Annals of burns and fire disasters最新文献

The aim of the study was to evaluate the application of different types of skin allograft as a skin substitute for coverage of major deep burn wounds, and their effect on the clinical outcomes and mortality of burned patients. This prospective study was conducted on 36 patients admitted to the Burn Unit from August 2016 to November 2019. The number and percentage of patients that needed auto-grafting after surgical intervention was 9 (100%) in Group I (allograft coverage not available), 13 (86.66%) in Group II (allograft source was from unrelated patients) and 8 (66.7%) in Group III (allograft from a first-degree relative). Patient survival was 55.6% in Group I, 86.7% in Group II and 91.7% in Group III. There was significant difference between the groups regarding time to complete healing, with P1 = 0.034* and P2 < 0.0001*. Human skin allograft harvested from living first-degree relatives is freshly donated at maximum viability and does not require complex preparation or preservation. It shows prolongation of graft survival that helps to improve general condition, decrease microbial wound contamination, improve vascularization and prepare the wound bed with healthy granulation tissue. This promotes wound healing and subsequent autograft take, and decreases mortality rate among burned patients.

Nosocomial bacteremia (NB) is one of the most severe infections in burns in intensive care units. Their prognosis is worsened with the emergence and spread of multidrug resistant bacteria (MDR). Our retrospective study aimed to investigate clinical and bacteriological characteristics of NB occurring in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia, during a 3-year period (2016-2018). We found 261 NB in 216 patients, for a prevalence of 25.7% and an incidence density of 13.4‰ days of in-patient stay. The vast majority (88.9%) of NB occurred during the first 2 weeks of hospitalization. The catheterrelated bacteremia rate was 11.1%. P. æruginosa (20.2%) and A. baumannii (16.8%) were the 2 species most frequently isolated when S. aureus represented only 7.5% of isolates. Resistance rates were high, with 71% of P. æruginosa resistant to ceftazidime, 64% of S. aureus being MRSA, 69,5% of resistance to 3rd generation cephalosporins among Enterobacteriaceae, and colimycin remaining the only regularly active antibiotic (98%) on A. baumannii. The MDR rate was 44%, represented mainly by A. baumannii, ESBL-E and P. æruginosa. The mortality rate due to NB was 25%, with a significantly higher rate of MDR in fatal NB compared to that in NB with favorable outcome (p = 0,000019).

Eyebrows have a critical functional and aesthetic role on the face. Alopecia on the eyebrows has multiple origins, including scars formed after deep burns on the head and neck region. Reconstruction of the eyebrows represents a challenge for plastic surgeons due to their particular anatomical structure and variations inside of genders. Follicular Unit Transplantation (FUT) is believed to be the gold standard for the treatment of all sorts of alopecia, including that located on the eyebrows. However, FUT is technically demanding and requires skills, extensive anatomical knowledge, and equipment. In settings where FUT is still not feasible, flaps such as the superficial temporal artery island scalp flap remain reliable options. A 32-year-old male patient presented at the National Burn and Plastic Surgery Center, Casablanca (Morocco), with right eyebrow alopecia caused by fire burn on the face. We reconstructed the alopecia using a superficial temporal artery island scalp flap. The result was excellent. The patient and the physician were both very satisfied, and the patient stated that he was more comfortable with his social relationships. Among the current procedures used for the reconstruction of eyebrow alopecia, the superficial temporal artery island flap remains a versatile solution, especially after burn injuries in male patients.

Burn animal models provide substantial insights into burn pathophysiology. Choice of the apt model is important for determining the clinical efficacy of new medicines. Therefore, standardization of burn models is crucial for scientific research. Use of common techniques like hot water, electricity and incandescent instruments to generate animal burn models is widely reported. However, great discrepancy in employed temperature and exposure times demands user-dependent standardization of the animal model prior to research. Establishment of custom generated in vivo burn models giving consideration to reduced use, suffering and risk of the experimental animal is equally crucial. Accordingly, this pilot study demonstrates a novel approach using rabbit and porcine cadaver skin for standardization of burn parameters prior to use in live animal models. Using a custom-made soldering iron coupled to a 16cm2 surface area copper plate, burns at randomly chosen temperatures of 80˚C and 120˚C, with exposure times ranging from 60s to 180s, were produced on rabbit and porcine cadaver skins. On gross and histopathological analysis, parameters required to generate characteristic changes for deep partial and full thickness burn involvement were established. The identified temperature and exposure time parameters were further validated in live animal models. In vivo validation established the success of this approach, highlighting reduced animal use, ease, reproducibility and efficacy in burn model standardization. The findings of this study will hopefully encourage researchers to opt for cadaver skin to determine parameters required to generate a specific degree of burn prior to its use in live animals for burn research.

