Burns最新文献_第6页

Does the heat source affect the risk of wound infection in children with scalds? 热源是否会影响烫伤儿童伤口感染的风险？

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-09-02 DOI: 10.1016/j.burns.2024.08.023

Matilda Karlsson, Arthur Johnson, Ingrid Steinvall, Laura Pompermaier

Introduction: Scalds are the leading cause of burns in children younger than 5 years of age with most being related to food preparation and consumption. Hot substances causing scalds have different degrees of viscosity varying from low (liquid substances, such as water), to high (semi-solids or solids, such as oils or grease). It is still underknown whether heat substances with different viscosities are associated with varying risks of developing burn wound infections (BWI). The aim of this study was to investigate the association between heat sources of different viscosities and development of BWI within the first week after injury in children with scalds.

Method: Children 5 years and younger of age admitted at the Linköping Burn Center for new scalds between 2015 and 2020 were included. Data source for the study population was the Burn Unit Database. BWI was defined as fulfilment of at least two ABA criteria at the time of systemic antibiotic therapy (AB) initiation between day 2-7 following scald. Medical record review was undertaken to identify the heat source causing the scald, BWI criteria, and the use of AB. Legal guardians were contacted in cases in which information was missing. Logistic regression was used to analyse the association between heat source and development of BWI.

Result: The study population consisted of 271 children, median age was 1.5 years, 61 % were boys, median burn size was 3.5 % of the total body surface area (TBSA), 10 (4 %) had a full thickness burn. BWI were identified in 69 (26 %) of the children. Most scalds were caused by contact with hot liquids (n=184), followed by semisolids (n=52) and solids (n=35). The logistic regression model showed that the size of the burn (TBSA) was associated with BWI, while type of heating agent was not.

Conclusion: Our results indicate that the viscosity of the heat source does not affect the risk of wound infection in children with scalds; only the size of the area burned was an independent factor for BWI.

简介：烫伤是导致 5 岁以下儿童烧伤的主要原因，其中大部分与食物的准备和食用有关。导致烫伤的热物质具有不同的粘度，从低粘度（液态物质，如水）到高粘度（半固体或固体，如油或油脂）不等。不同粘度的热物质是否与发生烧伤创面感染（BWI）的不同风险有关，目前尚不清楚。本研究旨在调查不同粘度的热源与烫伤儿童受伤后一周内发生 BWI 的关联：研究对象包括林雪平烧伤中心在 2015 年至 2020 年期间收治的 5 岁及以下新发烫伤儿童。研究人群的数据来源于烧伤科数据库。烫伤后第 2-7 天开始接受全身抗生素治疗 (AB) 时至少符合两项 ABA 标准即为 BWI。对病历进行审查，以确定导致烫伤的热源、BWI 标准和 AB 的使用情况。如果信息缺失，则会联系法定监护人。采用逻辑回归分析热源与 BWI 发生之间的关联：研究对象包括 271 名儿童，年龄中位数为 1.5 岁，61% 为男孩，烧伤面积中位数为体表总面积的 3.5%，10 人（4%）为全厚烧伤。69名儿童（26%）被确认为BWI。大多数烫伤是由接触热液体引起的（184 人），其次是半固体（52 人）和固体（35 人）。逻辑回归模型显示，烧伤面积（TBSA）与BWI有关，而加热剂类型与BWI无关：我们的研究结果表明，热源的粘度不会影响烫伤儿童伤口感染的风险；只有烫伤面积的大小才是导致 BWI 的独立因素。

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引用次数: 0

Evaluation of non-occlusive mesenteric ischemia for burn patients – A matched-pair analysis and treatment algorithm 烧伤患者非闭塞性肠系膜缺血的评估--配对分析和治疗算法。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-30 DOI: 10.1016/j.burns.2024.08.020

Florian Bucher, Nadjib Dastagir, Martynas Tamulevicius, Doha Obed, Thorben Dieck, Peter M. Vogt, Khaled Dastagir

Background

Burn injuries may cause gastrointestinal dysfunction leading to intestinal barrier dysfunction, abdominal compartment syndrome, and acute mesenteric ischemia. In the absence of major vascular occlusion, non-occlusive mesenteric ischemia (NOMI) often occurs in critically ill intensive-care burn patients.

