European burn journal最新文献

Silver foam dressings have been extensively used in the management of burn injuries; however, its application in children requires elucidation. A literature search was conducted from database inception to October 2023. Eligible studies reported paediatrics patients under 21 years of age receiving silver dressings for burns or scalds. This review was registered prospectively with PROSPERO (CRD42023470239). 18 studies met the inclusion criteria with a total of 701 patients. The pooled mean time to re-epithelisation (TTRE) was 12.9 days (95% CI: 11.2, 14.6, I² = 94%). The pooled mean duration of hospitalisation was 9.8 days (95% CI: 3.9, 15.7; I² = 100%). Mean number of total dressing changes per patient was 3.6 (95% CI: 2.2, 4.9; I² = 99%). There were a total of 98 complications, including 30 (30.6%) infections, 29 (29.6%) surgical requirements, 14 (14.3%) hypertrophic scarring, 17 (17.3%) escalations of care, 5 (5.1%) burn depth progression, and 3 (3.1%) others. Silver foam dressings appear as a safe and effective approach in terms of healing rate and dressing change frequency for selected paediatric patients with burn injuries. Despite the promising results, further comparative studies are required to evaluate the selection criteria and long-term effect of silver foam dressing.

Patients who have been injured by burns often suffer from persistent and debilitating post burn pruritus. Despite a myriad of therapeutic interventions and medications, this complex condition remains particularly difficult to ameliorate. Recently, a new generation of antipruritic medications has demonstrated clinical success in managing pruritus in a number of dermatologic, nephritic and hepatic disease states, targeting unique aspects of the pruritic pathways. While specific trials demonstrating efficacy and safety are currently lacking, the purported mechanisms of action and similarities to the targeted inflammatory markers, pruritogens and neural pathways of these new medications, in concert with clinical evidence, hold promise for burn patients.

Surgical site infections (SSIs) are a significant challenge in postoperative care, leading to increased morbidity, extended hospital stays, and elevated healthcare costs. Traditional antimicrobial dressings, such as those containing silver or iodine, have limitations, including cytotoxicity and the potential for antimicrobial resistance. Dialkylcarbamoyl chloride (DACC)-impregnated dressings offer a novel approach, employing a physical mechanism to bind and remove bacteria without the use of chemical agents, thereby reducing the risk of resistance. This review summarizes current evidence on the efficacy of DACC dressings in preventing SSIs and promoting wound healing. Findings from multiple studies indicate that DACC dressings reduce bacterial burden and SSI rates across various surgical procedures, including cesarean sections and vascular surgeries. Additionally, DACC dressings demonstrate potential in managing hard-to-heal wounds, such as diabetic foot ulcers, by reducing bacterial load and biofilm formation. Furthermore, they present advantages in antimicrobial stewardship and cost-effectiveness by minimizing the need for antibiotics and decreasing overall healthcare expenses. However, the current literature is limited by small sample sizes, methodological weaknesses, heterogeneity in study designs, and a lack of long-term data. Future research should focus on high-quality randomized controlled trials across diverse surgical populations, comprehensive cost-effectiveness analyses, and long-term outcomes to establish the full clinical impact of DACC dressings. With further validation, DACC-impregnated dressings could become a critical tool in sustainable postoperative wound care.

Background: Burn injuries can require hospitalization, operations, and long-term reconstruction. Burn-injured patients can experience short- or long-term disability. We investigated lost workdays (LWDs), short-term disability (STD), and long-term disability (LTD) in the 12-month period following a burn injury.

Methods: An observational cohort study was conducted using a commercial claims database, IBM^® MarketScan^®. Patients aged ≤65 years with an ICD-10 burn diagnosis from 2018 to 2019 were included. The International Classification of Diseases, 10th Revision (ICD-10), procedure and Current Procedural Terminology (CPT) codes were used to identify patients undergoing burn-related operations. Patients were mapped to data tables for LWDs, STD, and LTD for the 12 months pre- and post-injury. Paired t-tests were employed to compare the pre- and post-injury outcomes.

Results: We identified 1745 patients with burn diagnoses. Of those, 263, 1449, and 1448 patients had data available for LWDs, STD, and LTD, respectively. STD and LTD were reported by 8.1% and 0.0% of patients in the 12-month period pre-injury, respectively, and 20.3% and 1.0% of patients in the 12-month period post-injury, respectively. Average days of STD increased from 3.70 to 9.34 days following injury.

Conclusions: Burn injuries are associated with increased STD and LTD utilization. Quantifying the impact of burn injuries on patients' work will help us understand the economic implications of burns, which is a key area in burn research.

The development of artificial skin that accurately mimics the mechanical properties of human skin is crucial for a wide range of applications, including surgical training for burn injuries, biomechanical testing, and research in sports injuries and ballistics. While traditional materials like gelatin, polydimethylsiloxane (PDMS), and animal skins (such as porcine and bovine skins) have been used for these purposes, they have inherent limitations in replicating the intricate properties of human skin. In this work, we conducted uniaxial tensile tests on freshly obtained cadaveric skin to analyze its mechanical properties under various loading conditions. The stress-strain data obtained from these tests were then replicated using advanced skin simulants. These skin simulants were specifically formulated using a cost-effective and moldable multi-part silicone-based polymer. This material was chosen for its ability to accurately replicate the mechanical behavior of human skin while also addressing ethical considerations and biosafety concerns. In addition, the non-linear mechanical behavior of the developed skin simulants was characterized using three different hyperelastic curve-fit models (i.e., Neo-Hookean, Mooney-Rivlin, and Yeoh models). Moreover, these innovative simulants offer an ethical and practical alternative to cadaveric skin for use in laboratory and clinical settings.

