in various clinical scenarios.
{"title":"Advancements in skin grafting: Development and application of a novel two-blade dermatome for concurrent split-thickness and dermal graft harvesting","authors":"Sinan Dogan , Folke Sjöberg , Ahmed T. El-Serafi , Zacharias Sjöberg , Islam Abdelrahman , Ingrid Steinvall , Matilda Karlsson , Pia Olofsson , Andrew Lindford , Jyrki Vuola , Moustafa Elmasry","doi":"10.1016/j.burns.2024.107289","DOIUrl":"10.1016/j.burns.2024.107289","url":null,"abstract":"<div><div>This investigation delineates the evolution and prospective utilisation of an innovative two-blade dermatome, designed for the concurrent harvesting of a conventional split-thickness skin graft (STSG) and an additional dermal graft within the same surgical harvest. Historically, the extraction of dermal grafts has encountered substantial technical impediments, contributing to its limited acceptance and utilisation in clinical practice. The prototype dermatome, introduced in this technical note, offers a solution that could facilitate the more extensive adoption of dermal grafting techniques.</div><div>The dermal segment of an STSG, obtained as a second graft, confers four notable advancements: First, employing solely the dermal component for grafting and repositioning the uppermost skin flap to the donor site, markedly diminishes donor site morbidity. Second, owing to its elasticity, the dermal graft reduces the need for meshing, thereby enhancing cosmetic outcomes. Third, utilising both the uppermost skin layer and a deeper dermal layer for the recipient site can reduce donor site areas. Fourth, the dermal segment of the graft can serve as a dermal matrix in reconstructive procedures, potentially reducing the need for an allogenic dermal matrix and obviating the subsequent STSG; the dermal graft may heal independently, eliminating the need for an additional conventional STSG.</div><div>The findings of this study, predicated on the application of a first-generation two-blade dermatome on four cadavers, demonstrate the feasibility of extracting at least two distinct grafts with pre-determined thicknesses in a single, technically less challenging, surgical harvest procedure.</div><div>In conclusion, this proof-of-concept research elucidates the feasibility of a two-blade dermatome, capable of simultaneously yielding at least one conventional STSG and one dermal graft, thereby simplifying skin graft harvesting. Although these preliminary investigations were conducted on human cadavers, the results hold promise for the development of two-blade dermatomes and represent a significant advancement in skin graft harvesting. Further research is imperative to refine the prototype and to broaden our comprehension of the potential applications of dermal grafting in various clinical scenarios.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107289"},"PeriodicalIF":3.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.burns.2024.10.003
Monique J Ryan, Edward Raby, Reika Masuda, Samantha Lodge, Philipp Nitschke, Garth L Maker, Julien Wist, Mark W Fear, Elaine Holmes, Jeremy K Nicholson, Nicola Gray, Luke Whiley, Fiona M Wood
Whilst wound repair in severe burns has received substantial research attention, non-severe burns (<20 % total body surface area) remain relatively understudied, despite causing considerable physiological impact and constituting most of the hospital admissions for burns. Early prediction of healing outcomes would decrease financial and patient burden, and aid in preventing long-term complications from poor wound healing. Lipids have been implicated in inflammation and tissue repair and may play essential roles in burn wound healing. In this study, plasma samples were collected from 20 non-severe burn patients over six weeks from admission, including surgery, and analysed by liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance spectroscopy to identify 850 lipids and 112 lipoproteins. Orthogonal projections to latent structures-discriminant analysis was performed to identify changes associated with re-epithelialisation and delayed re-epithelisation. We demonstrated that the lipid and lipoprotein profiles at admission could predict re-epithelisation outcomes at two weeks post-surgery, and that these discriminatory profiles were maintained up to six weeks post-surgery. Inflammatory markers GlycB and C-reactive protein indicated divergent systemic responses to the burn injury at admission. Triacylglycerols, diacylglycerols and low-density lipoprotein subfractions were associated with re-epithelisation (p-value <0.02, Cliff's delta >0.7), whilst high-density lipoprotein subfractions, phosphatidylinositols, phosphatidylcholines, and phosphatidylserines were associated with delayed wound closure at two weeks post-surgery (p-value <0.01, Cliff's delta <-0.7). Further model validation will potentially lead to personalised intervention strategies to reduce the risk of chronic complications post-burn injury.