Pseudomonas æruginosa (PA) is among the major agents of infection in burns. Multidrug-resistant strains are commonly isolated, which hampers the management of these patients. Our purpose was to study the incidence density of PA colonization and PA infection and to investigate the antibiotic susceptibility of strains isolated in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia. It is a retrospective study including 1649 non-repetitive strains of PA during an 8-year period (2012- 2019). PA was the most common organism in TBC-BU bacterial ecology (15%). The incidence density of PA colonization and PA infection was 16.1‰ days of in-patient stay (DH) and 16.5‰ DH, respectively. A positive and statistically significant correlation was found between PA colonization and PA infection (rs=1; p=0,004). The colonization strains were mainly isolated from skin (25.1%) and central catheters (22.3%). Bacteremia was the most common infection (19.5%). The skin was the most common source of bacteremia (22.1%) followed by central catheters (18.3%). The highest rates of antibiotic resistance were found with piperacillin-tazobactam (72.4%), ceftazidime (49.4%), meropenem (74%), imipenem (70.5%), amikacin (74.6%), ciprofloxacin (56.5%) and fosfomycin (35.3%). We did not identify any colistin-resistant strain. The multidrug resistance rate was 78%. The metallo-carbapenemase-producing strains rate was 14.4%.

Thermal burns of the periorbital region offer a particular challenge to surgeons in terms of satisfactory operative reconstruction. Several approaches currently exist, including full-thickness skin grafting following scar excision. The authors present a novel technique for the reconstruction of periorbital thermal burns involving the anterior lamella of the eyelid with simultaneous full-thickness skin grafting and amniotic membrane grafting. A retrospective review of six patients with periorbital thermal burn injury involving the anterior lamella of the eyelid(s) who underwent operative reconstruction utilizing this technique was performed. The operative and post-surgical outcomes were evaluated. In total, sixteen graft sites were examined. All graft sites demonstrated appropriate coverage and healthy re-epithelialization over the previously necrotic and burned areas. No evidence of cicatricial changes or lagophthalmos was noted. The postoperative outcomes demonstrate excellent functionality and cosmesis. By providing acute reconstruction, the risk of ophthalmic damage and vision loss secondary to cicatricial eyelid changes may be avoided. Additionally, utilizing only a minimal amount of tissue for reconstruction preserves vital skin. This analysis demonstrates the viability of simultaneous full-thickness skin grafting and amniotic membrane grafting for the acute and sub-acute reconstruction of periorbital thermal burn injury.

This article takes up a series of questionnaire researches focusing on the importance of and the need for voluntary fire brigades in the view of various target groups. The questionnaires are part of a solution of the project IP44/2016/VSBM. The study based on the project conducts an analysis of possibilities of how to develop voluntary municipal fire brigades in the view of the main representatives of the respective municipalities, namely persons in authority, primarily chairmen and commanding officers. Since 2014, voluntary municipal fire brigades have been supported by the state in the form of a flat rate per organisation. In previous years, the Ministry of the Interior of the Slovak Republic provided a lot of fire engines, flood equipment trailers and other fire brigade technical equipment. Some questions concerning the activity of organising firemen, e.g. permission for members of voluntary municipal fire brigades to intervene in the event of extraordinary events, are still not solved. This article summarizes possibilities for optimizing voluntary municipal fire brigades, and opinions of persons in authority of voluntary municipal fire brigades regarding their position within the Integrated Rescue System of the Slovak Republic.

Burns are a global public health problem with a large number of psychosocial and psychological problems that may ensue after burn injuries. One of the commonest psychological problems seen after burn injuries is depression, anxiety and post-traumatic stress disorder (PTSD). The following paper reviews the existing literature on PTSD following burn injuries. The concept of PTSD is explained for the non-psychiatrist involved in burn rehabilitation. The various psychosocial factors that determine the causation and course of PTSD following burn injuries are discussed. PTSD following burn injuries in special populations like women, children and adolescents, intentional burns and self immolation are also discussed. The role of cultural factors in the development of PTSD are elucidated and future research needs are laid out. PTSD is a very common occurrence after burn injuries and needs a multidisciplinary team evaluation for its management.