Burns最新文献_第5页

Reconstruction of the axilla after burn injury – A decade of experiences and lessons learned 烧伤后腋窝的重建-十年的经验和教训

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-11 DOI: 10.1016/j.burns.2025.107777

Jennifer Ashley Watson, Samuel Knoedler, Luzie Hofmann, Mauro Vasella, Bong-Sung Kim

Background

Acute burns and their sequelae in the axilla are debilitating injuries. Reconstruction in this anatomically complex region is challenging due to limited tissue availability and the need to balance functional and aesthetic outcomes.

Methods

A retrospective review of patients undergoing axillary reconstruction at the University Hospital Zurich, Zurich, Switzerland, from 2014 to 2024 was conducted. Patients who received pedicled locoregional or free flap reconstructions for acute axillary burns or established contractures were included, while z-plasties and other local random pattern flaps were excluded.

Results

Twelve patients (8 males, 4 females; mean age: 44.1 years, mean BMI: 24.6 kg/m², mean TBSA: 36 %) underwent axillary reconstruction using 13 flaps: 10 free flaps (anterolateral thigh [n = 6], transverse myocutaneous gracilis [n = 1], profunda artery perforator [n = 2], superficial circumflex iliac perforator [n = 1]) and three locoregional flaps (parascapular [n = 2], split-latissimus dorsi [n = 1]). Acute reconstructions for third-degree axillary burns were performed in three patients (median time from injury: 12 days), and delayed reconstructions for axillary contractures were performed in 10 cases (median time from injury: 336 days). While no total flap loss occurred, five (38 %) cases experienced complications including delayed wound healing, seroma, or hematoma. Innovative strategies, such as fascial slings for flap suspension, two-stage scar release, and robotic-assisted microvascular anastomoses, enhanced surgical precision and outcomes.

Conclusion

For acute burns and post-burn axillary contractures, free or locoregional flaps offer effective reconstruction, ensuring early functional recovery when compared to dermal substitutes. A multidisciplinary, individualized approach remains essential for optimizing care in burn survivors with axillary injuries and contractures.

急性烧伤及其在腋窝的后遗症是使人衰弱的伤害。由于组织可用性有限，需要平衡功能和美学结果，在这个解剖复杂的区域进行重建是具有挑战性的。方法回顾性分析2014 ~ 2024年在瑞士苏黎世大学医院行腋窝重建术的患者。因急性腋窝烧伤或挛缩而接受带蒂局部或自由皮瓣重建的患者包括在内，而z形和其他局部随机皮瓣被排除在外。ResultsTwelve患者(8男性,4女性,平均年龄:44.1岁,意味着身体质量指数:24.6 公斤/ m²,意味着回溯:36 %)接受腋窝使用13皮瓣重建:10个免费皮瓣(大腿前外侧的[n = 6],对于横向股薄肌[n = 1],股深动脉穿支[n = 2],旋髂浅射孔器[n = 1])和三个局部区域皮瓣(parascapular [n = 2],split-latissimus dorsi [n = 1])。3例腋窝三度烧伤患者进行了急性重建（离伤中位时间：12天），10例腋窝挛缩患者进行了延迟重建（离伤中位时间：336天）。虽然没有发生皮瓣完全丢失，但有5例（38% %）出现并发症，包括伤口愈合延迟、血清肿或血肿。创新的策略，如用于皮瓣悬吊的筋膜吊带、两阶段疤痕释放和机器人辅助微血管吻合，提高了手术精度和效果。结论对于急性烧伤和烧伤后腋窝挛缩，游离皮瓣或局部皮瓣比真皮替代物可提供有效的重建，确保早期功能恢复。多学科，个性化的方法仍然是必要的优化护理烧伤幸存者腋窝损伤和挛缩。

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引用次数: 0

Comment on: "Adjunctive curcumin nano-micelles reduce overall pruritus intensity in refractory post-burn pruritus: A randomized controlled trial" 评论：“辅助姜黄素纳米胶束减少难治性烧伤后瘙痒的总体瘙痒强度：一项随机对照试验”

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-11 DOI: 10.1016/j.burns.2025.107769