Methods

A retrospective descriptive analysis of the burn registry of the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery of Hannover Medical School was performed from 1st January 2018 to 1st May 2024. Burn patients with NOMI were matched with burn patients who did not acquire acute mesenteric ischemia based on key variables and shared characteristics.

Results

A total of 20 patients were included in this study. Patients with NOMI showed a statistically significant elevation in serum lactate (p = 0.005) and were most likely to be in a shock state requiring vasopressors (p = 0.047). Overall prognosis was poor for the NOMI cohort, 80 % of whom had a fatal result (p = 0.024). A total of four patients received intra-arterial administration of alprostadil.

Conclusions

NOMI represents a potentially fatal condition for the burn patient. The current lack of sensitive biomarkers and accurate diagnostic tools for the early detection of NOMI onset is a major factor behind the overall poor prognosis. We propose the intra-arterial administration of alprostadil as a novel approach to targeted treatment for NOMI.

背景：烧伤可能导致胃肠道功能障碍，导致肠屏障功能障碍、腹腔隔室综合征和急性肠系膜缺血。在没有大血管闭塞的情况下，非闭塞性肠系膜缺血（NOMI）常常发生在重症监护烧伤患者身上：方法：从 2018 年 1 月 1 日至 2024 年 5 月 1 日，对汉诺威医学院整形、美容、手部和整形外科烧伤登记处进行了回顾性描述分析。根据关键变量和共同特征，将患有 NOMI 的烧伤患者与未患急性肠系膜缺血的烧伤患者进行配对：本研究共纳入 20 名患者。NOMI患者的血清乳酸有显著的统计学升高（p = 0.005），最有可能处于休克状态，需要使用血管加压药（p = 0.047）。NOMI队列的总体预后较差，其中80%的患者有死亡结果（p = 0.024）。共有四名患者接受了阿前列地尔动脉内给药：结论：NOMI对烧伤患者来说是一种潜在的致命疾病。目前缺乏敏感的生物标志物和准确的诊断工具来早期检测 NOMI 的发病，这是导致整体预后不良的一个主要因素。我们建议将动脉内注射阿普前列地尔作为一种新的靶向治疗NOMI的方法。

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引用次数: 0

Formononetin alleviates thermal injury-induced skin fibroblast apoptosis and promotes cell proliferation and migration 福莫西汀能缓解热损伤引起的皮肤成纤维细胞凋亡，促进细胞增殖和迁移。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-29 DOI: 10.1016/j.burns.2024.08.022

Meiyue Yang , Zhibo Yang , Xiangjun Huang , Xiaoping Li , Fangqin Chou , Shuiqing Zeng

The aim of this study was to explore the effect and mechanism of formononetin (FMNT) in thermal-injured fibroblast proliferation, apoptosis, and oxidative stress. After thermal injury, human skin fibroblast (HSF) cells showed inhibited proliferation, migration, extracellular matrix (ECM) synthesis; and increased apoptosis, reactive oxygen species (ROS) production, and inflammation. Specifically, after thermal injury, cell viability, migration distance, and protein levels of collagen I, collagen III, α-SMA, MMP1, and MMP3 were reduced; cell apoptosis rate and TUNEL-positive cell numbers were increased; the levels of Bax and cleaved caspase-3 were elevated, while Bcl-2 level was reduced. Moreover, the thermally injured HSF cells showed increased levels of ROS, MDA, LDH, TNF-α, and IL-1β, and decreased GSH, SOD, GSH-Px, and CAT. FMNT levels can partially eliminate the effects of thermal injury on HSF cells, as shown by promoting thermally injured HSF cell proliferation and migration, and inhibiting cell apoptosis, ROS production, and inflammation. FMNT exerted no significant effect on normal HSF cells. Additionally, the levels of the P13K/AKT/mTOR signaling-related proteins (p-P13K, p-AKT, and p-mTOR) were reduced in thermally injured HSF cells, whereas FMNT could promote p-P13K, p-AKT, and p-mTOR levels. FMNT can partially alleviate the thermal injury-induced inhibition of fibroblast proliferation and migration; FMNT also inhibited the apoptosis, ROS level, and inflammation in thermal-injured cells. The effects of FMNT may be mediated by regulating the P13K/AKT/mTOR pathway.

