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

Background

Burn injuries in children in low- and middle-income countries are common, serious, and preventable. Despite the high burden of disease, there is a paucity of data on the profile of paediatric burns in South Africa. Such data are essential to local burn prevention strategies.

Methods

A retrospective review of all recorded paediatric burns admissions to the paediatric burns unit at Chris Hani Baragwanath Academic Hospital was performed from 1 January 2015 – 31 December 2020. Ethical approval was obtained. Data extracted anonymously included patient age, sex, mechanism of injury, injury severity, date of injury and residential location.

Results

A total of 2980 admissions occurred during the study period. Infants ≤ 1 year accounted for 42.2 % (1259/2980), males 61.4 % (1689/2751), hot water burns 79.1 % (2357/2980), and major injury 40.1 % (1201/2980) of admissions. Most burn injuries occurred in winter (28.2 %, 842/2980), and most admitted patients lived in Soweto 45.5 % (1355/2980).

Conclusions

Most burns admissions in the study period were characterised by male children less than one year of age, hot water burns, major burn injuries and admissions in the winter months. These results are similar to national and international data regarding age, sex, mechanism of injury and seasonality of paediatric burns. The results from the study have been utilised to inform Surgeons For Little Lives’ paediatric burns prevention campaigns in Soweto and Gauteng Province.

We hereby present a rare case of a full-thickness skin burn after solar radiation by wearing a black bra. The patient underwent late 2020 a delayed bilateral autologous breast reconstruction with a bilateral DIEP flap, followed shortly after by a latissimus dorsi flap reconstruction of her left breast caused by flap necrosis of the left-sided DIEP flap and a secondary nipple reconstruction with afterward a small cosmetic correction. Shortly after she travelled for a holiday in November 2023 to Egypt. After less than 2 h sunbathing in the afternoon in her black bra, she recognized later in the evening redness and blistering of the skin of her right breast. After return and presentation to our outpatient department, we stated a 2b-3 degree burn of her right lateral breast. Under conservative treatment no progress was seen, thus we scheduled the patient for a direct resection and primary closure of the burned skin, which further healed uneventfully. This case presentation shows again the potential risk of solar burns in breast-reconstructed patients with reduced skin sensitivity even after years. Therefore patients undergoing breast reconstruction should be informed about this issue and medical professionals should be aware of this potential harm in these population groups.

Introduction

Isolated genital burns are not frequent injuries; more often, they are part of larger surface-area burn injuries. Aetiology and mechanisms of genital burn injuries differ regarding country, age and patients’ socioeconomic status.

Aim

The aim is to describe a rare case report of a 69-year-old man who incurred a deep penile burn after using an electrothermal sexual device.

Methods

The patient was admitted to the Department of Urology (blinded for review) with deep penile burn a week after the injury. Debridement, conservative therapy, and deferred reconstruction due to extensive lymphoedema were performed. Due to numerous small, contracted skin scars of penile corpus arising from multiple healed burns caused by self-mutilation by repeatedly using an electrothermal sexual device, the penile defect reconstruction was performed. A local ventral foreskin skin flap in combination with a full split-thickness graft was done in order to avoid extensive scar contracture with possible penile deviation.

Results

There were no complications in postoperative care in the follow-up period of 26 months, with satisfactory aesthetical and functional results.

Conclusion

In the case of penile wounds, the reconstruction technique depends on the injury's size, depth and localisation of the damage.

