Pub Date : 2025-07-25DOI: 10.1016/j.burnso.2025.100420
Rakib H. Sheikh , Avinesh Chelliah , Rachel D’Cruz , Andrew J.A. Holland , Torey Lawrence
Background
Perineal, genital and buttock burns are uncommon, but their consequences can be severe.
Methods
A decade-long (2014–2024) retrospective review was conducted on paediatric patients referred to the Children’s Hospital at Westmead (CHW), New South Wales with perineal, genital and buttock (PGB) burns.
Results
A total of 252 patients were identified with perineal, genital and buttocks burns. Most burns occurred as part of more extensive injuries involving the lower limbs, with only 10.7 % classified as isolated PGB burns. Adequate first aid was administered in 90.5 % of cases, either at the scene or upon hospital admission. Thirty two percent (n = 81) required skin grafting, including 42 cases involving the PGB area and 41.7 % needed an indwelling urinary catheter (IDC).
Conclusions
Even though PGB burns are rare, but complications can include urinary tract infections, hypertrophic scarring, and the need for ongoing scar management. These findings emphasise the importance of early intervention and specialised care in managing PGB burns in children.
{"title":"Paediatric perineal and genital burns: A decade of insights and implications","authors":"Rakib H. Sheikh , Avinesh Chelliah , Rachel D’Cruz , Andrew J.A. Holland , Torey Lawrence","doi":"10.1016/j.burnso.2025.100420","DOIUrl":"10.1016/j.burnso.2025.100420","url":null,"abstract":"<div><h3>Background</h3><div>Perineal, genital and buttock burns are uncommon, but their consequences can be severe.</div></div><div><h3>Methods</h3><div>A decade-long (2014–2024) retrospective review was conducted on paediatric patients referred to the Children’s Hospital at Westmead (CHW), New South Wales with perineal, genital and buttock (PGB) burns.</div></div><div><h3>Results</h3><div>A total of 252 patients were identified with perineal, genital and buttocks burns. Most burns occurred as part of more extensive injuries involving the lower limbs, with only 10.7 % classified as isolated PGB burns. Adequate first aid was administered in 90.5 % of cases, either at the scene or upon hospital admission. Thirty two percent (n = 81) required skin grafting, including 42 cases involving the PGB area and 41.7 % needed an indwelling urinary catheter (IDC).</div></div><div><h3>Conclusions</h3><div>Even though PGB burns are rare, but complications can include urinary tract infections, hypertrophic scarring, and the need for ongoing scar management. These findings emphasise the importance of early intervention and specialised care in managing PGB burns in children.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"12 ","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1016/j.burnso.2025.100418
Heidi Michaels , Evelyn Coile , Samuel P. Mandell , Janie Faris
Gram-negative infections in burn patients remain a challenge due to increasing antibiotic breakpoints and developing resistance of Pseudomonas species, Enterobacter species, and Stenotrophomonas maltophilia. Unfortunately, established breakpoints are lacking for newer antibiotic products in resistant Gram-negative bacteria; resulting in a significant obstacle when managing difficult to treat pathogens. Our goal was to determine if cefiderocol is efficacious in treating burn patients with Gram-negative bacterial infections.
Methods
We present 7 patients treated with cefiderocol for multidrug-resistant (MDR) and extensively drug-resistant (XDR) infections. Ages ranged from 7 to 64 years old, with burn size 8–97.9 % total body surface area. Six patients had flame burn injuries while one had an electrical injury. Four patients sustained inhalation injury and five required continuous renal replacement therapy during their hospital stay. The median ABSI was 13, and the modified Baux score was 123. A median of 9 different antibiotic classes were used per patient prior to cefiderocol. Therapy with cefiderocol ranged from 7 to 80 days with aggressive dosing up to 2 g every 6 h to ensure adequate tissue concentration. Five patients survived and achieved clinical cure. Of the two patients who died, one demonstrated microbiological clearance. Both patients likely died from superinfection with invasive mold. Only one patient demonstrated subsequent cultures resistant to cefiderocol (osteomyelitis) which was cured with amputation. No adverse events were attributed to the cefiderocol regimens. Six of the seven patients showed microbiological clearance for Gram-negative bacteria. Additional studies in patients with large thermal injuries are needed to determine optimal dosing regimens for these hypermetabolic patients.