本研究旨在探讨福莫西汀（FMNT）对热损伤成纤维细胞增殖、凋亡和氧化应激的影响及其机制。热损伤后，人皮肤成纤维细胞（HSF）的增殖、迁移和细胞外基质（ECM）合成受到抑制，细胞凋亡、活性氧（ROS）生成和炎症反应增加。具体来说，热损伤后，细胞存活率、迁移距离以及胶原蛋白 I、胶原蛋白 III、α-SMA、MMP1 和 MMP3 蛋白水平降低；细胞凋亡率和 TUNEL 阳性细胞数量增加；Bax 和裂解的 caspase-3 水平升高，而 Bcl-2 水平降低。此外，热损伤 HSF 细胞的 ROS、MDA、LDH、TNF-α 和 IL-1β 水平升高，GSH、SOD、GSH-Px 和 CAT 水平降低。FMNT 水平可部分消除热损伤对 HSF 细胞的影响，具体表现为促进热损伤 HSF 细胞的增殖和迁移，抑制细胞凋亡、ROS 生成和炎症反应。FMNT 对正常 HSF 细胞无明显影响。此外，在热损伤的 HSF 细胞中，P13K/AKT/mTOR 信号相关蛋白（p-P13K、p-AKT 和 p-mTOR）的水平降低，而 FMNT 可促进 p-P13K、p-AKT 和 p-mTOR 的水平。FMNT 可部分缓解热损伤引起的成纤维细胞增殖和迁移抑制；FMNT 还可抑制热损伤细胞的凋亡、ROS 水平和炎症反应。FMNT的作用可能是通过调节P13K/AKT/mTOR通路介导的。

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引用次数: 0

Efficacy of triamcinolone acetonide combined with botulinum toxin A in the treatment of hypertrophic scars and keloids: A meta-analysis 曲安奈德联合 A 型肉毒毒素治疗增生性疤痕和瘢痕疙瘩的疗效：荟萃分析。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-24 DOI: 10.1016/j.burns.2024.08.016

Jianzhen Shi , Siqi Zhang , Ziyue Zhang , Jianru Xu , Yanmei Chen , Siyu Sun

Background

This meta-analysis aims to evaluate the efficacy and safety of triamcinolone acetonide (TCA) combined with botulinum toxin type A (BTA) for treating hypertrophic scars and keloids.

Methods

A comprehensive search of randomized controlled trials published before September 2023 was conducted across the Cochrane Library, Embase, PubMed, Web of Science, and CNKI databases. The analysis involved calculating pooled weighted mean difference (WMD), pooled risk ratios (RR), and 95 % confidence intervals (CI).

Results

Inclusive of 11 studies with a total of 561 patients, the meta-analysis revealed a statistically significant difference in the effective rate between the BTA+ TCA and control groups (RR = 1.28, 95 % CI = 1.14–1.44). Moreover, BTA+ TCA demonstrated a significant improvement in Visual Analog Scale scores (WMD = −1.69, 95 % CI = −2.72 – −0.66) and Vancouver Scar Scale scores (WMD = −1.46, 95 % CI = −1.90 – −1.02) compared to the control group. However, no statistically significant difference in scar thickness was observed between the BTA+ TCA and control groups (WMD = −0.11, 95 % CI = −0.30 - 0.09).

Conclusion

This meta-analysis showed that the combined use of BTA and TCA demonstrates high effectiveness in scar treatment, but its influence on scar thickness is limited. Future research should further explore the sources of heterogeneity and validate the long-term effects and safety of this therapy.

背景：本荟萃分析旨在评估曲安奈德（TCA）联合A型肉毒毒素（BTA）治疗增生性疤痕和瘢痕疙瘩的有效性和安全性：在 Cochrane Library、Embase、PubMed、Web of Science 和 CNKI 数据库中对 2023 年 9 月之前发表的随机对照试验进行了全面检索。分析包括计算汇总加权平均差 (WMD)、汇总风险比 (RR) 和 95 % 置信区间 (CI)：荟萃分析显示，BTA+ TCA 组和对照组的有效率差异有统计学意义（RR = 1.28，95 % CI = 1.14-1.44）。此外，与对照组相比，BTA+ TCA 显著改善了视觉模拟量表评分（WMD = -1.69, 95 % CI = -2.72 -0.66）和温哥华疤痕量表评分（WMD = -1.46, 95 % CI = -1.90 --1.02）。然而，BTA+ TCA 组和对照组之间的疤痕厚度差异无统计学意义（WMD = -0.11，95 % CI = -0.30 - 0.09）：这项荟萃分析表明，联合使用 BTA 和 TCA 对疤痕治疗有很高的疗效，但对疤痕厚度的影响有限。未来的研究应进一步探索异质性的来源，并验证这种疗法的长期效果和安全性。

