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

Introduction

Facial burn injuries have a profound impact on patients’ lives due to the significant alterations in physical appearance. Recent advancements in medical technology aim to improve the healing process while minimizing scar formation. This study investigates the clinical outcomes of treating superficial to partial-thickness facial burns with a nanofibrous temporary epidermal matrix over a 12-month period, encompassing objective and subjective scar assessments.

Methods

A prospective cohort analysis was conducted involving ten patients with facial burns. The study assessed re-epithelialization time, complications, and long-term objective scar outcomes at the 8-month and 12-month marks.

Results

The study revealed a notable mean re-epithelialization time of 12.1 days (Standard Deviation: 3.78) without any complications. At the 8-month assessment, there were no discernible differences in objective scar outcomes between treated and intact areas. After a 12-month follow-up, a subtle reduction in skin quality was observed, which lacked clinical significance.

Conclusion

These findings emphasize the potential of nanofibrous temporary epidermal matrices as patient-friendly dressings for managing second-degree to partial-thickness facial burns. Their ability to address facial burns without increasing patient discomfort suggests the potential for a less traumatic healing experience, ultimately enhancing overall patient recovery.

Improvements in the mortality rate for burn injuries has led to an increase in the number of major burn survivors. Burn injuries pose significant physical and psychological consequences that impact the quality of life of burn survivors. The current study assessed the quality of life of major burn survivors in Saudi Arabia using the Burn Specific Health Scale-Brief (Arabic version). A total of 48 major burn survivors completed a validated online survey. Additional data, including demographics, burn injury characteristics, and treatment strategies, were collected from electronic health records. The mean extent of the patients’ burn injuries was 32 % of total body surface area. The average number of surgical interventions was four (ranging between two to 15 procedures). Over 40 % of the patients experience significant difficulties in performing their jobs. About 94 % are bothered by the appearance of their burn scars. Exposure to sun and hot weather remains a significant burden for the majority. The mean scale score was 99 out of 148. The number of surgical interventions was found to be related to a lower quality of life score (p-value = 0.02). Gender, age, and total body surface area had no predictive value for lower quality of life after burn injury. Even several years after sustaining burn injuries, burn patients continue to exhibit long-term complications and limitations in their functional status and daily living. Furthermore, the number of surgical interventions burn survivors have undergone is a negative predictor for their quality of life.

Post burn contracture usually need interference mostly for functional or cosmetic correction. Release and skin graft is the first option in the reconstructive ladder; it has its drawbacks either re-contracture or pigmentation of the graft. Release and flap coverage when available is the best. Free flaps, at a time, was the best and last option in the reconstructive ladder. Still, it is the most expensive surgery that consumes a long time for flap raising, anastomosis of its vessels, in addition to donner site morbidity, the need for stages of defatening and the possibility of failure.

Local flaps if available is the easiest technique for all plastic surgeons even the beginners. Back to basic: advancement, transposition and rotation flap are easy for any plastic surgeon. Linear scaring or contracture usually can be corrected by Z plasty or multiple Z if long. Sometimes double opposing Z plasties (5 flaps release) is used if one side of the line is healthy and the other is scared.

Z plasty and its varieties are not enough to correct very broad band contracture since its release usually develops large defect. In that case even the free flap alone is not enough; split skin graft is mandatory to complete the defect coverage.

Our technique is only for band contracture that neither very broad nor linear, and is surrounded by healthy skin, that technique is double opposing 5 flap (DO5F) release.

Background

Burn injuries can cause multiple burn-induced coagulopathies. Viscoelastic haemostatic tests received increasing attention in coagulation monitoring as a tool to evaluate the haemostatic function of whole blood. Their exact role in burn patients remains unclear. We wondered whether the results of viscoelastic haemostatic tests are correlated with patient outcome. We present a case report as well as the results of a literature review of studies addressing the relationship of viscoelastic haemostatic tests and patient outcome.

Case

We report the case of a 77 year old patient who had suffered flame burns to the chest, abdomen, neck and upper arms accounting for 16 % of the body surface area. One week after burn the patient underwent extensive burn surgery. Repeated perioperative viscoelastic coagulation testing with rotational thromboelastometry showed rapidly changing haemostatic states ranging from hyper- to hypocoagulability. Despite prophylactic use of anticoagulation, the patient developed pulmonary embolism on the second postoperative day. This case highlights the importance of close haemostatic monitoring of patients with burn-induced coagulopathies.