{"title":"Outcomes in patients with thermal injury treated with cefiderocol","authors":"Heidi Michaels , Evelyn Coile , Samuel P. Mandell , Janie Faris","doi":"10.1016/j.burnso.2025.100418","DOIUrl":"10.1016/j.burnso.2025.100418","url":null,"abstract":"<div><div>Gram-negative infections in burn patients remain a challenge due to increasing antibiotic breakpoints and developing resistance of <em>Pseudomonas</em> species<em>, Enterobacter</em> species<em>,</em> and <em>Stenotrophomonas maltophilia.</em> Unfortunately, established breakpoints are lacking for newer antibiotic products in resistant Gram-negative bacteria; resulting in a significant obstacle when managing difficult to treat pathogens. Our goal was to determine if cefiderocol is efficacious in treating burn patients with Gram-negative bacterial infections.</div></div><div><h3>Methods</h3><div>We present 7 patients treated with cefiderocol for multidrug-resistant (MDR) and extensively drug-resistant (XDR) infections. Ages ranged from 7 to 64 years old, with burn size 8–97.9 % total body surface area. Six patients had flame burn injuries while one had an electrical injury. Four patients sustained inhalation injury and five required continuous renal replacement therapy during their hospital stay. The median ABSI was 13, and the modified Baux score was 123. A median of 9 different antibiotic classes were used per patient prior to cefiderocol. Therapy with cefiderocol ranged from 7 to 80 days with aggressive dosing up to 2 g every 6 h to ensure adequate tissue concentration. Five patients survived and achieved clinical cure. Of the two patients who died, one demonstrated microbiological clearance. Both patients likely died from superinfection with invasive mold. Only one patient demonstrated subsequent cultures resistant to cefiderocol (osteomyelitis) which was cured with amputation. No adverse events were attributed to the cefiderocol regimens. Six of the seven patients showed microbiological clearance for Gram-negative bacteria. Additional studies in patients with large thermal injuries are needed to determine optimal dosing regimens for these hypermetabolic patients.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"12 ","pages":"Article 100418"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1016/j.burnso.2025.100419
Joanneke Maitz , Therese Pham , Daniel Isacson , Rodney Martin , James Laycock , Matthew Rickard , Peter Maitz
Large, severe burn injuries are an acute and traumatic injury that require complex treatment and management strategies. NovoSorb Biodegradable Temporizing Matrix (BTM) is a synthetic dermal template that has been proven effective in the management of large burns to temporize wounds and improve functional and aesthetic outcomes. In large, severe burns, vascular access and other invasive procedures for tube, drain or cannula placement are integral to the management. Traditionally, these procedures are performed through native skin, avoiding transection through wounds. However, in large severe burn injuries finding an area of unburnt and viable skin is challenging. In this case, we report the successful insertion of intravenous cannulation, an end-ileostomy, and a tracheostomy through BTM in a 23-year-old male with 95% total body surface area (TBSA) burns. Challenges and learning points were met with simple and cost-effective solutions. This case highlights the versatility of BTM, suggesting that once partially or fully integrated, the neo-dermis can be treated like native skin for invasive procedures or surgical interventions. This is the first documented case of tracheostomy and ileostomy through BTM, providing valuable insights into its application in acute and traumatic burn injuries and large surface area wounds.
{"title":"Versatility of biodegradable temporizing matrix in acute burn management: Invasive procedures through a synthetic dermal substitute","authors":"Joanneke Maitz , Therese Pham , Daniel Isacson , Rodney Martin , James Laycock , Matthew Rickard , Peter Maitz","doi":"10.1016/j.burnso.2025.100419","DOIUrl":"10.1016/j.burnso.2025.100419","url":null,"abstract":"<div><div>Large, severe burn injuries are an acute and traumatic injury that require complex treatment and management strategies. NovoSorb Biodegradable Temporizing Matrix (BTM) is a synthetic dermal template that has been proven effective in the management of large burns to temporize wounds and improve functional and aesthetic outcomes. In large, severe burns, vascular access and other invasive procedures for tube, drain or cannula placement are integral to the management. Traditionally, these procedures are performed through native skin, avoiding transection through wounds. However, in large severe burn injuries finding an area of unburnt and viable skin is challenging. In this case, we report the successful insertion of intravenous cannulation, an end-ileostomy, and a tracheostomy through BTM in a 23-year-old male with 95% total body surface area (TBSA) burns. Challenges and learning points were met with simple and cost-effective solutions. This case highlights the versatility of BTM, suggesting that once partially or fully integrated, the neo-dermis can be treated like native skin for invasive procedures or surgical interventions. This is the first documented case of tracheostomy and ileostomy through BTM, providing valuable insights into its application in acute and traumatic burn injuries and large surface area wounds.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"12 ","pages":"Article 100419"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nexobrid, bromelain-based debriding enzyme, is widely used in burn treatment to remove necrotic skin tissue. However, the formation of a necrotic layer, known as “pseudoeschar”, after debridement remains poorly understood. We performed a pathological evaluation of pseudoeschar.