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引用次数: 0

Multi-disciplinary mass burn casualty simulation exercise 多学科大规模烧伤模拟演习。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-23 DOI: 10.1016/j.burns.2024.08.017

B. Schmitt, L. Moore, K. Heath, E. Concannon, M. Wagstaff

Disaster simulation exercises are important to test service processes, capabilities, and deficiencies; disaster response planning should encompass the entire multidisciplinary team over an extended period. Our service simulated a modest eight burn casualty scenario to test our service capabilities over a 10-week period across medical, nursing, and allied health professions. Requirements due to the mass burns casualty cohort were predicted in terms of theatre requirements, allied health treatment hours required, and nursing hours requirements. Prospective business-as-usual service provision data were also collected over the 10-week study period with respect to theatre utilisation, allied health workload, nursing hours, and burns ward bed census. These data were then superimposed on predicted mass burn casualty requirements to gauge total workload demands over the study period. Results showed an expected significant initial spike in theatre requirements in the first week post mass casualty, with ongoing deficiencies in theatre allocation occurring throughout the 10-week study period. Allied health staff were working at or near capacity in a business-as-usual setting with major spikes in workload demand occurring due to the mass burn casualty cohort. Total workload demands clearly exceeded current staff capacity for most of the allied health professions over the 10-week period. Bed census exceeded funded nursing bed capacity for all but seven days of the study period. Predicted combined nursing hours exceeded funded capacity for all but two days. This simulation clearly demonstrated the high and immediate increase in workload demands across all professions over a prolonged 10-week period and that high business-as-usual demand can greatly affect staff capacity to cope with a mass casualty surge in admissions. It was able to provide evidence, and awareness, for leadership and management on the need for resources and resource re-allocation in a mass burn casualty scenario. It also informed a review of our current triggers for activating our SA Health Multiple Burns Plan.

灾难模拟演习对于测试服务流程、能力和缺陷非常重要；灾难响应计划应在较长时间内涵盖整个多学科团队。我们的服务模拟了一个规模不大的八人烧伤情景，以测试我们在为期 10 周的时间里在医疗、护理和专职医疗专业方面的服务能力。我们预测了大规模烧伤伤员队列所需的手术室、专职医疗所需的治疗时数和护理时数。在为期 10 周的研究期间，我们还收集了有关手术室利用率、专职医疗工作量、护理时间和烧伤病房床位普查的前瞻性 "一切照旧 "服务提供数据。然后将这些数据与预测的大规模烧伤伤员需求叠加，以衡量研究期间的总工作量需求。研究结果表明，在发生大规模伤亡后的第一周，预计的手术室需求量会出现大幅飙升，而在为期 10 周的研究期间，手术室分配会持续不足。在正常情况下，专职医疗人员的工作能力达到或接近饱和状态，而大规模烧伤人员群则导致工作量需求大幅增加。在为期 10 周的时间里，大多数专职医疗人员的总工作量需求明显超过了现有的工作人员能力。在研究期间，除七天外，床位普查都超过了护理床位的资助能力。除两天外，其他所有天数的预测综合护理时数都超过了资助容量。这一模拟清楚地表明，在长达 10 周的时间内，所有专业的工作量需求都会立即大幅增加，而且正常的高需求会极大地影响工作人员应对大规模伤亡入院激增的能力。它能够为领导层和管理层提供证据，并使他们认识到在大规模烧伤伤员情况下对资源和资源重新分配的需求。它还为审查我们目前启动南澳大利亚健康多重烧伤计划的触发因素提供了信息。

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引用次数: 0

A one year follow-up on quality of adherent scars after autologous fat grafting processed by a filtration technique 采用过滤技术处理自体脂肪移植后，对附着性疤痕质量进行为期一年的跟踪调查

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-23 DOI: 10.1016/j.burns.2024.08.018