{"title":"Clinical prediction of wound re-epithelisation outcomes in non-severe burn injury using the plasma lipidome.","authors":"Monique J Ryan, Edward Raby, Reika Masuda, Samantha Lodge, Philipp Nitschke, Garth L Maker, Julien Wist, Mark W Fear, Elaine Holmes, Jeremy K Nicholson, Nicola Gray, Luke Whiley, Fiona M Wood","doi":"10.1016/j.burns.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.burns.2024.10.003","url":null,"abstract":"<p><p>Whilst wound repair in severe burns has received substantial research attention, non-severe burns (<20 % total body surface area) remain relatively understudied, despite causing considerable physiological impact and constituting most of the hospital admissions for burns. Early prediction of healing outcomes would decrease financial and patient burden, and aid in preventing long-term complications from poor wound healing. Lipids have been implicated in inflammation and tissue repair and may play essential roles in burn wound healing. In this study, plasma samples were collected from 20 non-severe burn patients over six weeks from admission, including surgery, and analysed by liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance spectroscopy to identify 850 lipids and 112 lipoproteins. Orthogonal projections to latent structures-discriminant analysis was performed to identify changes associated with re-epithelialisation and delayed re-epithelisation. We demonstrated that the lipid and lipoprotein profiles at admission could predict re-epithelisation outcomes at two weeks post-surgery, and that these discriminatory profiles were maintained up to six weeks post-surgery. Inflammatory markers GlycB and C-reactive protein indicated divergent systemic responses to the burn injury at admission. Triacylglycerols, diacylglycerols and low-density lipoprotein subfractions were associated with re-epithelisation (p-value <0.02, Cliff's delta >0.7), whilst high-density lipoprotein subfractions, phosphatidylinositols, phosphatidylcholines, and phosphatidylserines were associated with delayed wound closure at two weeks post-surgery (p-value <0.01, Cliff's delta <-0.7). Further model validation will potentially lead to personalised intervention strategies to reduce the risk of chronic complications post-burn injury.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 1","pages":"107282"},"PeriodicalIF":3.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.burns.2024.10.005
Nesma M. Allam , Manar M. Badawy , Doaa A. Elimy
<div><h3>Background</h3><div>Inhalation injury is an acute respiratory tract injury that occurrs by inhalation of smoke, toxic gases, or steam. Early management is needed to reduce its mortality and morbidity. The purpose of this study was to ascertain whether Pilates training could help burn patients with inhalation injury after flame thermal burn in increasing pulmonary function, respiratory muscle strength, and functional ability.</div></div><div><h3>Methods</h3><div>In this prospective, randomized, controlled trial, sixty participants (26 males and 34 females) with inhalation injury and deep partial-thickness flame burns of 30–40 % total body surface area (TBSA) were randomized in blocks of four, with a 1:1 allocation ratio into two groups: Group A (Pilates Group); received Pilates training plus conventional physical therapy program, and Group B (Control Group); received conventional physical therapy program only. This study was conducted at the Faculty of Physical Therapy's outpatient clinic, Cairo University, 3 sessions/week for 12 weeks. The primary outcome measure was the forced vital capacity (FVC) measured by a spirometer, while the secondary outcome measures were peak expiratory flow rate (PEFR), forced expiratory volume in 1 s (FEV1), FEV1/FVC% assessed by a spirometer, strength of respiratory muscles (maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) assessed by the digital manovacuometer, and the functional capacity evaluated by 6-Minute Walk Test (6-MWT).</div></div><div><h3>Results</h3><div>A two-way mixed-design MANOVA was used to analyze the results within and between groups. There were no significant differences in demographic data between groups (P > 0.05). There were significant differences in all variables after treatment in group A compared with group B; FVC (95 % CI: 0.38, 1.13) (P = 0.001), FEV1 (95 % CI: 0.39, 0.97) (P = 0.001), FEV1/FVC % (95 % CI: 1.90, 17.19) (P = 0.02), PEFR (95 % CI: 0.47, 0.99) (P = 0.001), MIP (95 % CI: 5.12, 11.44) (P = 0.001), MEP (95 % CI: 2.57, 8.24) (P = 0.001), 6-MWT (95 % CI: 27.22, 54.96) (P = 0.001), FVC (% predicted) (95 % CI: 3.58, 12.58) (P = 0.001), FEV1 (% predicted) (95 % CI: 1.21, 11.11) (P = 0.02), PEFR (% predicted) (95 % CI: 1.33, 10.83) (P = 0.01), MIP (% predicted) (95 % CI: 2.26, 11.72) (P = 0.001) and MEP (% predicted) (95 % CI: 1.33, 10.37) (P = 0.01).