Ying-Ming Ma , Hui Sun , Wei Shen , Hua-Jie Zhong

引用次数: 0

Comment on: "Long-term sleep disturbance following burn injury: Insights from the Burn Model System" 评论：“烧伤后的长期睡眠障碍：来自烧伤模型系统的见解”

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-10 DOI: 10.1016/j.burns.2025.107776

Sara Fattahpoor

引用次数: 0

Spanish translation, cultural, and content validation of the Mouth Impairment and Disability Assessment in a prospective, longitudinal evaluation of pediatric patients with facial burn injuries 口腔损伤和残疾评估的西班牙语翻译、文化和内容验证在一项前瞻性、纵向评估儿科面部烧伤患者

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-08 DOI: 10.1016/j.burns.2025.107775

Bernadette Nedelec , Ingrid Parry , Clarissa Ochoa , David G. Greenhalgh , Zoë Edger-Lacoursière , Jakub Sawicki

The Mouth Impairment and Disability Assessment (MIDA) was developed to provide clinicians with an outcome measure that thoroughly and objectively evaluates the impairment and disabilities associated with burn injuries of the face involving the mouth. However, thus far, it is only available in English and French-Canadian and has not been used with pediatric burn survivors. Additionally, there is limited longitudinal outcome data describing the recovery trajectory associated with burn injuries of the mouth. Thus, the purpose of this study was to translate the MIDA into Spanish, validate the content with the pediatric burn survivor population who have sustained a burn injury involving their mouth, and prospectively collect data to document the recovery profile and examine the psychometric properties.

Methods

This was a prospective, observational case series of pediatric burn survivors. Prior to commencing patient recruitment, a forward-backward translation and cultural adaptation process was undertaken to create a Spanish version of the MIDA. English- and Spanish-speaking pediatric burn survivors who met the inclusion criteria and had signed the informed consent were evaluated using the MIDA at approximately one month, three months, six months, and 12 months post-burn. Individual and subscale summary data from the MIDA are reported. Construct validity was assessed by examining the correlations between MIDA subscale scores at baseline and measures of vertical and horizontal mouth opening.

Results

Sixteen predominantly Hispanic (75 %) pediatric burn survivors were evaluated approximately one-month post-burn, eleven were evaluated at three and six months, and nine at twelve months. The majority were male (62.5 %) with a mean age of 10.4 years old and mean total body surface area burn of 33.3 %. The median number of surgeries was two, with a median of one involving the face, mouth, or neck. Content validity was confirmed through cognitive debriefing and self-reported difficulties with all items within the measure at various points across time. The recovery profile varied across time, with many reporting a reduction in function between one and three months, most reporting an improvement by six or twelve months, but some continuing to experience extreme difficulty or dissatisfaction at twelve months.

Discussion

The Spanish version of the MIDA can now be used with the burn survivor population to evaluate the outcome of face and neck burns that may result in mouth impairment and disability. In addition, it proved to be a valid measure for quantifying the challenges that arise for pediatric burn survivors. There is a need for future research to investigate which treatment interventions optimize long-term outcomes.