The management of severe burns is a complex process that requires a multidimensional approach to ensure optimal healing of burn wounds, minimize complications, and improve the prognosis of patients. Surgical debridement is considered the gold standard for removing necrotic tissue; however, this approach involves risks such as bleeding, the potential removal of viable tissue during excision, and technical challenges in complex anatomical areas. Recent advancements highlight the role of enzymatic debridement using NexoBrid^®, which offers a less invasive alternative to surgical excision while having the ability to selectively debride necrotic tissue and preserve viable tissue. NexoBrid^® has shown efficacy in reducing debridement time, minimizing the need for additional surgeries, and improving overall wound healing outcomes. This review discusses the clinical indications, advantages, and considerations for choosing between surgical and enzymatic debridement. Emerging studies suggest the potential for enzymatic debridement to be safe and effective even for larger burn areas, making it a promising option in modern burn care. However, ongoing evaluation and integration into clinical protocols will be essential to fully realize its benefits in specialized burn treatment and to establish protocols.

Autologous skin grafts are the gold standard for definitive wound coverage in burn care, but allograft skin grafts are essential for providing temporary coverage in cases of extensive burns. The Helsinki Skin Bank, established in 1995 at the Helsinki Burn Centre, is Finland's only licensed skin bank, serving a population of 5.5 million. It procures human skin allografts from multi-organ donors in the Greater Helsinki area and preserves them using glycerol, a method pioneered by the Euro Skin Bank. Between 2009 and 2020, the Helsinki Skin Bank procured skin from 263 donors and provided allografts to 248 patients, primarily burn victims. Over time, procurement methods have improved significantly, resulting in an increase in the amount of skin harvested per donor. Despite rising costs due to more stringent European Union regulations and the need for round-the-clock operations, the bank has remained cost-effective. The glycerol preservation method ensures microbiological safety and effective storage, with minimal contamination issues. The future may see advances in skin substitutes and stem cell treatments, but for now, allogenic skin remains crucial in burn care due to its availability, ease of use, and cost-efficiency. Running a small, professional skin bank for a single burn center has proven successful and sustainable.

Burn injuries can have long-lasting effects not only on a person's bodily integrity but also on their psychosocial well-being. Since medical advancements have increased survival from burn injuries, improving psychosocial health has become a pivotal goal for burn rehabilitation. Besides health-related quality of life, life satisfaction has become an important parameter for evaluating long-term outcomes after burns. We reviewed life satisfaction after burns among adult burn patients to evaluate the current assessment methods and gain insight into recovery patterns. PubMed, EMBASE, Medline, and Cochrane Library were searched systematically for studies in the English language covering life satisfaction after burns, resulting in the inclusion of 18 studies. The Satisfaction With Life Scale (SWLS) was the most commonly used assessment tool. Others included the Life Satisfaction Index-A (LSI-A) and a non-standardized tool. Most studies' recovery patterns showed a decreased life satisfaction post-burn injury. There was strong agreement that inhalation injury, body dysfunction, an extended hospital stay, and psychological illness before the injury are possible determinants of post-burn life satisfaction and have shown a negative correlation. There seems to be a consistent use of assessment tools, which opens up the possibility of a further comparative investigation to better understand factors that influence life satisfaction after a burn so that this knowledge can be used to improve patients' recovery.

Background: The primary aim of this study was to evaluate the performance of four burn prognostic scores-Abbreviated Burn Severity Index (ABSI), Ryan, Belgium Outcome Burn Injury (BOBI), and revised Baux score (rBaux) in a Croatian burn center. A secondary aim was to compare patient outcomes before and after the organizational and protocol changes.

Methods: A retrospective study and comparison of four prediction scores was conducted over a nine-year period in burn patients with ≥20% total body surface area (TBSA) burned. Additionally, outcomes before and after organizational changes were compared.

Results: A total of 149 patients were included, with the mean patient age of 54.62 ± 19.38 years, the mean of TBSA of 42.98 ± 19.90, and an overall mortality rate of 48.99%. The area under the ROC curve (AUROC) was 0.79 for the rBaux and ABSI score, 0.77 for the BOBI score, and 0.76 for the Ryan score. The duration of mechanical ventilation and length of stay (LOS) in burn intensive care units (BICU) decreased after the organizational changes, though survival rates remained similar.

Conclusions: Prognostic scores are good predictors of mortality but with moderate predictive accuracy. Continuity of care in intensive care could be important for better outcomes.

Background: Diabetic patients often present with complex limb pathology, resulting in impaired sensation in the distal extremities making tactile injuries such as burns difficult to notice. We posit that poorly controlled diabetes mellitus, evidenced by increasing elevations in hemoglobin A1c, is associated with delayed wound healing and increased complications in burn patients.

Methods: The TriNetX Network, a database of 89 million patients across the U.S., was queried for diabetic patients with foot and ankle burns. Patients were divided into four groups based on A1c: properly controlled (<7%), moderately controlled (7-9%), poorly controlled (>9%), and propensity-matched non-diabetic controls. Evaluated outcomes included split-thickness skin grafting, infections, amputations, acute kidney failure (AKF), and mortality within one month of the burn.

Results: When comparing the poorly controlled A1c cohort with the properly controlled and moderately controlled A1c cohorts, we found a significant increase in amputations (p = 0.042) and cutaneous infections (p = 0.0438), respectively. When evaluating non-diabetics to diabetic patients, significantly increased rates of amputations (p < 0.0001), cutaneous infections (p = 0.0485), systemic infections (p = 0.0066), and AKF (p = 0.0005) were noted in the latter.

Conclusions: Poorly controlled diabetes shows a significant correlation with increased complications following foot and ankle burns, including amputations, infections, and AKF.