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

Purpose

Burns are among the top five cause of unintentional injuries among youth. We aimed to determine the incidence and risk factors of burns in select youth from Pakistan and also explored their perceptions about burns.

Methods

A sequential explanatory mixed methods study was conducted which comprised of two phases. Phase 1 consisted of a cross-sectional quantitative survey (QUAN) in which 550 vocational school youth (15 to 24 years-olds) filled out the WHO community survey tool for injuries and violence and provided data on burns in previous 12 months (2021–22). Phase 2 consisted of qualitative (QUAL), in-depth interviews (IDIs) with participants selected from Phase 1 based on the occurrence of burns. STATA™ version 15.1 was used for Phase 1 data analysis and Zero-Inflated Negative Binomial regression was used for determining the Incidence Rate Ratio (IRR) of burns. Thematic analysis was performed for in-depth interviews from Phase 2.

Results

Out of 547 participants, 356 (65%) were males while 191 (35%) were females. Burns were reported by 85 participants (15%). A total of 137 counts of burns were reported showing multiple burns by some participants. The IRR for burns among young females was 2.89 (1.78–4.69) compared to males in the previous 12 months (2021–22). Age, sex, father’s education, and combined family income were significant risk factors for burns in youth. Six IDIs were conducted with burn victims, two were males while six were females. Four cooking-related burns, and two occupational burns during vocational training were reported. Themes that emerged from IDIs were internal and external factors, personal carelessness and lack of knowledge and safety about burns. Two sub-themes that were significant for recovery from burns were family support and access to healthcare.

Conclusion

Young females are at a higher risk of burn injuries in Pakistan. Various social, demographic, and behavioral risk factors are associated with burns. Pre-burn and post-burn interventions are needed for prevention from burns in youth.

Determining the size of a burn injury is a critical metric in the care of the burn patient. Several long-standing methods exist to estimate burn size to include the Rule of Nines, Lund-Browder Chart, and Palmar method; all of which remain in clinical use today. Development and use of these metrics first began in the late 1800s. Understanding these clinical tools and others, with an appreciation of their development, limitations, and utility, is important for the competent burn care clinician today. This review provides an evolutional history for these metrics and use in clinical practice.

Cultured epidermal autograft (CEA) is a permanent skin replacement indicated for use in adult and pediatric patients with deep dermal or full thickness burns comprising a total body surface area (TBSA) ≥ 30 %. CEA (Epicel®) was approved for use in adults in the United States in 2007 as a Humanitarian Use Device (HUD) under a Humanitarian Device Exemption (HDE) and was approved for pediatric use in 2016. In 2019, a CEA Registry was established with an objective of prospective data collection and analysis of demographic, treatment, and outcome data for the real-world use of CEA. At the time of data cut–off (June 2022), 68 patients (50 adults and 18 children) had completed data in the registry, up through hospital discharge, for this analysis. Mean total body surface area (TBSA) of the burn was 58 % in adults and 56 % in pediatric patients, and almost half had inhalation injury in each group. Approximately 74 % of adults and 67 % of pediatric patients had TBSA ≥ 50 %. Overall survival was 87 % (84 % adults, 94 % pediatric). Mean % graft take (engraftment) of CEA was 81 % in adults and 84 % in pediatric patients. Outcomes from this prospective collection of data in severely burned patients treated with CEA demonstrate favorable engraftment and survival rates and are in general agreement with recent literature.

Introduction

The neck is especially liable to severe contractures following burns, especially in developing countries. Severe neck contractures are functionally devastating as they can also result in respiratory compromise and intubation difficulties. In this study, we examine out experience with neck contractures over a period from January 2019 through July 2022 in Ain Shams University burn unit, which receives referrals from all over Egypt, most of which are challenging due to late presentation.

Methods

We prospectively evaluated 70 patients with post-burn neck contracture, and surgically managed them according to Makboul and El-Oteify’s classification of neck contractures. Interventions for release included use of skin grafts, local flaps, tissue expansion and free tissue transfer. Recurrence was also correlated to method on release.

Conclusion

The most common grade of contracture was moderate (n=34). Broad scars comprised the most common pattern of scar (n=32). Recurrence of neck contracture increased with release by skin grafts (28.6%).

Background

Burn injuries, which affect two layers of the skin, are commonly quantified as a percentage of the total body surface area involved (%TBSA). Acute Kidney Injury (AKI) represents a rapid and typically reversible decrease in kidney function, as indicated by the glomerular filtration rate (GFR). In the context of burn injuries, AKI can be categorized as either early or late onset, each having distinct causes. Neglecting to identify and manage AKI can significantly impact the prognosis of burn injuries.

Methods

This research was an analytical observational study employing a cross-sectional design and subsequent correlation analysis. Data was collected from medical records during the year 2022. Out of a total of 171 cases, only 71 were suitable for evaluation. The statistical analysis of categorical data involved the use of the chi-square test.