Case presentation
We report the case of a man in his 50 s who suffered a flame burn on his right shoulder and upper arm. Pre-soaking with normal saline was performed overnight, followed by enzymatic debridement with Nexobrid 22 h post-injury. Pinpoint bleeding was observed after debridement, and pseudoeschar formation was observed on the 6th day post-injury. A skin biopsy was taken from the burn wound on the 10th day post-injury, followed by surgical treatment.
Histopathological findings
Histopathological evaluation revealed that the pseudoeschar consisted of collagen and elastic fibers. Additionally, inflammatory cells, collagen, and elastic fibers appeared to ascend from the lower dermis to the pseudoeschar, penetrating through the ulcer layer.
Discussion and conclusion
The pseudoeschar comprised collagen and elastic fibers. Its formation may involve the transepithelial elimination of degenerated dermal components, a mechanism similar to that observed in perforating dermatoses. Further research is needed to elucidate the underlying mechanisms and clinical significance of pseudoeschar formation.
{"title":"Pathological evaluation of pseudoeschar formation after enzymatic debridement with nexobrid: a case report","authors":"Tomotaka Miura , Masato Shiba , Yuichiro Kitagawa , Tetsuya Fukuta , Kodai Suzuki , Takahito Miyake , Kazuhiro Kobayashi , Hideshi Okada","doi":"10.1016/j.burnso.2025.100417","DOIUrl":"10.1016/j.burnso.2025.100417","url":null,"abstract":"<div><h3>Background</h3><div>Nexobrid, bromelain-based debriding enzyme, is widely used in burn treatment to remove necrotic skin tissue. However, the formation of a necrotic layer, known as “pseudoeschar”, after debridement remains poorly understood. We performed a pathological evaluation of pseudoeschar.</div></div><div><h3>Case presentation</h3><div>We report the case of a man in his 50 s who suffered a flame burn on his right shoulder and upper arm. Pre-soaking with normal saline was performed overnight, followed by enzymatic debridement with Nexobrid 22 h post-injury. Pinpoint bleeding was observed after debridement, and pseudoeschar formation was observed on the 6th day post-injury. A skin biopsy was taken from the burn wound on the 10th day post-injury, followed by surgical treatment.</div></div><div><h3>Histopathological findings</h3><div>Histopathological evaluation revealed that the pseudoeschar consisted of collagen and elastic fibers. Additionally, inflammatory cells, collagen, and elastic fibers appeared to ascend from the lower dermis to the pseudoeschar, penetrating through the ulcer layer.</div></div><div><h3>Discussion and conclusion</h3><div>The pseudoeschar comprised collagen and elastic fibers. Its formation may involve the transepithelial elimination of degenerated dermal components, a mechanism similar to that observed in perforating dermatoses. Further research is needed to elucidate the underlying mechanisms and clinical significance of pseudoeschar formation.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"12 ","pages":"Article 100417"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-27DOI: 10.1016/j.burnso.2025.100416
Rohit Mittal , Jeffrey E. Carter , Steven A. Kahn
Burn patients can present to a medical facility at any given time. By their nature, one cannot predict when a burn injury will occur. Anecdotal accounts suggest that most burn patients present after “business hours,” however, limited objective data exists on presentation patterns of burn injury. Retrospective arrival times of all patients presenting to the emergency room at two different burn centers in different states were collected over a 1-year period to determine total number of patients arriving during business hours vs. after hours. Business hours were defined as 8:00AM–4:00PM. A secondary time window of extended business hours by an additional 2 h (8:00AM–6:00015PM) was also assessed. Over the course of 1 year, 712 patients were identified at both centers and 63.5 % of all patients presented after normal business hours (p = 0.029). When business hours were extended by 2 h, 51.1 % of patients still presented after hours (p = 0.041). This study suggests most patients do not present to a burn center during normal hours. The implications of this on patient outcomes, quality of care, and research warrant further investigation.