口腔损伤和残疾评估（MIDA）旨在为临床医生提供一种全面客观地评估面部涉及口腔的烧伤相关损伤和残疾的结果测量。然而，到目前为止，它只适用于英语和法裔加拿大人，并没有用于儿科烧伤幸存者。此外，描述与口腔烧伤相关的恢复轨迹的纵向结果数据有限。因此，本研究的目的是将MIDA翻译成西班牙语，在口腔烧伤的儿童烧伤幸存者人群中验证其内容，并前瞻性地收集数据以记录恢复情况并检查心理测量学特性。方法：对儿童烧伤幸存者进行前瞻性观察性研究。在开始患者招募之前，进行了向前向后翻译和文化适应过程，以创建西班牙语版本的MIDA。符合纳入标准并签署知情同意书的英语和西班牙语儿童烧伤幸存者在烧伤后约1个月、3个月、6个月和12个月使用MIDA进行评估。报告了MIDA的个人和次尺度汇总数据。建构效度是通过检验基线MIDA分量表得分与垂直和水平开口测量之间的相关性来评估的。结果16名主要为西班牙裔（75% %）的儿童烧伤幸存者在烧伤后约1个月接受评估，11名在烧伤后3个月和6个月接受评估，9名在烧伤后12个月接受评估。男性居多（62.5 %），平均年龄10.4岁，平均体表面积烧伤33.3% %。手术次数的中位数为2次，其中涉及面部、口腔或颈部的中位数为1次。内容效度通过认知汇报和自我报告在不同时间点对测量中所有项目的困难来确认。随着时间的推移，恢复情况有所不同，许多人报告在一到三个月内功能下降，大多数人报告在6到12个月内有所改善，但有些人在12个月内继续经历极端困难或不满。西班牙语版本的MIDA现在可以用于烧伤幸存者人群，以评估面部和颈部烧伤可能导致口腔损伤和残疾的结果。此外，它被证明是量化儿科烧伤幸存者面临的挑战的有效措施。有必要进一步研究哪种治疗干预措施能优化长期结果。

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引用次数: 0

Deep learning framework for bronchoscopic diagnosis of burn inhalation injury 支气管镜下烧伤吸入性损伤诊断的深度学习框架

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-08 DOI: 10.1016/j.burns.2025.107770

Kaihe Zhang , Suveer Singh

Burn inhalation injury (BII) increases mortality and morbidity in burns patients. Accurate bronchoscopic grading, as the gold standard diagnostic modality, is important for prognostication and to optimize management. However, the most common currently used clinical grading system (abbreviated injury score, AIS) for BII, as a standardized grading method, uses manual judgement of visual features of the tracheobronchial mucosa. This is subjective and has limitations in classification accuracy, and reliability. A better, automated bronchoscopic grading system would have great clinical value. Hence, this study tested the predictive capability of a supervised deep learning technology-based rating method for bronchoscopically diagnosed BII. A pre-trained vision transformer model (ViT) was fine-tuned to automatically grade burn inhalation injury from clinical bronchoscopy recordings of 36 patients (1089 quality-controlled frames) at the London Burns centre. Labelled images were differentiated into training, validation, and test sets (70:20:10). The model was then applied to 2 tasks;1. Identification of the severity grade (modified simple system -none, mild, moderate, severe) and 2. Binary – presence or not of BII. Performance indicators (accuracy, precision, F1 and recall) were measured. Then, the ViT was developed further by transfer learning and data augmentation techniques, and predictive performance retested. Test sets of images in the trained model achieved 98.17 % accuracy, 98.15 % F1 score, 98.29 % precision and 98.17 % recall. For task 2, the enhanced model achieved an accuracy of 98.17 %, F1-score 98.21 %, precision 98.36 %, recall 98.17 %. Compared to traditional human visually graded scoring systems, and even other deep learning model-based studies, our method demonstrated a very promising predictive deep learning framework for application in grading inhalation injuries more accurately.

烧伤吸入性损伤（BII）增加了烧伤患者的死亡率和发病率。准确的支气管镜分级，作为金标准诊断方式，对预后和优化管理很重要。然而，目前临床上最常用的BII分级系统（缩写injury score， AIS）是一种标准化的分级方法，采用人工判断气管支气管黏膜的视觉特征。这是主观的，在分类的准确性和可靠性方面有限制。一个更好的、自动化的支气管镜分级系统将有很大的临床价值。因此，本研究测试了基于监督深度学习技术的评分方法对支气管镜诊断的BII的预测能力。预先训练的视觉变压器模型（ViT）经过微调，可以根据伦敦烧伤中心36名患者（1089个质量控制框架）的临床支气管镜记录自动分级烧伤吸入损伤。标记的图像被分为训练集、验证集和测试集（70:20:10）。然后将该模型应用于2个任务；鉴定严重程度等级（修改简单系统-无，轻度，中度，重度）；二进制-是否存在BII。测量了性能指标（准确度、精密度、F1和召回率）。然后，通过迁移学习和数据增强技术对ViT进行进一步开发，并重新测试预测性能。训练模型中的图像测试集准确率达到98.17 %，F1分数达到98.15 %，准确率达到98.29 %，召回率达到98.17 %。对于任务2，增强模型的准确率为98.17 %，f1得分为98.21 %，精密度为98.36 %，召回率为98.17 %。与传统的人类视觉评分系统和其他基于深度学习模型的研究相比，我们的方法展示了一个非常有前途的预测深度学习框架，可以更准确地对吸入性损伤进行评分。