</div></div><div><h3>Conclusion</h3><div>The current study demonstrated that a Pilates exercise program in addition to a traditional physical therapy program for 12 weeks significantly improved the pulmonary function (FVC, FEV1, PEFR and FEV1/FEV), strength of respiratory muscles (MIP and MEP), and functional capacity (6-MWT) in patients with inhalation injury after flame burns. These results underscore the importance of including Pilates exercises in the rehabilitation plan for burn patients with inhalation injury. Future studies are needed to evaluate the effect of Pilates exercises on other degrees
{"title":"Effect of Pilates exercises on pulmonary function, respiratory muscle strength, and functional capacity in patients with inhalation injury after flame thermal burn: A prospective randomized controlled trial","authors":"Nesma M. Allam , Manar M. Badawy , Doaa A. Elimy","doi":"10.1016/j.burns.2024.10.005","DOIUrl":"10.1016/j.burns.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Inhalation injury is an acute respiratory tract injury that occurrs by inhalation of smoke, toxic gases, or steam. Early management is needed to reduce its mortality and morbidity. The purpose of this study was to ascertain whether Pilates training could help burn patients with inhalation injury after flame thermal burn in increasing pulmonary function, respiratory muscle strength, and functional ability.</div></div><div><h3>Methods</h3><div>In this prospective, randomized, controlled trial, sixty participants (26 males and 34 females) with inhalation injury and deep partial-thickness flame burns of 30–40 % total body surface area (TBSA) were randomized in blocks of four, with a 1:1 allocation ratio into two groups: Group A (Pilates Group); received Pilates training plus conventional physical therapy program, and Group B (Control Group); received conventional physical therapy program only. This study was conducted at the Faculty of Physical Therapy's outpatient clinic, Cairo University, 3 sessions/week for 12 weeks. The primary outcome measure was the forced vital capacity (FVC) measured by a spirometer, while the secondary outcome measures were peak expiratory flow rate (PEFR), forced expiratory volume in 1 s (FEV1), FEV1/FVC% assessed by a spirometer, strength of respiratory muscles (maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) assessed by the digital manovacuometer, and the functional capacity evaluated by 6-Minute Walk Test (6-MWT).</div></div><div><h3>Results</h3><div>A two-way mixed-design MANOVA was used to analyze the results within and between groups. There were no significant differences in demographic data between groups (P > 0.05). There were significant differences in all variables after treatment in group A compared with group B; FVC (95 % CI: 0.38, 1.13) (P = 0.001), FEV1 (95 % CI: 0.39, 0.97) (P = 0.001), FEV1/FVC % (95 % CI: 1.90, 17.19) (P = 0.02), PEFR (95 % CI: 0.47, 0.99) (P = 0.001), MIP (95 % CI: 5.12, 11.44) (P = 0.001), MEP (95 % CI: 2.57, 8.24) (P = 0.001), 6-MWT (95 % CI: 27.22, 54.96) (P = 0.001), FVC (% predicted) (95 % CI: 3.58, 12.58) (P = 0.001), FEV1 (% predicted) (95 % CI: 1.21, 11.11) (P = 0.02), PEFR (% predicted) (95 % CI: 1.33, 10.83) (P = 0.01), MIP (% predicted) (95 % CI: 2.26, 11.72) (P = 0.001) and MEP (% predicted) (95 % CI: 1.33, 10.37) (P = 0.01).</div></div><div><h3>Conclusion</h3><div>The current study demonstrated that a Pilates exercise program in addition to a traditional physical therapy program for 12 weeks significantly improved the pulmonary function (FVC, FEV1, PEFR and FEV1/FEV), strength of respiratory muscles (MIP and MEP), and functional capacity (6-MWT) in patients with inhalation injury after flame burns. These results underscore the importance of including Pilates exercises in the rehabilitation plan for burn patients with inhalation injury. Future studies are needed to evaluate the effect of Pilates exercises on other degrees","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107284"},"PeriodicalIF":3.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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