{"title":"Beyond business hours: Patient arrival patterns at burn centers","authors":"Rohit Mittal , Jeffrey E. Carter , Steven A. Kahn","doi":"10.1016/j.burnso.2025.100416","DOIUrl":"10.1016/j.burnso.2025.100416","url":null,"abstract":"<div><div>Burn patients can present to a medical facility at any given time. By their nature, one cannot predict when a burn injury will occur. Anecdotal accounts suggest that most burn patients present after “business hours,” however, limited objective data exists on presentation patterns of burn injury. Retrospective arrival times of all patients presenting to the emergency room at two different burn centers in different states were collected over a 1-year period to determine total number of patients arriving during business hours vs. after hours. Business hours were defined as 8:00AM–4:00PM. A secondary time window of extended business hours by an additional 2 h (8:00AM–6:00015PM) was also assessed. Over the course of 1 year, 712 patients were identified at both centers and 63.5 % of all patients presented after normal business hours (p = 0.029). When business hours were extended by 2 h, 51.1 % of patients still presented after hours (p = 0.041). This study suggests most patients do not present to a burn center during normal hours. The implications of this on patient outcomes, quality of care, and research warrant further investigation.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"12 ","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-13DOI: 10.1016/j.burnso.2025.100409
Barclay T. Stewart , Kyler Menge , T.Varugis Kurien , Caitlin Orton , Rebecca Estrada , Gretchen Carrougher , Callie Thompson , Gary Hsieh , Tam N. Pham
Anticipatory guidance delivered via a mobile application (app) can support people with burn injury during the early recovery period. We sought to create a prototype app (Burn Connect and Recover – BurnCORE) to complement care provided at burn centers and serve as a transition to the burn survivorship community. We employed a user-centered design (UCD) approach in collaboration with a diverse group of burn care and technology stakeholders (e.g., patients, carers, clinicians, software engineers) to determine key content, functions, and interface preferences. UCD is an iterative design process where a multi-disciplinary team of application designers receive feedback from future end-users to improve understanding of user requirements, optimal features of user experience (UX), and user-app interface considerations (UI). We performed UCD according to its phases: Phase I--community advisory for foundational inspiration; Phase II--cognitive interviews with patients, their carers, and clinicians to determine key content and features; and Phase III--iterative co-design with stakeholders using low-fidelity prototypes. Participants in Phase I suggested that we focus on key gaps in knowledge of the timeline and domains of burn recovery, strategies to promote self-agency and motivation, eliminating barriers to using burn-specific resources, and select issues that aimed to improve UX. Stakeholders recommended several major application features: understanding the initial burn experience, visualizing recovery, and habituation of daily/weekly tasks. Examples of iterative stakeholder feedback include addition of recovery performance tracking, monitored community chat functions, and better ways to visualize recovery over time. UCD allowed us to confirm important burn recovery domains, define valuable features, and elicit from stakeholders key UX/UI features to optimize app engagement.
{"title":"Optimizing the user-experience (UX) and −interface (UI) of a mHealth application to aid recovery from burn injury (BurnCORE) through a user-centered design approach","authors":"Barclay T. Stewart , Kyler Menge , T.Varugis Kurien , Caitlin Orton , Rebecca Estrada , Gretchen Carrougher , Callie Thompson , Gary Hsieh , Tam N. Pham","doi":"10.1016/j.burnso.2025.100409","DOIUrl":"10.1016/j.burnso.2025.100409","url":null,"abstract":"<div><div>Anticipatory guidance delivered via a mobile application (app) can support people with burn injury during the early recovery period. We sought to create a prototype app (Burn Connect and Recover – BurnCORE) to complement care provided at burn centers and serve as a transition to the burn survivorship community. We employed a user-centered design (UCD) approach in collaboration with a diverse group of burn care and technology stakeholders (e.g., patients, carers, clinicians, software engineers) to determine key content, functions, and interface preferences. UCD is an iterative design process where a multi-disciplinary team of application designers receive feedback from future end-users to improve understanding of user requirements, optimal features of user experience (UX), and user-app interface considerations (UI). We performed UCD according to its phases: Phase I--community advisory for foundational inspiration; Phase II--cognitive interviews with patients, their carers, and clinicians to determine key content and features; and Phase III--iterative co-design with stakeholders using low-fidelity prototypes. Participants in Phase I suggested that we focus on key gaps in knowledge of the timeline and domains of burn recovery, strategies to promote self-agency and motivation, eliminating barriers to using burn-specific resources, and select issues that aimed to improve UX. Stakeholders recommended several major application features: understanding the initial burn experience, visualizing recovery, and habituation of daily/weekly tasks. Examples of iterative stakeholder feedback include addition of recovery performance tracking, monitored community chat functions, and better ways to visualize recovery over time. UCD allowed us to confirm important burn recovery domains, define valuable features, and elicit from stakeholders key UX/UI features to optimize app engagement.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"11 ","pages":"Article 100409"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-13DOI: 10.1016/j.burnso.2025.100415
Sarah Sabur, Amine El harti, Chaymaa Benyamna, Sara Karti, Ahlam El Youssoufi, Marouane Habla, Mounia Diouri
Delirium is an acutely disturbed state of mind or consciousness frequent in patients with extensive burns. The causes are multiple but CNS (central nervous system) infection is among the rare and severe causes of delirium with high fever in burn patients and with the lack of fast and correct diagnosis and adequate treatment, the prognosis is mostly severe. Even with the presence of other causes of delirium in burn patients, the CNS infection must be excluded first, especially when we have a massive bacteremia.