Daniëlle D. Rijpma , Mariëlle E. Jaspers , Anouk Pijpe , Matthea M. Stoop , Antoine J. van Trier , Paul P. van Zuijlen

Autologous fat grafting (AFG), mostly in combination with adhesiolysis, has become the workhorse for reconstructing a dysfunctional or absent subcutaneous layer. In a previous study we showed that fat grafts isolated by centrifuging led to more than 20 % improvement in scar pliability. Nevertheless, there is still debate on which technique should be used to process and purify fat grafts. Therefore, a cohort with matured scars was obtained using the same study protocol but with filtration as processing technique. Scar quality was evaluated by the Patient and Observer Scar Assessment Scale (POSAS version 2.0), the Cutometer (pliability) and the DSM II ColorMeter (erythema and melanin). Scar evaluation was performed pre-operatively (baseline) and at 3 and 12 months after AFG. Between 2014 and 2018, 46 patients were included. Mean scar age was 20 ± 17 years and the majority of scars was caused by burns. Compared with baseline, patients showed improvement in scar quality measured by POSAS items at 12 months follow-up. The item score of ‘pliability’ improved the most from 7.4 to 5.8 (p = 0.001). Item scores of ‘pain’, ‘itch’ and ‘color’ also improved significantly. Clinicians also scored ‘pliability’ as most improved, but this was not statistically significant (p = 0.111). Objectively measured pliability and erythema and melanin showed no statistically significant differences at 12 months follow-up. Patient-reported outcomes revealed a significant improvement in scar quality, especially scar pliability, after AFG processed by filtration in patients with adherent scars. However, no scar quality improvement was found when assessed with objective tools.

自体脂肪移植（AFG）大多与粘连溶解术相结合，已成为重建功能障碍或缺失皮下层的主要方法。在之前的一项研究中，我们发现通过离心分离的脂肪移植物可使疤痕柔韧性提高 20%以上。尽管如此，关于使用哪种技术处理和纯化脂肪移植物仍存在争议。因此，我们采用相同的研究方案，但以过滤作为处理技术，获得了一批成熟疤痕。疤痕质量通过患者和观察者疤痕评估量表（POSAS 2.0 版）、Cutometer（柔韧性）和 DSM II ColorMeter（红斑和黑色素）进行评估。术前（基线）、AFG 术后 3 个月和 12 个月进行疤痕评估。2014 年至 2018 年间，共纳入 46 例患者。平均疤痕年龄为 20 ± 17 岁，大部分疤痕由烧伤引起。与基线相比，患者的疤痕质量在随访 12 个月时通过 POSAS 项目得到改善。柔韧度 "项目得分从 7.4 降至 5.8（p = 0.001），改善幅度最大。疼痛"、"瘙痒 "和 "颜色 "项目得分也有明显改善。临床医生也认为 "柔韧度 "改善最大，但这并不具有统计学意义（p = 0.111）。在 12 个月的随访中，客观测量的柔韧性、红斑和黑色素在统计学上没有明显差异。患者报告结果显示，对有粘连疤痕的患者进行 AFG 过滤处理后，疤痕质量有明显改善，尤其是疤痕的柔韧性。然而，在使用客观工具进行评估时，并未发现疤痕质量有任何改善。

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引用次数: 0

The impact of platelet transfusion on prognosis in adult burn patients with thrombocytopenia: A propensity score matching analysis 输注血小板对患有血小板减少症的成年烧伤患者预后的影响：倾向得分匹配分析

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-22 DOI: 10.1016/j.burns.2024.08.003

Kun Xiao , Wei Xiong , Qiang Liu , Hongao Deng , Zhanglin Zhang , Kuai Yu , Piaoping Hu , Yunzhi Dong , Aiping Le

Background and objectives

Thrombocytopenia is common among burn patients. Platelet transfusion is frequently administered to increase platelet counts. However, it is not clear whether platelets affect the outcome after transfusion among adult burn patients with thrombocytopenia. Our aim is to explore whether platelet transfusion affects the prognosis of adult burn patients with thrombocytopenia.

Methods

We undertook a retrospective analysis of 368 adult burn victims with thrombocytopenia from the Department of Burn at the First Affiliated Hospital of Nanchang University, China, from January 2014 to July 2021. Propensity score matching (PSM) was utilized to reduce selection bias and confounding factors. After PSM, the platelet transfusion group and the no-platelet transfusion group each had 46 patients. Our primary outcome was 30-day all-cause mortality.