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引用次数: 0

Continuous zigzag excision: A surgical technique for keloids of the auricular helix after burn injury 连续之字形切除：一种治疗烧伤后耳螺旋瘢痕疙瘩的外科技术。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-08 DOI: 10.1016/j.burns.2025.107773

Huijun Zhang, Xiaozhuo Zhao, Xin Chen

Background

The auricle is vulnerable to burn injury because of its anatomical location. Auricular keloids that form after burns can have significant psychosocial and quality-of-life effects. We developed a new surgical technique to treat this type of keloid—the continuous zigzag excision technique—and report our experience here.

Methods

A retrospective clinical study was carried out on consecutive patients with helix keloids who underwent reconstruction using continuous zigzag excision between January 2018 and December 2023. The data analyzed included patients’ medical history, physical examination findings, ear photographs, surgical information, and pre- and post-operative Vancouver scar scale (VSS) scores, along with patient satisfaction.

Results

A total of 24 patients with 36 helix keloids were included in the study. Among them, 18 patients with 28 helix keloids (77.8 %) were either satisfied or very satisfied with their postoperative outcomes. Three patients with 4 helix keloids (11.1 %) felt neutral since the shape of their ears after the surgery did not match their ideal expectations; however, they experienced relief from itching and pain, and were not interested in additional treatments. Three patients with 4 helix keloids (11.1 %) were dissatisfied because of keloid recurrence, which resolved with radiotherapy or steroid injections. The mean postoperative VSS score was significantly lower than the preoperative score (P < 0.01).

Conclusion

The continuous zigzag excision technique is effective for treating keloids of the helix caused by burn injury. This method can achieve good cosmetic results with minimal complications and a relatively low rate of recurrence without other additional treatments.

背景：耳廓因其特殊的解剖位置，极易发生烧伤。烧伤后形成的耳瘢痕疙瘩会对患者的社会心理和生活质量产生重大影响。我们开发了一种新的手术技术来治疗这种瘢痕疙瘩——连续之字形切除技术——并在此报告我们的经验。方法：对2018年1月至2023年12月连续行螺旋状瘢痕疙瘩持续之字形切除重建的患者进行回顾性临床研究。分析的数据包括患者的病史、体格检查结果、耳部照片、手术信息、术前和术后温哥华疤痕量表（VSS）评分以及患者满意度。结果：共有24例36个螺旋状瘢痕疙瘩纳入研究。其中螺旋瘢痕疙瘩28例，18例（77.8% %）术后满意或非常满意。3例4螺旋瘢痕疙瘩患者（11.1 %）术后耳形不符合理想，感觉中性；然而，他们经历了瘙痒和疼痛的缓解，并且对额外的治疗不感兴趣。4螺旋瘢痕疙瘩3例（11.1 %）因瘢痕疙瘩复发不满意，经放疗或类固醇注射解决。术后VSS平均评分明显低于术前评分（P ）结论：连续之字形切除技术是治疗烧伤后螺旋瘢痕的有效方法。这种方法可以达到良好的美容效果，并发症最小，复发率相对较低，无需其他额外的治疗。