The most recognised role of vitamin D in the body is for calcium absorption, and sufficiency is defined as a vitamin D blood serum level greater than 20 ng/mL (50 nmol/L). In growing children, hypovitaminosis D is associated with bone and muscle weakness, fractures, and osteoporosis. Burns patients are at a greater risk of low vitamin D levels due to lack of ultraviolet rays reaching the skin during prolonged hospital admission and sun avoidance post-burn injury. This study aimed to identify any individual, seasonal or burn injury characteristics in paediatric patients that were associated with low total vitamin D levels. Three different vitamin D metabolites were analysed to identify if, and where, in the synthesis pathway any insufficiencies may be occurring. Liquid Chromatography Mass Spectrometry (LCMS) was used to concurrently assess vitamin D3 (25OHD3 or Calcifediol), its epimer (3epi-25(OH)D3), and its precursor Pre Vitamin D3 (Cholecalciferol), in the plasma from 193 Australian paediatric burn patients, compared to 46 healthy controls. The results indicated that 61 % of healthy controls and up to 76 % of all burn patients had below normal clinical ranges of Total 25OHD3 (25(OH)D3 + 3epi-25(OH)D3). However, there were no significant differences between patient groups (control, acute, scarring, and reconstructive). The season of sample collection contributed significantly to total vitamin D levels but patients who were undergoing reconstructive surgery 1–17 years post-burn had consistently low vitamin D levels across all seasons. Routine screening, dietary monitoring, and potential supplementation of vitamin D in the burns population is recommended as it may impact recovery, growth and development of the child post-burn.

Background

Surgical debridement and split thickness graft is the most common treatment for acute burn patients that require surgery. However, there is a relevant minority that will require more complex reconstructive options. Microsurgery has evolved as a valuable tool in the acute setting allowing early closure of complex wounds in order to avoid infection, maintain function and even for limb salvage in one stage reconstruction. We present our experience in the management of severely acute burned patients with free flaps, flap survival rate and complications in Chile’s National Health service.

Method

We performed a retrospective analysis of all major burn patients admitted in our unit who received a microsurgical flap in the period between april 2019 and march 2023. Data was collected on patient sex, age, mechanism of injury, total burned surface area (TBSA), location of the defect, days to reconstruction, flaps used, operatory time, flap survival and complications.

Results

In the study period we had 925 admissions. A total of 36 patients had 42 free flaps (5,1%). All but two patients were male (95 %), mean age 46 years (range 20–––76 years). Total body surface area burned averaged 14 % (range 1–64 %). The majority of injuries were caused by high voltage electricity (59 %) and fire (33 %). 59 % compromised lower limbs and 31 % upper limbs. In 81 % of the cases anterolateral thigh flaps were used. Mean time to reconstruction was 39 days(range 1–64 days), we had 9 complications (21 %) and only one flap was lost (2,9%).

Discussion

The introduction of free flaps in the burn reconstruction field was first described in sequelae management. In the acute phase it has also proven to be safe and feasible with a surgical indication of 1,5% to 2% of the admissions in different series. In our unit, 5,1% of our admissions required it, with a low flap loss rate. The increased confidence for its use in the acutely burned setting allowed us to achieve complex coverage while maintaining surgical risk and an internationally acceptable rate of losses and complications. Free flaps cpnstitute an active approach in the classical treatment of this pathology pushing the boundaries in the local environment.

Extensive burns around the anus cause scarring and contracture, leading to difficulty in defecation due to anal stenosis and restriction of hip joint movement, which causes suffering to the patient. Conventional Z-plasty is not effective for widespread zonular scar contracture, and methods such as double combined Z-plasty and reversed Z-plasty have been developed. However, these methods are difficult to use because the position of the anus is displaced when the flap is moved.

The purpose of this study was to introduce a new technique to effectively release contracture in wide scars using tetra-combined Z-plasty, which has the following characteristics: 1. There is no deviation of the anus. 2. It prevents anal restenosis. 3. The funnel-shaped three-dimensional structure can be reconstructed.

These characteristics suggest that tetra-combined Z-plasty is also well-suited for the release of scar contracture in a wide range of skin landmark organs, including the perineum, penis, umbilicus, nipples, stoma, and tracheostomy.

Background

Pre-clinical studies suggest that non-steroidal anti-inflammatory therapy may reduce acute inflammation and modulate scar formation after burn injury. The objective of this trial was to determine if celecoxib administered soon after acute burn improved scar quality.

Methods

A single centre, parallel group, placebo-controlled, randomised, superiority trial. Adults with non-major acute burn injury were eligible for recruitment. Participants within 48 h of admission for acute burn injury received either six weeks of celecoxib 200 mg twice daily or identically packaged placebo capsules. The primary outcome was participant-reported Patient Observer Scar Assessment Scale (POSAS) at day 42 following burn injury. The best possible score using this assessment is 7 and the worst 70. Key safety outcomes included study drug side effects.