Result

In this study, 62.7 % of male participants had burn injuries with a Total Body Surface Area (%TBSA) greater than 20 %, compared to 64.2 % with %TBSA less than 20 %. The average age for patients with %TBSA greater than 20 % was 37.4 years, while for those with %TBSA less than 20 %, it was 42.5 years. The average body weight for these groups was 64 kg and 65 kg, respectively. In terms of kidney function, patients with %TBSA greater than 20 % had an average creatinine level of 1.41 mg/dL and an estimated Glomerular Filtration Rate (eGFR) of 95.79 mL/min/1.73 m². In contrast, those with %TBSA less than 20 % had average values of 0.86 mg/dL for creatinine and 115.12 mL/min/1.73 m² for eGFR. Regarding Acute Kidney Injury (AKI), 7 % of patients with burn injuries of %TBSA less than 20 % suffered from AKI, compared to 53.5 % who did not. Among patients with %TBSA greater than 20 %, 25.4 % experienced AKI, while 14.1 % did not.

Conclusion

The study reveals a significant correlation between the severity of burn injuries and the occurrence of Acute Kidney Injury (AKI). Specifically, patients with burn injuries affecting over 20% of their Total Body Surface Area (TBSA) are 13.6 times more likely to develop AKI compared to those with less extensive burns, covering less than 20% of TBSA.

Introduction

Burns from hot asphalt, although rare, typically occur in workers in the paving industry. Removal of asphalt, while not mandatory, improves patient comfort and allows early assessment of underlying tissue damage. Previous reports have emphasized the use of surface-active agents or butters to remove tar or asphalt from the affected area without causing further damage to the skin.

Case presentation

A 69-year-old man was working as a driver of an asphalt tanker. While working on the side of the tanker, hot asphalt splashed off the roof of the tanker's hood. He sustained burns to his left face, neck, upper and lower extremities, and hands from the hot asphalt. Melted butter was soaked into gauze and applied to asphalt-covered areas of the face, neck, body, upper and lower extremities, and hands. The butter soaked into the gauze emulsified the asphalt, and the asphalt soaked into the gauze was painlessly removed. To remove the asphalt from the fingertips, melted butter was placed in plastic gloves and the hands were dipped into the gloves so that all fingers efficiently touched the melted butter. By doing so, the asphalt on the fingertips was easily emulsified by the butter in the gloves.

Conclusion

The method of removing asphalt stuck to the hands by placing melted butter in gloves and applying the gloves to the hands should be considered as an option.

Introduction

The COVID-19 pandemic resulted in unprecedented changes to healthcare services. Non-emergent, out-patient care was either discontinued, greatly reduced, or switched to telehealth during the first wave of the pandemic. Here, we describe an American Burn Association (ABA) verified Burn Center’s experience with telehealth services during and after the COVID-19 emergency.

Material and methods

In this retrospective study, all patients who underwent out-patient care at a large academic hospital’s ABA Burn Center between March 2018 and March 2023 were identified from the electronic medical record system. Descriptive analysis was carried out to delineate trends in outpatient in-person and telehealth services during the COVID-19 pandemic. The travel distance saved from the introduction of telehealth was determined.

Results

During the study period, 3471 patients underwent a total of 7444 out-patient visits for burn care. There were no telehealth visits prior to the onset of the COVID-19 pandemic. In the first year of the COVID-19 pandemic, 14.9% of all out-patient visits were conducted with telehealth. This decreased to 8.3% and 6.8% of all out-patient care in the second and third years of the pandemic, respectively. The average round trip travel distance saved was 123 miles (2.8–––2312 miles). No complications were reported specific to receiving telehealth care.

Conclusions

Telehealth is a feasible option for out-patient burn care in selected patients and reduces travel for patients. Further studies are needed to assess patient and clinician satisfaction, clinical outcomes, and the economic impact of telehealth utilization to help guide appropriateness of use.

Resourceful surgical planning for coverage of large burns has led to refinement of early innovative procedures including meshed split thickness skin grafts (STSG), MEEK procedure, and use of cultured epidermal autografts (CEAs). The use of STSG remains standard of care for burn wound coverage; however, manual expansion of STSG is limited due to shortcomings with expansion rates greater than 4:1. The MEEK micrografting method is a method of preparing skin grafts with a device instead of manually with an autograft mesher, allowing reliable expansion rates of autografts up to 9:1. Although the CEA indication for use includes both with and without STSG, use of meshed STSG placed under CEA has been reported to minimize shear forces and hasten graft take. The purpose of this study was to evaluate success of graft take in patients receiving MEEK and CEA for wound coverage in extensive burns at a single burn center experienced in the use of both MEEK and CEA. Data in 15 patients who received both MEEK and CEA for the treatment of large burns (mean total body surface area [TBSA] of 66%) demonstrated a high rate of successful engraftment (87%), and an overall 73% survival rate.