European burn journal最新文献

Surgical treatment of burn wounds has had a tremendous impact on burn patients. The survival of patients with massive burns is now very common. Expeditious coverage of the wound has been a major contributor to improved survival, but survival is not enough. There is a need to improve the ultimate functional and cosmetic outcomes of the wound in order to facilitate a patient's return to society. This paper reviews strategies, using fairly basic techniques, to optimize the outcomes of burn patients. While there are many new skin products available, the strategies presented here can apply to any surgeon treating burns throughout the entire world.

We read with interest the recent publication of Dinesen et al. [...].

Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but it offers the potential to overcome the long-term limitations of simpler options. In this paper, we present our experience with microvascular free flaps for the release of burn scar contractures of the neck as a potential high-quality permanent solution. Methods: Over a 10-year period, nine free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFFs) and one ulnar forearm flap were used to release neck contractures. Results: All nine flaps were completed successfully with significant improvement in the neck's range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, five out of nine cases required at least one secondary procedure for flap defatting to reach optimal results. Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries.

Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to date has investigated disparities in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This observational cohort study addresses this gap and examines seven psychosocial outcomes (levels of anger, sadness, depression, anxiety, fatigue, peer relationships, and pain) in pediatric burn patients. The BMS database is a national collection of burn patient outcomes from four centers in the United States. BMS outcomes collected were analyzed using multi-level, linear mixed effects regression modeling to examine associations between race/ethnicity and outcomes at discharge after index hospitalization, and 6- and 12-months post-injury. A total of 275 pediatric patients were included, of which 199 (72.3%) were Hispanic. After burn injury, of which the total body surface area was significantly associated with racial/ethnicity category (p < 0.01), minority patients more often reported higher levels of sadness, fatigue, and pain interference and lower levels of peer relationships compared to Non-Hispanic, White patients, although no significant differences existed. Black patients reported significantly increased sadness at six months (β = 9.31, p = 0.02) compared to discharge. Following burn injury, adult minority patients report significantly worse psychosocial outcomes than non-minority patients. However, these differences are less profound in pediatric populations. Further investigation is needed to understand why this change happens as individuals become adults.

Adequate fluid resuscitation in adults with major burns is crucial to prevent or minimize burn shock, but needs to be balanced against the complications of over-resuscitation. A single-center, retrospective review of 95 ICU patients with severe burns from Jan 2014 to Aug 2021 was performed. Some 52 patients were managed with a liberal targeted fluid goal of 4 mL/kg/%TBSA, and 43 patients were managed after we incorporated a restricted fluid goal of 2 mL/kg/%TBSA into our standard resuscitation strategy. Of the 95 patients included in this analysis, 76 patients (80%) survived admission. The median age was 41 years, and the median TBSA was 36%. All patients received Ringer's lactate as the primary fluid for resuscitation, and 40 of the 95 patients (42%) received colloids as a rescue infusion within 24 h of injury. Some 44 of the 95 patients (46.3%) had a concurrent inhalational injury. The median length of hospital stay was 37 days, and the median ICU length of stay was 18 days. A total of 17 of the 95 patients developed ARDS (17.9%), 51 of the 95 (53.7%) patients developed pneumonia, and 34 of the 95 patients (35.8%) developed AKI within the first 7 days of admission. The median fluid administered during the first day of hospitalization from 2019 onwards remained close to 4 mL/kg/%TBSA, despite transitioning to a 2 mL/kg/%TBSA formula for a 24 h fluid goal (unless there was an electrical burn, in which case the 4 cc/kg formula was utilized). Further exploratory analyses also suggested that under-resuscitation and administration of albumin may be associated with increased mortality, though this did not reach statistical significance. ARDS development was associated with increased age and TBSA as well as increased fluid intake within the first 24 h. A change in the targeted fluid goal from liberal (4 mL/kg/%TBSA) to a restricted (2 mL/kg/%TBSA) formula did not change the actual fluids administered over 24 h when guided by clinical criteria. Our review did suggest that under-resuscitation contributed to mortality, but that excessive fluid resuscitation likely contributed to ARDS risks for large TBSA patients. Our data suggest that strategies to optimize fluid administration are important to improve patient outcomes, but should focus on clinical parameters rather than calculated fluid goals.