{"title":"Continuous zigzag excision: A surgical technique for keloids of the auricular helix after burn injury","authors":"Huijun Zhang, Xiaozhuo Zhao, Xin Chen","doi":"10.1016/j.burns.2025.107773","DOIUrl":"10.1016/j.burns.2025.107773","url":null,"abstract":"<div><h3>Background</h3><div>The auricle is vulnerable to burn injury because of its anatomical location. Auricular keloids that form after burns can have significant psychosocial and quality-of-life effects. We developed a new surgical technique to treat this type of keloid—the continuous zigzag excision technique—and report our experience here.</div></div><div><h3>Methods</h3><div>A retrospective clinical study was carried out on consecutive patients with helix keloids who underwent reconstruction using continuous zigzag excision between January 2018 and December 2023. The data analyzed included patients’ medical history, physical examination findings, ear photographs, surgical information, and pre- and post-operative Vancouver scar scale (VSS) scores, along with patient satisfaction.</div></div><div><h3>Results</h3><div>A total of 24 patients with 36 helix keloids were included in the study. Among them, 18 patients with 28 helix keloids (77.8 %) were either satisfied or very satisfied with their postoperative outcomes. Three patients with 4 helix keloids (11.1 %) felt neutral since the shape of their ears after the surgery did not match their ideal expectations; however, they experienced relief from itching and pain, and were not interested in additional treatments. Three patients with 4 helix keloids (11.1 %) were dissatisfied because of keloid recurrence, which resolved with radiotherapy or steroid injections. The mean postoperative VSS score was significantly lower than the preoperative score (<em>P</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>The continuous zigzag excision technique is effective for treating keloids of the helix caused by burn injury. This method can achieve good cosmetic results with minimal complications and a relatively low rate of recurrence without other additional treatments.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107773"},"PeriodicalIF":2.9,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607249","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}

引用次数: 0

Patients’ experiences of treatment and the scar management pathway during the Early Laser for Burn Scars (ELABS) trial: An embedded qualitative study 早期激光治疗烧伤疤痕（ELABS）试验中患者的治疗经历和疤痕管理途径：一项嵌入式定性研究

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-07 DOI: 10.1016/j.burns.2025.107772

Vanessa Heaslip , Sharon Docherty , Shelley Rhodes , Ukoumunne Obioha , Katie Breheny , Kate Attrill , Jonathon Pleat , Mark P. Brewin

Background

Due to improvements in acute burn management, burn injuries are a leading cause of morbidity globally. Alongside physical sequelae of burns, there are significant psychological implications. Limited qualitative research exists exploring quality of life (QoL) and delayed reintegration into society; the latter is argued as the greatest unmet challenge in burn rehabilitation. Furthermore, there is a lack of research into non-scar outcomes after pulse dye laser (PDL) treatment of burn scars. This qualitative study examines the patient’s experience of early PDL treatment and its impact upon QoL and social reintegration.

Methods

This qualitative study is nested within a national, multicentre, parallel-arm randomised controlled trial (RCT) across seven National Health Service hospitals in the United Kingdom (Early Laser for Burn Scars (ELABS), Trial registration ISRCTN14392301). The Consolidated Criteria for Reporting Qualitative Studies were used. Of the 153 participants in the trial, 34 were approached across a range of demographic, burn and site criteria including: gender, age, burn location, depth, total body surface area (TBSA), skin type, site location, and treatment arm. Data was collected using semi-structured telephone interviews. reflexive thematic analysis was used to analyse the transcribed data.

Results

20 participants were interviewed. Six themes were constructed: frustration with initial burns treatment, feeling disconnected, human costs (with three sub themes: having to adapt, it’s changed how I feel about myself, and it doesn’t just affect me), money worries, reflections on pulse dye laser treatment, and moving forwards.

Conclusion

The scar management journey is long and complex due to significant physical, psychological, financial, and psychosocial impacts. These can negatively affect QoL and reintegration into society. Use of early PDL treatment can ameliorate these challenges by positively impacting upon QoL and supporting individuals whilst they create their ‘new normal’ and adjust to reintegration into society.

