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

Abnormal calcium deposition is among the many sequelae that may arise following major burn injury. This may take the form of heterotopic ossification (HO) or calcinosis cutis (CC) within scarred skin. These two processes are distinct, but clinicians sometimes use the term “heterotopic ossification” as a catch-all term to reference any abnormal calcium deposition in a burn survivor. While HO is well-described, less attention has been devoted to CC. We present a case of CC to highlight the distinct presentations of CC vs. HO in hopes of promoting the use of semantically correct terms within the burn care community.

Background

Cooking-related burn injuries are a public health problem, and may be even more likely to occur in countries that are experiencing a transition to cleaner cooking fuels like liquefied petroleum gas (LPG). The risk of burns from cooking with these newer fuels, and safety measures or training to prevent injuries, is not well documented. This study examines the burden of burn injuries and burn prevention education provided to consumer by LPG stove and cylinder vendors.

Methods

A cross-sectional study was conducted among 100 burn patients admitted to Muhumbili National Hospital from February 2022 to January 2023 to assess cooking-related burns.

Results

We found that among 377 patients with all burn injuries, 100 (26.5%) were cooking-related, with charcoal (51%) and LPG (35%) stoves being the most reported. Females (61%) were more affected than males (39%), and lower education levels were more likely to be associated with burn injuries. Of all burn patients admitted, 57 (15.1%) died. Among those who experienced a cooking-related burn, 7 (7%) died. Children were more affected (59%) by any cooking-related burn injuries, but adults were more likely to experience LPG-related burns (56%). Small cylinders with a burner placed directly over the cylinder as one unit, without a connecting hose, caused less injury than stoves using a larger cylinder with a rubber connecting hose.

Conclusion

Safety measures for LPG stoves and fuels, including policies to increase awareness and prevent burn injuries, must be prioritized in countries like Tanzania that are transitioning from solid fuels to LPG fuels for cooking.

Worldwide, burns are the fourth most frequent type of injury. The treatment of burn wounds requires a lot of experience and an interdisciplinary approach including both surgical treatment and pharmacological wound care. The most common management of burn wounds is debridement and wound closure through the use of skin grafts. The purpose of the study was to evaluate the hemostatic and antibacterial effects of the commercially available Tromboguard® foam dressing with an active layer containing alginates and chitosan. The site of application of the product was the donor fields for skin grafts. Findings proved that a polyurethane foam dressing with an active chitosan-alginate layer is a useful option for achieving rapid hemostasis, antimicrobial protection and effective healing at split-thickness skin graft donor sites. Substances present in the active layer promote clot formation and the wound healing process.

Background

There is a global concern regarding increasing colonization and/or infection of paediatric burns patients with multi-drug-resistant organisms, especially in Africa. Surveillance of antimicrobial resistant patterns enables clinicians to opt for the most appropriate empiric antimicrobial agent according to the unit’s susceptibility profile.

Objective

This study sought to compile unit-specific antibiograms comparing the organism prevalence and their antimicrobial resistance trends in the paediatric burns unit, Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2015 to December 2019.

Methods

A retrospective, laboratory-based review was conducted of bacterial and fungal isolates including antimicrobial susceptibility testing (AST) data from blood cultures and tissue samples. Enterobacterales, non-fermenters, gram-positive organisms, and yeasts were analysed as a percentage of total positive blood cultures comparing 2015–2017 to 2018–2019 data. Analysis of antimicrobial resistance trends was performed for extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacterales (CRE), extensively-drug-resistant (XDR) Acinetobacter baumannii, and meticillin-resistant Staphylococcus aureus (MRSA) for the years 2015, 2017, and 2019.

Results

A total of 1243 blood culture isolates were studied with A.baumannii (208/1243;17 %), coagulase negative staphylococci (141/1243; 11 %) and Candida auris (53/1243; 4 %) representing the predominant gram-negative bacteria, gram-positive bacteria, and yeast, respectively. A significant decrease in ESBLs (p = 0.00) was noted with a rise in CREs (p = 0.00) during the study period. Majority of the A. baumannii were XDR (≥77 %) despite an appreciable decrease. A notable decrease in MRSA (p = 0.00) isolates was observed. Pseudomonas aeruginosa (72/275; 26 %) was the leading organism recovered from a total of 275 tissue isolates.

Conclusion

The results of this study encourage review of the current antimicrobial choices in the unit for empiric antibacterial cover. Due to the low numbers of yeasts, we cannot comment on the institution of early antifungal strategies. We support reinforced infection prevention and control practices as well as antimicrobial stewardship initiatives.