Burn survivors, spouses, and parents of children with burns may experience psychological distress for a prolonged period. Mindfulness-Based Stress Reduction (MBSR) is an intervention that can improve psychological well-being. This study aimed to examine the effectiveness of an MBSR group intervention in a convenience sample. An MBSR group intervention was conducted for burn survivors (n = 8) and parents of children with burns (n = 9), each comprising eight sessions. The participants completed the Beck Depression Inventory-II-NL, PTSS Checklist DSM-5, Five Facet Mindfulness Questionnaire-Short Form, Self-Compassion Scale-Short form, and evaluation questions at baseline, immediately after, and three months post-intervention. All participants completed the intervention. The intervention was rated very useful (M = 8.8), and the participants were very satisfied (M = 8.8). The highest effect was observed in the parents' group on mindfulness skills and self-compassion. For both groups, there was an increase in personal goal scores immediately after the intervention. Qualitative data show that the participants in both groups experienced more inner peace, more awareness of thoughts and emotions, and more self-compassion. This exploratory study suggests that a mindfulness intervention is feasible and can be effective in improving mindfulness skills and self-compassion, particularly in parents of children with burns.

Access to burn camps and clubs is cited as an essential element for children following a burn injury. In the Northern Regional Burns Service, this takes the form of a club run by a multidisciplinary team, offering residential camps and family day trips. In this service evaluation, Group Concept Mapping was used to evaluate the perception of the club by staff, children and families. Opportunistic sampling was used to seek responses to the following prompts: "The challenges for children and families after a burn injury are…" and "The role of The Grafters Club is…". The results indicate that participants perceived the club to be effective at addressing body image and confidence issues for the children but highlighted an unmet parental expectation that the club would also facilitate the sharing of experiences, normalisation of emotional reactions, and processing of guilt and other psychological distress for parents. When taken concurrently with pre-existing evidence in the literature base, it is proposed that a club model of psychosocial support for children and families could provide an accessible and informal opportunity for parental support that may be less subject to barriers perceived with traditional formal psychological support.

National Burns Care Standards (NBCS) within the UK recommend psychological care throughout the burn pathway and psychosocial screening of inpatients admitted for over 24 h, at a time when this is clinically appropriate and prior to discharge. This brief report presents preliminary data from an audit of psychosocial screening in adult burns inpatients within a Scottish Burns Unit over a three-year period. Results are reported on the frequency and type of psychosocial screening completed. Differences between the groups of inpatients who were screened and those not screened are presented and discussed with a focus on plans for increasing the number of inpatients screened and improvements in how psychosocial screening data is collected.

Ethnic inequalities exist across healthcare, including access to and experiences and outcomes of mental health services. Access to and engagement with burns clinical psychology services is essential for all patients. This study aimed to explore the ethnic diversity of adults referred to a burns clinical psychology service compared to those admitted to the burns service. It also aimed to investigate associations between ethnicity and indicators of access and engagement (receiving, declining or not attending psychological assessments, receiving psychological therapy and the number of therapy sessions completed). Routinely collected data over eight years were analysed. Analysis revealed an association between ethnicity and referral to the burns clinical psychology service. Patients from White British and Other ethnic backgrounds were less likely to be referred, whereas patients from Black and Asian ethnic groups were more likely to be referred. There were no statistically significant associations between ethnicity and receiving, declining or not attending psychological assessments or receiving psychological therapy. Furthermore, there was no statistically significant difference in the number of psychological therapy sessions received between the ethnic groups. Therefore, patients from ethnic minority groups did not appear to have significant difficulties engaging with the service but further research is recommended.

While thermal injuries to the external genitalia occur less often than burns to the trunk and extremities, such injuries can potentially leave patients with devastating lifelong sequelae. Though much is known about treating burns in commonly exposed areas of the body, there is a lack of agreement concerning the management of genital thermal injuries. In this review, we seek to synthesize the past and existing literature into a clear analysis while reviewing current recommendations and new developments in the management of genital thermal injuries of the penis and scrotum. Specifically, recommendations for managing genital burns are discussed, including the role of urinary and fecal diversion, debridement, use of skin grafts, and flap coverage choice. Finally, less common thermal injuries, such as frostbite of the genitalia, are discussed.