{"title":"Meningitis as a rare cause of delirium in burn patient: Case report","authors":"Sarah Sabur, Amine El harti, Chaymaa Benyamna, Sara Karti, Ahlam El Youssoufi, Marouane Habla, Mounia Diouri","doi":"10.1016/j.burnso.2025.100415","DOIUrl":"10.1016/j.burnso.2025.100415","url":null,"abstract":"<div><div>Delirium is an acutely disturbed state of mind or consciousness frequent in patients with extensive burns. The causes are multiple but CNS (central nervous system) infection is among the rare and severe causes of delirium with high fever in burn patients and with the lack of fast and correct diagnosis and adequate treatment, the prognosis is mostly severe. Even with the presence of other causes of delirium in burn patients, the CNS infection must be excluded first, especially when we have a massive bacteremia.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"11 ","pages":"Article 100415"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-11DOI: 10.1016/j.burnso.2025.100414
Norman Alejandro Rendon Mejia , Luisa Fernanda Cuervo Ollervides , Laura Elizabeth Piñon Gaytan , Jose Francisco De la Torre Ramos , Alejandra Aguirre Aguilar , Carlos Alan Benitez Membrila
Frostbite, a debilitating injury caused by freezing temperatures, disproportionately affects marginalized populations, yet data from non-circumpolar regions remain critically underrepresented. We present the first documented case in Mexico of severe frostbite requiring bilateral below-knee amputation in a 26-year-old Indigenous man discovered unconscious with alcohol intoxication in subfreezing conditions. Clinical assessment revealed fourth-degree frostbite manifesting as dry necrosis, absent distal pulses, and purulent vesicles. Computed tomography angiography demonstrated popliteal artery occlusion and subfascial gas, confirming concurrent necrotizing fasciitis. Emergency bilateral amputation with fasciocutaneous flap reconstruction resulted in an uncomplicated recovery, enabling discharge on postoperative day 6 for multidisciplinary rehabilitation. This case underscores the ethical complexity of prioritizing limb salvage versus infection mitigation in resource-limited settings and advocates for context-specific, dynamic frostbite management guidelines. Furthermore, frostbite emerges as a sentinel of systemic inequity, reflecting social determinants such as inadequate access to cold-weather protection, alcohol misuse, and healthcare disparities. Culturally tailored prevention strategies—including multilingual community education and equitable healthcare infrastructure—are imperative. As climate change intensifies extreme weather events, frostbite management must evolve beyond acute interventions to address structural vulnerabilities, integrating public health and policy reforms.
