Burns open : an international open access journal for burn injuries最新文献

Contact burns involving the joints of the lower limbs are rare. When these burns are of the fourth degree, their treatment becomes a real challenge because they can damage important anatomical elements in statics and locomotion such as muscles, tendons, and bones. The functional prognosis of the lower limbs can be seriously compromised. We report the case of a steel worker, victim of a work accident that caused burns and deep wounds to the knee and contralateral ankle, with section of the patellar and Achilles tendons. Immediate surgical treatment with debridement of the burned and severed tissues and direct suture of the injured tendons, combined with a long period of rehabilitation, allowed the patient to return to his workstation.

We present a rare case of a pediatric patient who was admitted with burns and was found to have spontaneous (non-surgical) pneumoperitoneum. Pneumoperitoneum is always considered an ominous radiological finding, necessitating emergent surgical exploration. However, around 5–15% cases can occur in the absence of visceral perforation, known as spontaneous or non-surgical pneumoperitoneum. We describe the case of a 5 year old boy admitted with 25% scald burn who developed nonspecific abdominal symptoms. Abdominal x-ray revealed presence of pneumoperitoneum, without any clinical manifestations of peritonitis. Computed tomography (CT) could not identify any site of perforation. The patient had transient hemodynamic disturbance requiring inotropes, but he soon improved with conservative approach and required minimal invasive procedure in the form of abdominal paracentesis. We stress the importance of effectively ruling out surgical causes before confirming the diagnosis of non-surgical pneumoperitoneum, and to be aware of this complication in pediatric burn patients. In the absence of symptoms and signs of peritonitis, conservative approach may be adopted in order to avoid unnecessary surgical interventions.

Colonisation with Pseudomonas aeruginosa considerably increases the mortality rate in burns, due to its common resistance to antibiotic treatment. Simple dressings consisting of gauze soaked in acetic acid have been proven as effective in eradicating pseudomonas however few studies have demonstrated the optimum concentration or treatment regime.

We report a burned infant who developed iatrogenic chemical injuries to her donor sites as a complication of topical acetic acid treatment. Possible contributing factors and strategies to improve safety are discussed.

Background

Our Burn center has used the Parkland formula (4 ml/kg/TBSA%) adjusted by physiological parameters to guide fluid resuscitation in burn patients. Our main objective was to examine fluid resuscitation in patients with major burn injury and its effect on mortality, need for renal replacement therapy (RRT) and the length of stay (LOS) in the Intensive Care Unit (ICU). Further aims were to determine which factors were associated with fluid resuscitation volumes during the first 24 h, and whether these fluid volumes had an association with the volumes infused during the next 48 h.

Methods

This retrospective observational study accrued patients (N = 46) admitted to the Helsinki Burn Center between 2016 and 2018 with burn injuries ≥ 20% TBSA. The national intensive care registry and the electronic patient record system provided data on fluid infusions, urine output, laboratory measurements, presence of inhalation injury, surgical procedures within 72 h from injury, patient demographics, need for renal replacement therapy and mortality. Patients were divided into groups based on infused fluid volumes and univariate regressions were performed to identify factors associated with fluid volumes.

Results

48% of the patients received fluids more than 6 ml/kg/TBSA% during the first 24 h. 35% of the patients received fluid volumes exceeding the Ivy index (250 ml/kg/d) and was associated with higher TBSA%, SOFA and SAPS scores as well as increased mortality and need for RRT. Higher lactate and lower base excess were associated with higher fluid volumes. Urine output had no association with the resuscitation volumes. Larger resuscitation volumes during the first 24 h were associated with larger fluid volumes given also during the next 48 h. Higher cumulative fluid volume in 0–72 h resulted in increased need of RRT and higher ICU mortality.

Conclusion

Using the Parkland formula and adjusting the infusion based on physiological parameters leads to over resuscitation in many of the patients. It seems that the more fluids are given during the initial resuscitation phase, the more fluids are also administered during the subsequent phase. Higher cumulative fluid volumes are associated with RRT requirements and higher mortality. We postulate that starting fluid resuscitation with a lower infusion rate could be beneficial, as it may lead to smaller cumulative fluid volumes during the first 72 h, leading to reduced mortality and kidney injury.