背景：由于急性烧伤管理的改善，烧伤是全球发病率的主要原因。除了身体上的烧伤后遗症外，还有显著的心理影响。有限的定性研究探索生活质量（QoL）和延迟重新融入社会；后者被认为是烧伤康复中最大的未解决的挑战。此外，对于脉冲染料激光（PDL）治疗烧伤疤痕后的无疤痕结果的研究也很缺乏。本质性研究探讨患者早期治疗的经验及其对生活质量和社会重新融入的影响。方法本定性研究是在英国7家国家卫生服务医院（早期激光治疗烧伤疤痕（ELABS），试验注册号ISRCTN14392301）的一项全国性、多中心、平行组随机对照试验（RCT）中进行的。采用了报告定性研究的综合标准。在153名试验参与者中，34人根据人口统计学、烧伤和部位标准进行了接触，包括：性别、年龄、烧伤部位、深度、全身表面积（TBSA）、皮肤类型、部位位置和治疗组。数据采用半结构化电话访谈方式收集。采用反身性主题分析对转录数据进行分析。结果对20名参与者进行了访谈。我们构建了六个主题：对最初烧伤治疗的挫败感，感觉与外界脱节，人力成本（还有三个子主题：必须适应，它改变了我对自己的感觉，它不仅影响到我），金钱担忧，对脉冲染料激光治疗的反思，以及继续前进。结论瘢痕治疗过程漫长而复杂，对身体、心理、经济和社会心理均有显著影响。这些会对生活质量和重新融入社会产生负面影响。使用早期PDL治疗可以通过积极影响生活质量和支持个人创造“新常态”并适应重新融入社会来改善这些挑战。

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引用次数: 0

Discriminative power of organ-specific SOFA assessment in burn sepsis: A temporal biomarker analysis 烧伤败血症中器官特异性SOFA评估的鉴别能力：一种时间生物标志物分析

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-07 DOI: 10.1016/j.burns.2025.107771

Hang Su , Bo Yuan , Yan Liu , Wenjing Xi , Liang Qiao

Background

Severe burn patients face diagnostic challenges in distinguishing sepsis from systemic inflammation using Sepsis-3 criteria. Current Sequential Organ Failure Assessment (SOFA) validation studies focus on composite scores, neglecting subsystem-level analysis in burn-specific pathophysiology.

Methods

This retrospective cohort study analyzed 55 severe burn patients (TBSA>30 %) from a Chinese burn center (2021–2022), comparing 19 sepsis cases with 36 controls. We analyzed SOFA subsystems and biomarkers (creatinine, platelet count, NT-proBNP, and PCT) during both the early phase (days 1 and 3 post-burn) and the late phase (after day 3 post-burn), performed TBSA-adjusted logistic regression, and constructed a nomogram.

Results

Cardiovascular (84.2 % vs 2.8 %, p < 0.001), renal (31.6 % vs 0 %, p < 0.001), and coagulation (42.1 % vs 5.6 %, p < 0.001) subsystems showed superior diagnostic specificity. Platelet trajectories revealed critical divergence at day 3 (septic: 66 vs control: 120 ×10⁹/L, p < 0.001), while creatinine elevation persisted across phases (day 1: 100 vs 62 μmol/L, p < 0.001, day 3: 84 vs 65 μmol/L, and late phase: 118 vs 58μmol/L, p < 0.001). PCT demonstrated isolated diagnostic utility confined to the late phase (6.12 vs 0.55 μg/L, p < 0.001). Day 3 platelet count, late-phase creatinine, and PCT were incorporated into the nomogram, which achieved an AUC of 0.930 in ROC analysis.

Conclusion

Subsystem-specific SOFA analysis identifies creatinine elevation and thrombocytopenia as key sepsis indicators in burns. Serial platelet and creatinine monitoring from day 3 post-injury enhances early detection, while PCT demonstrates diagnostic utility only in the late phase. A clinically applicable nomogram was developed to predict sepsis risk. These findings suggest that these specific organ systems are the principal contributors to the SOFA score in burn-related sepsis.