Results

Logistic multivariate regression analysis showed that third-degree burn area [β = -0.040, odds ratio (OR) = 1.052, 95 % confidence interval (CI) = 1.015–1.091] and platelet transfusion (OR =2.227, 95 % CI = 0.473–10.483) were independent risk factors (P < 0.05). KaplanMeier analysis showed that the 30-day mortality of patients in the platelet transfusion group and no-platelet transfusion group were 47.8 % and 19.6 %, respectively (P < 0.05)

Conclusion

Platelet transfusion was an independent risk factor for 30-day mortality in adult burn patients with thrombocytopenia.

背景和目的：血小板减少症在烧伤患者中很常见。输注血小板可增加血小板计数。然而，血小板是否会影响患有血小板减少症的成年烧伤患者输血后的预后尚不清楚。我们的目的是探讨输注血小板是否会影响血小板减少症成人烧伤患者的预后：我们对南昌大学第一附属医院烧伤科 2014 年 1 月至 2021 年 7 月的 368 名血小板减少的成年烧伤患者进行了回顾性分析。采用倾向评分匹配法（PSM）减少选择偏差和混杂因素。经过倾向得分匹配后，输注血小板组和不输注血小板组各有46名患者。我们的主要结果是 30 天全因死亡率：逻辑多变量回归分析显示，三度烧伤面积[β = -0.040，几率比（OR）= 1.052，95 % 置信区间（CI）= 1.015-1.091]和血小板输注（OR =2.227，95 % CI = 0.473-10.483）是独立的风险因素（P＜0.05）。

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引用次数: 0

An insight into glycemic variability in burn patients 烧伤患者血糖变异性透视。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-22 DOI: 10.1016/j.burns.2024.08.015

Masome Aghaei Lasboo

引用次数: 0

The treatment effect of operative intervention for flame versus scald burns in resource-limited settings 在资源有限的情况下，对火焰烧伤和烫伤进行手术干预的治疗效果

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-18 DOI: 10.1016/j.burns.2024.08.014

Sarah Peiffer , Linda Kayange , Selena An , Olivia Boddie , Anthony Charles , Jared Gallaher

Introduction

In resource-limited environments, it is critical to triage burn patients most likely to benefit from operative intervention. This study sought to identify patients with a more significant treatment effect after operative intervention following burn injury at a tertiary burn center in Lilongwe, Malawi.

Methods

This is a retrospective analysis of burn patients presenting to Kamuzu Central Hospital from 2011 to November 2022. We compared patients based on whether they had scald or flame burns. Using logistic regression, we estimated the adjusted treatment effect of operative intervention on in-hospital mortality. Operative intervention was defined as burn excision and debridement with or without skin grafting.

Results

We included 3266 patients. 2099 (64.7 %) patients had a scald burn, and 1144 (35.3 %) had a flame burn. 630 patients (19.3 %) underwent surgery. Crude mortality among all patients was 18.1 %, and for patients who underwent surgery, it was 9.7 %. When adjusted for total body surface area burned (TBSA) and age, the average treatment effect of surgery on mortality was − 0.07 (95 % CI − 0.11, − 0.033) for patients with scald burns and − 0.17 (95 % CI − 0.22, − 0.11) for patients with flame burns (Fig. 1). For patients with flame burns, the adjusted odds ratio of death associated with surgery was 0.26 (95 % CI 0.17, 0.39).

Conclusions

Operative intervention confers a survival advantage for patients with flame burns, and the average treatment effect was more significant compared to patients with scald burns. In general, in resource-limited environments flame burns should be prioritized for surgery over scald burns to improve patient outcomes.

