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

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.

The cooling rate of the running water on the burn wound depends on both physiological and water parameters. Prolonged use of cold water on the burn wound may cause hypothermia. We aimed to investigate the running water as first aid for burns and find out the cooling effect of bio-heat transfer to avoid hypothermia. Measuring the temperature variation across the tissue layers is the main limitation of working with in vivo experiments and a one-dimensional model. Moreover, multiple boundary conditions cannot be used in one-dimensional models. These limitations motivate us to develop ADVENTURE Thermal to perform a finite element analysis of the bio-heat equation in the 3D skin model for the burn analysis. A circular wound was developed on a 3-layered skin with a hot disk of 92 °C for 15 s. Then the wound area was cooled with the running water, which had different parameters. Running water at 15 °C takes 20–30 % less time than being immersed in water at the same temperature. Results reveal that cooling rates of burns significantly depend on the temperature and heat transfer coefficient of the water. To avoid hypothermia, the use of the running water with a heat transfer coefficient ranging from 800 to 1000 W/m² °C (flow rate around 1.6 L/min) and temperature ranging from 15 to 20 °C for not more than 10 min is recommended. In the end, the running water cools the tissue with a small blood perfusion rate faster. The results agree with the experiment.

The perioperative maintenance of a patient’s core temperature is a challenge during burn care. While patient warming devices are sometimes used to prevent intraoperative hypothermia, raising the ambient temperature of the theatre is the most common practice. Theatre temperature can impact on the performance and comfort of surgery staff but standards for theatre temperatures in burn care are poorly defined. Therefore, in this study we investigated the current, global, clinical practices in burn care with respect to the ambient temperature of theatres that are used to treat severe burn injuries. An internet-based, descriptive, Qualtrics^XM survey was distributed electronically to 81 burn professionals to identify the temperatures at which the surgical teams operate on severe burn injuries. The survey was completed by 33 participants from 15 countries and revealed that there is a wide range of temperatures (24–45°C) at which burn injuries are treated. The prevention of hypothermia was the clinical justification most reported for those theatre temperatures. Temperatures between 26 and 30°C appear to be most comfortable for the staff. One respondent mentioned that surgeries are often limited to 5 h to avoid hypothermia in patients, however, others noted surgery durations of up to 8–12 h in raised temperatures, which may impact the physiology and performance of the team, potentially impacting the safety of the patients. The adoption of an optimal theatre temperature to address the surgical team’s comfort levels, their performance, and patient hypothermia, may improve outcomes in cases of severe burn injury.

Introduction

Surgical luminance (also known as operative lighting) allows for adequate visualisation of the operative field, a necessity for delivering safe surgery. Light-emitting diode (LED) surgical luminance systems are widely used in modern medicine.

We present a case of a 59-year-old male patient who sustained an iatrogenic burn from operative lights during an emergency vascular bypass revision procedure. According to the author's literature review, this is the first documented case of a burn of this nature to be reported in the United Kingdom.

Aim/Purpose of the report

This report highlights an unusual mechanism of sustaining a cutaneous burn intra-operatively by LED lighting. We aim to highlight a potential safety hazard related to using standard operative lighting equipment.

Methods

We present a thorough review of the patient's progression from the point of injury to definitive treatment, including follow-up.

Discussion

In this case report, we conclude that the surgical operative lights caused the burn. The burn was a mixed depth, deep-dermal and partial-thickness burn in the suprapubic area that was exposed to the operative lights. This required surgical excision and reconstruction with a split-thickness skin graft which healed well with 100% graft take.

Conclusion

Operating lights, although regarded safe, have the potential to cause significant cutaneous injury. Increased awareness and education are required to ensure safe practices.

Objective

Scalding and flame burns come first in the etiology of pediatric burns. Today, with the increase in internet use, the effect of social media on the etiology of burns is also seen. When the story of some children who applied for burns was questioned recently, it was observed that the children were affected by various images, videos, and duels on social media. They wanted to try what they saw with a sense of curiosity. This study aims to draw attention to child burns caused by social media's effects and raise awareness about their preventability.

Methods

Children who stated that they got burned because of watching social media in our burn center within one year were included in the study retrospectively. Children's age, gender, burning pattern, and graft needs were evaluated.