重度烧伤患者在使用脓毒症-3标准区分脓毒症和全身性炎症方面面临诊断挑战。目前的顺序器官衰竭评估（SOFA）验证研究侧重于综合评分，忽视了烧伤特异性病理生理学的子系统水平分析。方法回顾性队列研究分析了中国烧伤中心（2021-2022）55例严重烧伤患者（tbsa30 %），比较了19例败血症患者和36例对照组。我们分析了SOFA子系统和生物标志物（肌酐、血小板计数、NT-proBNP和PCT）在烧伤早期（烧伤后第1天和第3天）和晚期（烧伤后第3天），进行了tbsa调整的逻辑回归，并构建了nomogram。ResultsCardiovascular (84.2 vs 2.8  % % p & lt; 0.001)、肾(31.6 vs 0  % % p & lt; 0.001),和凝固(42.1 vs 5.6  % % p & lt; 0.001)子系统显示优越的诊断特异性。血小板轨迹在第3天显示出临界差异（脓毒症：66 vs对照组：120 ×10⁹/L， p <； 0.001），而肌酐升高在各个阶段持续存在（第1天：100 vs 62 μmol/L， p <； 0.001，第3天：84 vs 65 μmol/L，晚期：118 vs 58μmol/L， p <； 0.001）。PCT表现出局限于晚期的孤立诊断效用（6.12 vs 0.55 μg/L, p <； 0.001）。将第3天血小板计数、晚期肌酐、PCT纳入nomogram， ROC分析AUC为0.930。结论系统特异性SOFA分析确定肌酐升高和血小板减少是烧伤脓毒症的关键指标。损伤后第3天的连续血小板和肌酐监测有助于早期发现，而PCT仅在晚期诊断有用。开发了一种临床适用的nomogram预测脓毒症风险。这些发现表明，这些特定的器官系统是烧伤相关败血症SOFA评分的主要贡献者。

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引用次数: 0

Use of selective decontamination of the digestive tract in burn patients: A European survey 选择性去污在烧伤患者消化道的应用：一项欧洲调查。

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-06 DOI: 10.1016/j.burns.2025.107774

Emma Atsuko Tsuchiya , Mette Krag , Morten Hylander Møller , Martin Risom Vestergaard , Nicolai Haase , Marie Helleberg , Rikke Holmgaard , Johan Heiberg

Background

Infectious complications are a major cause of morbidity and mortality in burn patients. Selective decontamination of the digestive tract (SDD) is a prophylactic antimicrobial strategy aimed at suppressing potential pathogenic microorganisms in the gut microbiome. This study aimed to assess the values and preferences for the use of SDD in burn centres across Europe and to evaluate clinicians’ interest in further research on its efficacy.

Methods

We circulated a survey on the values and preferences for the use of SDD between March and October 2024, targeting surgeons, anaesthesiologists, and intensivists at European burn centres. The survey comprised 13 questions focusing on SDD usage criteria, regimens, and willingness to participate in a multicentre randomised clinical trial. Data were analysed and presented descriptively.

Results

We invited 45 burn centres to participate; 22 responded (49 % response rate). Among these, 27 % (6/22) reported routine use of SDD, primarily for patients with extensive burns or those requiring intensive care. Most centres using SDD (5/6) administered a combination of enteral and intravenous antibiotics and/or antifungals, while one centre (1/6) relied on enteral antimicrobials alone. The most common regimen included intravenous cefotaxime combined with enteral polymyxin E, tobramycin, and amphotericin B or nystatin. Notably, 82 % (18/22) of respondents expressed interest in participating in a multicentre randomised clinical trial on SDD in burn patients.

Conclusion

A minority of European burn centres routinely used SDD, while the majority did not. Among those that used SDD, treatment regimens were largely aligned with practices commonly used in ICU patients. Notably, there was significant interest among European burn centres in participating in future clinical trials comparing SDD versus no SDD in burn patients.