Knowledge translation and consumer testing aims to move research findings from scientists, professional journals, and conferences to the hands of end-users and organizations who use the information regularly. The purpose of this report is to outline the process by which the Burn Model System (BMS) has worked with the Model System Knowledge Translation Center (MSKTC) to develop and disseminate patient education materials to consumers. The National Institute on Disability, Independent Living, and Rehabilitation Research-funded BMS in collaboration with the MSKTC uses a multi-step process for developing and consumer-testing evidence-based/consensus-derived educational information prioritized by consumers. The final written products are made available in both English and Spanish at/below an 8th grade reading level. Products are disseminated through websites, clinical encounters, social media, and national/international engagement with clinicians and burn-related organizations. Written products are reviewed every five years to ensure they remain current and relevant. Number of online views for each product is a key measure of dissemination. Since 2011, the collaboration between the BMS and the MSKTC has produced or updated 22 educational factsheets, three videos, three infocomics, and one infographic. Collectively, these products have been viewed over two million times by people in 216 countries. Online views of all products have generally increased year-to-year. This process makes relevant health information accessible and understandable for consumers. As a result, Burn Model System informational products have been increasingly viewed by US and international consumers.

Background

Spina bifida cystica (SB) is one of the most common neural tube defects affecting 1 in 2,500 newborns worldwide. Due to the neurological deficits associated with SB, injuries from thermal exposure, trauma, or other etiology may be more severe rendering their treatment a challenge for a traditional approach to burn and wound management. Despite this relatively high disease incidence rate, few studies exist to evaluate wound development or the natural history of wound healing in patients with SB.

Case presentation

We present a case of a pediatric patient with a history of SB who sustained a full thickness burn to the right plantar foot in February of 2023. The 8-year-old was riding an all-terrain vehicle when his right foot made contact with the hot tailpipe. The insensate neuropathy associated with the patient’s SB contributed to the extreme severity of thermal contact injury. We report the burn, treatments, the usage of a novel dermal replacement, and outcomes of this case.

Conclusion

This case demonstrates successful limb salvage in a pediatric patient with severe plantar foot burns utilizing a novel collagen-elastin dermal matrix for tissue reconstruction. Limb salvage was the preferred treatment option over amputation and a prosthetic considering the patient’s age and need for future prostheses. Given the severity of the burn, the impaired wound healing due to his baseline neuropathy, and his baseline ambulatory status, the optimal outcome in this case was limb salvage, which was successfully achieved.

Skin graft fixation dressing is important in preventing graft shear and loss which are a major source of morbidity particularly in burn patients. We report the successful use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) in burn injuries of the hand for both skin graft fixation and maintenance of safe hand positioning.

A 27-year-old man suffered burn injuries on his hands and face which included deep partial thickness burns of his right hand following an industrial explosion. A day after the injury, early debridement and skin grafting of the hand was performed. NPWTi-d was applied by cutting the form into smaller blocks and stacking them in an overlapping fashion we termed the “Jenga method” to securely fix the skin graft in place and fix the hand in intrinsic plus hand positioning for 1 week. The device was set to 10 ml saline immersion for 3 min every 3.5 h and section pressure reduced from −125 mmHg to −75 mmHg due to hand discomfort. Graft take was 95 % and the patient recovered with no joint contracture or other complications.

We report this case to demonstrate the use of NPWTi-d for effective skin graft fixation and non-invasive immobilization of the hands and fingers in a safe limb position in a patient with burn injuries and present the stacked block foams “Jenga method” as a useful easy technique for application of NPWT.

Background and aim

Electrocution is a well-documented preventative cause of unnatural death globally. The demographic profile and trends of fatal electrocutions in the eThekwini district, KwaZulu Natal, South Africa were analyzed and aimed to identify regional factors for targeted prevention.

Methods

A retrospective descriptive study analyzed all fatal electrocutions autopsied at three medico-legal mortuaries in eThekwini from 1st January 2006 to 31st December 2016. Clinical, postmortem and police findings were collated, categorized and statistically analyzed.

Results

A total of 512 electrocution fatalities were identified at autopsy during the 11 year study period (1,35 fatal electrocutions/ 100 000 population). Cases escalated until 2013 and then gradually decreased, with significant difference between the number of cases per study year (p < 0.001). Most deaths occurred in domestic environments, amongst males (3rd to 4th decade), in summer, during weekends and around midday. The under 10 years were the most vulnerable age group overall (28,71 % of all cases), notably those under 3-years old. Most female victims were under 10 years old (43.81 %). The highest percentage of cases occurred outside the metro. Illegal connections accounted for almost 50 % of cases identified by source.

Conclusion

The eThekwini district in KwaZulu Natal documented the most electrocutions for any study undertaken in South Africa to date. Regional trends in child electrocutions, particularly females under 10 years and fatalities attributed to illegal connections are crucial considerations for directed prevention.

Residential fires are a devastating and stressful life event. The high number of residential fires per year and significant associated stressors impacts all aspects of daily life. This reflexive narrative approach highlights gaps in inpatient and outpatient burn care for those who have suffered a residential fire from an occupational therapy perspective. The findings show that healthcare professionals need to consider social support systems, use therapeutic listening, provide stress management techniques and be advocates throughout the recovery process.