Life threatening burns of non-accidental origin in neonates are extremely rare. Their management represents a great challenge, particularly since necrosectomy of deep burns and grafting at this young age are technically very demanding. Thus, a strategic surgical master plan is mandatory to achieve rapid and definitive autologous coverage and avoidance of undue risks and iatrogenic burden for the fragile neonatal patient. We present the case of a four day-old neonate who sustained non-accidental deep burns involving 40 % of its total body surface area (TBSA) and the successful application of a laboratory grown, autologous dermo-epidermal skin analogue, termed Zurich Skin (also named denovoSkin), within a clinical trial sub-study. Due to COVID-19 pandemic restrictions, a telemedicine-based approach was installed and a total of 260 cm² Zurich Skin were transplanted, video assisted, on a wound bed previously prepared with a dermal substitute, thereby covering 20 % TBSA. Take of Zurich Skin was excellent on the chest, good to moderate on the abdomen, and poor on other small areas, where we observed a prolonged healing. After maturation, Zurich Skin showed a close to natural skin coverage without need for further reconstructive surgery. This unique case delivers the proof of concept that Zurich Skin can be successfully applied in early life and even under most adverse medical and paramedical circumstances, provided a carefully crafted masterplan properly addressing the key issues can be executed by joint forces of committed partner institutions.

Burns care can alter the trajectory of burn re-epithelialisation. Currently, it is not known which dressings optimise wound re-epithelialisation when used in conjunction with Negative Pressure Wound Therapy (NPWT). Here we present the case of NR, an 11yoM who had two different dressing combinations (Mepitel™ and ACTICOAT™; and ACTICOAT™) applied to his wound with differing outcomes. The areas with Mepitel™ and ACTICOAT™ re-epithelialised faster than those areas with ACTICOAT™ alone. We hypothesise this to be due to a combination of increased cytotoxic effects, minimised microdeformations and increased localised trauma with dressing removal usually facilitated by Mepitel™. Further research is required; however, based on this case we advise that a porous, wound contact layer is placed beneath nanocrystalline silver dressings when utilising in conjunction with NPWT.

Background

Laser or light therapy hair removal is commonly used for hair removal in beauty salons and other non-medical practices. The process utilises light energy which is absorbed by the melanin in the hair. The subsequent heat energy damages the hair follicles inhibiting or delaying future hair growth. Burn injuries are a very rare side effect of this procedure and more commonly seen in patients with darker skin pigments.

Case presentation

We present a case of a 30 year old female who was a delayed presentation of full thickness burns to her right lower leg around a tattoo following hair removal with an intense pulsed light (IPL) device.

Conclusions

Burn wounds as a result of light therapy hair removal procedures are very rare. However the involvement of surrounding tattoos in creating excessive heat transfer to surrounding tissue needs to be highlighted. This potential side effect is not often recognised or explained to customers and therefore important to note for providers as light therapy use becomes increasingly popular.

Objective

To review the cases of Stevens-Johnson syndrome and/or toxic epidermal necrolysis in adult male patients to determine the incidence of genitourinary manifestations, the indication for urethral catheters, and to provide recommendations for management.

Materials and methods

This is a retrospective observational study of adult male patients over a ten year period. The study group is divided into patients with and without genitourinary manifestations.

Results

We identified 57 patients who met the study inclusion criteria, of whom 39 had genitourinary involvement. The most common location of lesions was the phallus although many patients had multiple sites of involvement. These lesions were treated similarly compared to other nongenitourinary cutaneous lesions. Four patients presented with dysuria, one with frequency, and one with hesitancy and intermittency. A urethral catheter was placed in 25 of the 39 patients. None of the patients who were not catheterized and did not have lower urinary tract symptoms at the time of presentation developed voiding symptoms during their hospital stay. Apart from a one-time episode of incontinence in one patient that resolved spontaneously, none of the patients who were catheterized developed voiding issues after their catheters were removed. No patients required follow-up with urology after discharge.

Conclusions

No patients developed a symptomatic urethral stricture. Many patients had multiple sites of involvement. Despite no standardized treatment being used, all cutaneous lesions were successfully treated in patients who survived their illness, with documented resolution of genitourinary lesions on physical examination. Routine urethral catheterization and urologic consultation are not necessary in these patients.