背景：感染性并发症是烧伤患者发病和死亡的主要原因。选择性去污消化道（SDD）是一种预防性抗菌策略，旨在抑制肠道微生物组中潜在的致病微生物。本研究旨在评估全欧洲烧伤中心使用SDD的价值和偏好，并评估临床医生对其疗效进一步研究的兴趣。方法：我们在2024年3月至10月期间对欧洲烧伤中心的外科医生、麻醉师和重症监护员进行了一项关于SDD使用价值和偏好的调查。调查包括13个问题，重点是SDD的使用标准、方案和参与多中心随机临床试验的意愿。对数据进行了分析和描述。结果：我们邀请了45家烧伤中心参与；22人回复（49% %回复率）。其中，27% %（6/22）报告常规使用SDD，主要用于大面积烧伤或需要重症监护的患者。大多数使用SDD的中心（5/6）联合使用肠内和静脉注射抗生素和/或抗真菌药物，而一个中心（1/6）仅依赖肠内抗菌素。最常见的治疗方案包括静脉注射头孢噻肟联合肠内多粘菌素E、妥布霉素、两性霉素B或制霉菌素。值得注意的是，82% %（18/22）的受访者表示有兴趣参加烧伤患者SDD的多中心随机临床试验。结论：少数欧洲烧伤中心常规使用SDD，而大多数没有。在使用SDD的患者中，治疗方案在很大程度上与ICU患者常用的做法一致。值得注意的是，欧洲烧伤中心对参与比较烧伤患者SDD与无SDD的未来临床试验有很大的兴趣。

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引用次数: 0

A healing assessment of full-thickness burns compared to excisional wounds after meshed split-thickness skin grafting 全层烧伤与切口创面移植后的愈合评估

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2025-11-05 DOI: 10.1016/j.burns.2025.107768

Brooke E. Pierson , Monica L. Collins , Dillon Williams , Mary A. Oliver , Davon Lee , Lauren T. Moffatt , Taryn E. Travis , Jeffrey W. Shupp , Bonnie C. Carney

Burn followed by excision has long been the primary method used to create burn injury in model organism systems. Forgoing the burn and creating an excisional injury to replicate the burn wound is an alternative model to study full thickness injury to the skin; however, it has yet to be investigated whether this method adequately mimics the clinical trajectory of a healing burn injury. We aimed to investigate this excisional model and compare it to the traditional burn followed by excision model to understand the impact of the initial burn injury and determine whether the excisional model is an adequate method for porcine burn injury research. For this study, porcine subjects received either a full-thickness burn followed by excision or a full-thickness excision wound only. Both models then underwent 4:1 meshed split-thickness autografting. Skin biopsies and digital photographs were taken over the next 14 days to evaluate healing, and non-invasive probes were used to evaluate scar characteristics four and seven weeks after initial injury. There was a significant difference between the burn + excision and excision= only groups in the early time points when measuring re-epithelialization, dermal thickness, rete ridge ratio, cellularity, and erythema. Considerably fewer differences were noted in these parameters at the later time points, indicating more similarity in later tissue remodeling and scar formation between these two groups. This study demonstrates that the rate of wound healing after excision and grafting differs between wounds with a preceding burn injury and those without. However, that difference fades as wound healing progresses through the scar remodeling phase. These findings suggest that the type of porcine model used to study burn wound healing after excision and grafting impacts initial healing processes which should be considered when selecting a model and comparing results among different studies.

烧伤后切除一直是模型生物系统中造成烧伤损伤的主要方法。放弃烧伤并创建一个切除损伤来复制烧伤创面是研究皮肤全层损伤的另一种模型；然而，这种方法是否能充分模拟烧伤愈合的临床轨迹还有待研究。我们旨在研究该切除模型，并将其与传统的烧伤后切除模型进行比较，以了解初始烧伤损伤的影响，并确定切除模型是否适合用于猪烧伤研究。在这项研究中，猪受试者要么接受全层烧伤后切除，要么只接受全层切除伤口。然后，两个模型都进行了4:1网格分裂厚度的自嫁接。在接下来的14天内进行皮肤活检和数码照片以评估愈合情况，并在初始损伤后4周和7周使用非侵入性探针评估疤痕特征。烧伤+ 切除组与单纯切除组在早期时间点的再上皮化、真皮厚度、皮肤嵴比、细胞结构、红斑等指标均有显著性差异。在之后的时间点上，这些参数的差异要小得多，这表明两组之间在后期组织重塑和疤痕形成方面更相似。本研究表明，伤口切除和移植后的愈合速度不同，伤口有以前的烧伤和那些没有。然而，随着伤口愈合进入疤痕重塑阶段，这种差异逐渐消失。这些结果表明，用于研究烧伤创面切除和移植后愈合的猪模型类型影响初始愈合过程，在选择模型和比较不同研究结果时应考虑这一点。

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