Results

In one year, eight patients (three girls and five boys) were admitted to the hospital with the complaint of burns caused by the effect of social media. All of them were flame burns. The ages of these patients were between 6 and 12 years, and their burn percentage was between 1 and 12. Grafts were performed in 4 patients. Three recovered with dressings after debridement, and one improved during outpatient follow-up. The hospitalization period of 7 patients who received inpatient treatment was recorded to be between 1 and 15 days.

Conclusions

Children's access to the Internet at an early age and unsupervised exposes them to many dangers, including burns. These burns can have serious consequences, such as hospitalization and graft needs. Steps should be taken to recognize and prevent the threat of social media. The study was presented as an oral presentation at the 39th National Congress of Pediatric Surgery held in İzmir/Kuşadası/Türkiye on 2–5 November 2022.

Introduction

Burn is skin and tissue damage caused by various agents such as fire, scalds, electricity, chemicals, or radiation injuries. Globally, burn injuries pose a substantial public health challenge, with a high risk of mortality and morbidity, accounting for over 310,000 annual deaths. Nearly 75 % of burns in young children result from scald burns and infants have the highest mortality rates. Factors such as large surface area of burn, inhalational injury, poverty, and the presence of sepsis contribute significantly to mortality and morbidity in burns.

Objective

To assess the pattern of presentation of pediatric burn injuries and their management outcomes.

Methods

A hospital-based retrospective cross-sectional study was conducted. Data were extracted from patient charts, cleaned, coded, checked for completeness, and entered into SPSS version 25 for analysis. Descriptive statistics and logistic regression were used for data analysis, and graphical presentations were utilized to present the result findings.

Results

Among the 218 paediatric burn patients admitted to the Addis Ababa Burn, Emergency and Trauma Hospital’s burn unit, 71.1 % had sustained scald burns due to hot water splashes, while 20.2 % of the patients were admitted due to flame burns. Superficial partial thickness burns occurred in 53.6 % of the patients, with the upper extremity and trunk being the most commonly affected sites. Approximately 38.2 % of the patients developed acute complications, with sepsis of the wound focus being the most common. Chronic complications occurred in 30.7 % of patients, primarily in the form of post-burn contractures. A mortality rate of 3.2 % was observed during the admission period with 2.3 % of deaths occurring in children under 5 years and those with major burns.

Conclusion & Recommendation

The primary causes of burns in the pediatric age group are predominantly preventable scalds. Children, especially when unsupervised at home, particularly in kitchens, demand meticulous attention and care to mitigate the risk of burn injuries.

Keloids are differentiated from hypertrophic scars by their invasive lateral growth vs. the expansive growth of hypertrophic scars. This case report demonstrates the dynamic nature of keloids and the importance of clinical follow-up on its natural progression over time, especially when differentiation from hypertrophic scars is difficult. Serial photographic documentation is an invaluable aid for follow-up evaluation.

The purpose of this study was to report our experience caring for burn patients with femur fractures and to compare outcomes of fractures treated with internal fixation within and after 48 h of injury. Twenty femur fractures were identified in the 17 burn patients. Two patients died prior to definitive fixation of their fractures. Of the fractures fixed internally within 48 h, 60% (6 out of 10) of fractures went on to predicted union and 44% of patients had systemic complications. Of the fractures treated after 48 h, only 25% (2 out of 8) went onto predicted union and all patients had significant systemic complications. To our knowledge, this is the largest series of femur fractures in burn patients reported, and in this series early internal fixation was associated with more favorable outcomes.

Purpose

Burns are considered as serious health problem in low-income country. They lead to patients’ morbidity and mortality beside their burden on the health care system. This study was conducted to review the clinical presentation and management outcome in a secondary referral hospital in Sudan (sub-Saharan country).

Methods

This is a retrospective hospital-based cohort study. It was conducted during 2019–2021. Data was collected to determine socio-demographic characteristics of patients, site of burns, cause of burn and management outcome. Any patient presented with burns during the study periods was enrolled in the study area.

Results

Total number of surgical emergency admitted during the study periods were 8126. Total number of patients who are included in this study were 133 with male predominant (53 %). Seventy-two of them are below age of 10 years. Half of the patients (53 %) presented with scalding burn. Only, 36 % of them presented to the emergency department during the first 12 h. Seventy eight percentage of them were treated and discharged while 6 % of them died. Open wound dressing was done for 84 % of patients while skin graft was done in 12 % of patients.

Conclusion

This study demonstrates the situation in a low-income setting with higher prevalence among children. There are challenges and difficulty in managing burn patients.