{"title":"Fourth-degree frostbite complicated by necrotizing fasciitis in an indigenous Mexican patient: bilateral below-knee amputation and ethical challenges in tissue salvage a case report","authors":"Norman Alejandro Rendon Mejia , Luisa Fernanda Cuervo Ollervides , Laura Elizabeth Piñon Gaytan , Jose Francisco De la Torre Ramos , Alejandra Aguirre Aguilar , Carlos Alan Benitez Membrila","doi":"10.1016/j.burnso.2025.100414","DOIUrl":"10.1016/j.burnso.2025.100414","url":null,"abstract":"<div><div>Frostbite, a debilitating injury caused by freezing temperatures, disproportionately affects marginalized populations, yet data from non-circumpolar regions remain critically underrepresented. We present the first documented case in Mexico of severe frostbite requiring bilateral below-knee amputation in a 26-year-old Indigenous man discovered unconscious with alcohol intoxication in subfreezing conditions. Clinical assessment revealed fourth-degree frostbite manifesting as dry necrosis, absent distal pulses, and purulent vesicles. Computed tomography angiography demonstrated popliteal artery occlusion and subfascial gas, confirming concurrent necrotizing fasciitis. Emergency bilateral amputation with fasciocutaneous flap reconstruction resulted in an uncomplicated recovery, enabling discharge on postoperative day 6 for multidisciplinary rehabilitation. This case underscores the ethical complexity of prioritizing limb salvage versus infection mitigation in resource-limited settings and advocates for context-specific, dynamic frostbite management guidelines. Furthermore, frostbite emerges as a sentinel of systemic inequity, reflecting social determinants such as inadequate access to cold-weather protection, alcohol misuse, and healthcare disparities. Culturally tailored prevention strategies—including multilingual community education and equitable healthcare infrastructure—are imperative. As climate change intensifies extreme weather events, frostbite management must evolve beyond acute interventions to address structural vulnerabilities, integrating public health and policy reforms.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"11 ","pages":"Article 100414"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-31DOI: 10.1016/j.burnso.2025.100413
Laurin Schöne , Jolanta Klukowska-Rötzler , Aristomenis K. Exadaktylos , Radu Olariu , Esther Vögelin , Esin Rothenfluh
The purpose of this study was to assess epidemiological features and injury characteristics of hand burn injuries based on a retrospective data collection from 2012 to 2023 at a maximum care University Hospital. 1809 burn injuries were registered in the Emergency Department of the Hospital, including 538 chemical burns to the eye. Deducting the latter of the total number, 24 % affected the hand as an isolated burn and 37 % as a combined burn injury. 43 % of all hand burns (combined and isolated) were female and 57 % were male. The age group from 20 to 29 years was significantly most affected. 21 % of hand burns happened at work, with 80 % of them being male. The most prevalent cause was contact (24 %), at home and at work. 84 % of all hand burns were treated non operatively and did not cause high costs. In general, there has been a decrease of burn injuries worldwide, but we did not recognize a declining trend of hand burns, some of them related to work. Most patients with hand burns present with mild degrees, but particularly work-related hand burns can be more severe with long term sequelae. The study highlights the importance of prevention programs and initiatives.
{"title":"Epidemiology and characteristics of hand burns: a 12-year retrospective analysis at a University Hospital","authors":"Laurin Schöne , Jolanta Klukowska-Rötzler , Aristomenis K. Exadaktylos , Radu Olariu , Esther Vögelin , Esin Rothenfluh","doi":"10.1016/j.burnso.2025.100413","DOIUrl":"10.1016/j.burnso.2025.100413","url":null,"abstract":"<div><div>The purpose of this study was to assess epidemiological features and injury characteristics of hand burn injuries based on a retrospective data collection from 2012 to 2023 at a maximum care University Hospital. 1809 burn injuries were registered in the Emergency Department of the Hospital, including 538 chemical burns to the eye. Deducting the latter of the total number, 24 % affected the hand as an isolated burn and 37 % as a combined burn injury. 43 % of all hand burns (combined and isolated) were female and 57 % were male. The age group from 20 to 29 years was significantly most affected. 21 % of hand burns happened at work, with 80 % of them being male. The most prevalent cause was contact (24 %), at home and at work. 84 % of all hand burns were treated non operatively and did not cause high costs. In general, there has been a decrease of burn injuries worldwide, but we did not recognize a declining trend of hand burns, some of them related to work. Most patients with hand burns present with mild degrees, but particularly work-related hand burns can be more severe with long term sequelae. The study highlights the importance of prevention programs and initiatives.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"11 ","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Burn injuries account for almost 0.3 million deaths annually worldwide. Household burn injury is one of the common causes of burn injuries. This issue in South Asia is concerning and is an important epidemiological problem that needs to be explored and reported. This study aimed to estimate the current burden, types, and severity of unintentional household burn injuries and identify the associated factors of unintentional household burn injuries.
Methods
We reviewed all available studies (qualitative or quantitative) on unintentional household injuries in South Asia. All studies on household burn injuries from 2000 to 2020, including all the relevant published information as described in the inclusion criteria.
Results
The findings of the study revealed that in South Asian regions the low socio-economic status, and poor prevention and treatment policies for the burden of burn injuries are the predominant factors and that the associated risk factors play a role in unintentional burn injury incidents with lack of education and awareness effecting mainly women and children to have accidents at households suffering from burn injuries, morbidity, and mortality. No data is available for the Maldives and Bhutan.
Conclusion
Unintentional burn injuries cause morbidity and mortality, primarily among women and children. With the lack of financial resources and inadequate policies for burn care, prevention, and treatment in South Asian countries, it is essential to reduce the burden.
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