Results

Restrictions imposed during the COVID-19 pandemic resulted in slow recruitment and early termination after 59 of the 150 planned participants were enrolled. The primary outcome was available for 21/30 (70 %) participants in the celecoxib arm and for 23/29 (79 %) who received placebo. There was no significant difference in the primary outcome between treatment groups with a mean POSAS of 33.4 (standard deviation 12.7) in the celecoxib arm and 36.9 (13.7) in the control arm giving a difference of −3.49 (95 % CI [-11.57, 4.59], p =.39). Gastrointestinal symptoms occurred in 3/30 (10 %) allocated celecoxib and in none allocated placebo. Secondary outcomes including graft loss and delayed healing were similar between groups.

Conclusions

Anti-inflammatory therapy did not improve scar quality. Due to early trial termination and significant loss to follow up these findings should be interpreted cautiously. To improve generalisability and to attain recruitment targets, future trials should apply different approaches to improve participant retention as well as including patients with larger burn injuries and an older population.

Trial registration: ACTRN12618000732280.

Chemical burns rank among the most hazardous and severe types of burns due to their potential to inflict considerable tissue damage, resulting in pain, inflammation, necrosis, and scarring. This report details a case of burn injury that necessitated the reconstruction of a defect in the hallux. The reconstruction was performed using an Acellular Dermal Matrix (MatriDerm® MedSkin Solution by Dr. Suwelack AG, Billerbeck, Germany). This intervention became necessary after the patient was erroneously administered Nitric Acid intramuscularly at a different institution. The patient presented with a third degree burn that compromised the medial aspect of the hallux’s skin, the distal phalanx and nail bed. Early debridement was performed, and Negative Pressure Wound Therapy (NPWT VAC, 3 M, US) was used to preserve and promote tissue viability. Eight days later, the patient was taken to the OR, and Acellular Dermal Matrix and split-thickness skin graft were used to reconstruct her right hallux’s defect. The patient achieved adequate clinical evolution and was discharged with complete reconstruction of the burned area. Acellular Dermal Matrix proved to be an important and viable option for reconstructive surgery after a chemical burn, and further studies are warranted to ensure its routine usage in this kind of lesions.

Phenol, a corrosive aromatic compound, is used in many polymers and plastics for industrial purposes. It has previously been used as an antiseptic agent. Phenol burns are partially thick and may cause skin hyperpigmentation. Surgical intervention, including debridement, is often unnecessary. We report the case of a resin industrial worker who sustained phenol burns in both lower extremities due to a work accident. The estimated total surface area (TBSA) was 11 %. His wound showed signs of epithelialization 7 days after the burn injury without debridement or skin grafting, with daily water irrigation and dressing alone. The patient was discharged from the hospital on day 23 after the accident with no residual organ damage or functional impairment. A conservative approach to phenol burns would be of great benefit to patients in terms of functional prognosis.

The COVID-19 pandemic has exacerbated the significance of burn injuries as a critical public health challenge, demanding the exploration of effective strategies for prevention and care, particularly for individuals with burns. This retrospective observational cohort study aimed to analyze the characteristics of adult burn patients admitted to three reference centers in Iran from October 2020 to October 2023. The study focused on patients and burn wound characteristics, complications and morbidities, and treatment plans. Among the 382 patients aged 20 to 84, our findings suggested that being male decreased the likelihood of COVID-19 infection by about 77 %. Thermal burns accounted for 50.2 % of COVID-19-positive patients and 49.8 % of COVID-19-negative patients. Notably, the risk of COVID-19 infection increased with higher degrees of burn (p = 0.006) in both groups. Among the complications, pneumonia (p = 0.003) and paralytic ileus (p = 0.015) were significantly more common in COVID-19-positive patients. Additionally, COVID-19-positive patients underwent more frequent interventions such as skin grafting (p = 0.035) and surgical debridement (p = 0.030). These findings emphasize the importance of a carefully planned and proactive multidisciplinary management strategy to ensure optimal care for burn patients.