在资源有限的环境中，对最有可能从手术干预中获益的烧伤患者进行分流至关重要。本研究旨在确定在马拉维利隆圭一家三级烧伤中心接受手术干预后治疗效果更显著的烧伤患者。这是一项对2011年至2022年11月期间到卡穆祖中心医院就诊的烧伤患者进行的回顾性分析。我们根据患者是烫伤还是火焰烧伤对其进行了比较。通过逻辑回归，我们估算了手术干预对院内死亡率的调整治疗效果。手术干预的定义是烧伤切除术和清创术，无论是否植皮。我们纳入了 3266 名患者。2099例（64.7%）患者为烫伤，1144例（35.3%）为火焰烧伤。630名患者（19.3%）接受了手术治疗。所有患者的粗死亡率为 18.1%，手术患者的粗死亡率为 9.7%。根据烧伤总面积（%TBSA）和年龄进行调整后，手术对烫伤患者死亡率的平均治疗效果为-0.07（95 % CI - 0.11, - 0.033），对火焰烧伤患者的平均治疗效果为-0.17（95 % CI - 0.22, - 0.11）（图 1）。对于火焰烧伤患者，与手术相关的调整后死亡几率比为 0.26 (95 % CI 0.17, 0.39)。手术干预为火焰烧伤患者带来了生存优势，与烫伤患者相比，平均治疗效果更为显著。在资源有限的环境中，火焰烧伤应优先考虑手术治疗，而不是烫伤，以改善患者的预后。

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引用次数: 0

Clinical comparison study of square flap method and five-flap Z-plasty technique for correction of post-burn axillary contractures: Analysis of length gain and evaluation of functional outcome 方形皮瓣法与五瓣Z成形术矫正烧伤后腋窝挛缩的临床对比研究：长度增加分析和功能效果评估

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns

Pub Date : 2024-08-17 DOI: 10.1016/j.burns.2024.08.012

Mahmoud A. Hifny , Ahmed Gaber Abdelmegeed

Introduction

While there is no consensus on the best surgical procedure for post-burn axillary contractures, it is crucial to consider the elongation rate along the scar axis as a useful measurement index for determining the optimal surgical approach. The square flap and five flap z-plasty techniques are commonly employed scar lengthening procedures to address scar contractures in the axilla. These approaches successfully disrupt the linear scar, leading to significant elongation while reducing transverse tension. Our study aims to compare the increase in band length and functional results of these two approaches for treating post-burn contractures in the axilla.

Methods

A retrospective study was carried out utilizing data from 34 patients with mild-to-moderate band-like contractures located on the anterior or posterior axillary lines who underwent surgical correction through either the square flap method or five-flap z-plasty technique. The effectiveness of surgical methods was evaluated using two objective indices: improvement in contracture band length and improvement in abduction angle at the shoulder joint.

Results

All patients achieved complete contracture release. There is no statistically significant difference between the two groups regarding the improvement in the degree of abduction postoperatively. Although there was a significant increase in the length of the contracture band postoperatively in both groups, the average increase in length for cases treated with a square flap was significantly greater than those managed with a five-flap Z-plasty (87.7 ± 44.8 % vs. 38.80 ± 11.119 %,) respectively.

Conclusion

The square flap technique is considered a better alternative to the commonly used 5-flap Z-plasty method because it can achieve higher elongation in the contracture band, restore joint function, and create optimal shape when dealing with single linear band contractures over the axilla.

虽然对于烧伤后腋窝挛缩的最佳手术方法还没有达成共识，但关键是要考虑疤痕轴线的拉长率，这是确定最佳手术方法的有用测量指标。方形皮瓣和五瓣z成形术是解决腋窝瘢痕挛缩的常用瘢痕延长术。这些方法成功地破坏了线性疤痕，在减少横向张力的同时显著拉长了疤痕。我们的研究旨在比较这两种方法在治疗烧伤后腋窝挛缩时所增加的瘢痕带长度和功能效果。我们利用 34 位轻度至中度带状挛缩（位于腋窝前线或后线）患者的数据进行了一项回顾性研究，这些患者通过方形皮瓣技术或五瓣 Z 形成形术接受了手术矫正。手术方法的有效性通过两个客观指标进行评估：挛缩带长度的改善和肩关节外展角度的改善。所有患者都完全解除了挛缩。两组患者术后外展程度的改善在统计学上没有明显差异。虽然两组患者术后挛缩带的长度都有明显增加，但使用方形皮瓣治疗的病例的平均长度增加幅度明显大于使用五瓣 Z 形成形术的病例（分别为 87.7381 ± 44.8192 % 对 38.80 ± 11.119 %）。与常用的五瓣Z成形术相比，方形皮瓣技术被认为是一种更好的替代方法，因为在处理腋窝单线性带状挛缩时，方形皮瓣技术可以实现挛缩带的更高伸长率，恢复关节功能，并创造最佳形状。

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