Principal results

We identified four studies addressing the relationship between viscoelastic tests and outcome in burn patients, two prospective observational studies and two retrospective cohort studies. Two studies generated prediction models identifying predictors of mortality or complications. Maximum amplitude during viscoelastic testing was found to be an independent outcome predictor in both prediction models. Two other studies suggest that fibrinolysis at 30 min during viscoelastic testing was associated with mortality.

Conclusions

Haemostatic management of patients with burn-induced coagulopathies remains challenging. We suggest that viscoelastic haemostatic tests can help to guide clinical decisions. Specific markers, such as maximal strength of the clot and lysis at 30 min after the time of maximal clot strength have been associated with increased mortality. Future research should explore the exact role of viscoelastic haemostatic testing in burn patients.

Introduction

Laryngotracheal stenosis after inhalation injury can occur not only in the acute period but also in the late period. Stenosis usually develops in only one area and, in some cases, may require intubation or tracheostomy. However, selecting the treatment for extensive laryngotracheal stenosis in patients with severe mental retardation may be difficult.

Case presentation

A 20-year-old man with severe intellectual disabilities was admitted to our emergency department with burns on the face and lower limbs. Severe inhalation injury was suspected; therefore, intubation was performed. The patient was extubated on day 14; however, extensive laryngeal stenosis from the supraglottic area to the cricothyroid ligament area developed on day 37, resulting in carbon dioxide narcosis requiring cricothyrotomy. We believed that the risk of re-stenosis was high, and his mental retardation would make postoperative management difficult; therefore, we selected conservative therapy. Extensive stenosis persisted over 2 years after injury with a tracheostomy tube.

Conclusion

Given the risk of re-stenosis, conservative therapy or laryngotracheal reconstruction is preferred for the treatment of extensive laryngotracheal stenosis after inhalation injury. Conservative therapy is advisable when patients cannot comply with the rest required for the treatment.

Large surface full-thickness burns pose a significant clinical challenge to the burn surgeon. Integra® dermal matrix has now been commercially available for more than 3 decades. Over this time, its role continues to evolve, and it remains an important tool in the hands of a burn surgeon. Integra® is now being successfully used in acute burn injury, chronic wounds, and reconstructive surgery. Successful outcomes, however, are predicated on a multitude of factors. This overview serves to provide a history of the device, review data and lessons learned, and provide an algorithm for success based on the experience of the authors.

Introduction

Major burns and the intensive care required induce numerous physiologic changes and stress responses that impact recovery for months after hospital discharge. Little is known about sleep quantity and quality after index hospitalization discharge. We report on actigraphy and sleep outcome data from subjects enrolled in a prospective trial of home-based virtual rehabilitation (HBVR) after burn injury.

Methods

We conducted a randomized controlled trial of a HBVR program over 12 weeks after index hospitalization. In both HBVR and control (usual care) groups, subjects were provided a wrist actigraphy accelerometer device (Garmin vívofit®) to wear. Sleep data were retrieved remotely and analyzed. Actigraphy data were defined a priori as complete if subjects had 5 out of 7 days of actigraphy wear in a week. Average weekly sleep was calculated and reported by group assignment. Sleep-relevant and fatigue outcomes were measured by PROMIS questionnaires at randomization (discharge + 0–30 days), 12-weeks, and 12-months. Descriptive statistics were used for comparisons and linear mixed effect model were used to evaluate trends in PROMIS T-scores between groups.

Results

Fifty subjects were enrolled and 48 had complete sleep data. Mean age was 38 ± 14 years and mean burn size was 16 ± 13 % TBSA with a majority of subjects male (71 %). Average sleep duration was within general population norms, with little difference between subjects in the intervention and controls groups in the 12 weeks after study randomization (7.3 vs.7.2 h respectively, p = 0.25). Subjects in control group spent more time in light sleep (4.1 vs. 3.9 h, p < 0.01) and experienced a higher proportion of nights with sleep disturbances (0.75 vs. 0.70, p = 0.006). Thirty-two subjects (66 %) completed PROMIS questionnaires at both time of randomization and following the 12-week intervention period. Average PROMIS sleep disturbance T-scores were not significantly different at 3-months. The control group had significant improvement in average PROMIS T-scores at 3-months compared to the HBVR group (p = 0.015). PROMIS scores trended towards improvement over the 12-month study period for both groups.

Conclusions

Actigraphy data complement self-reported sleep data among burn-injured adults after hospital discharge. People with burn injury had mildly increased sleep disturbance, sleep impairment, and fatigue after hospital discharge but trended toward population norms over time.

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.