Annals of burns and fire disasters最新文献

Combustion of surgical drapes during surgery is a rare event which can nonetheless lead to serious consequences. Iatrogenic burns caused by this complication are often deep and lead to functional and aesthetic sequelae. Nevertheless, awareness of the triggering factors and mechanisms, as well as knowledge of the proper use of various at-risk products such as alcohol-based antiseptic agents and compressed oxygen can reduce the incidence of these undesirable events. Clear communication between the various actors in the operating room is also an essential prevention measure. In this article, we describe the case of a 53-year-old patient who caught fire during a port-a-cath procedure under local anaesthesia with sedation. The resulting burns covered 5% of his total body surface area on the chest, neck, face and back. The purpose of this article is to provide a reminder of the precautions required in the operating room to prevent these dramatic incidents.

The use of new oxygen supports associated to non-invasive respiratory strategies is well-established in clinical practice, especially after its extensive application in the management of Covid-19 respiratory failure. The use of high flow nasal cannula (HFNC) in patients undergoing procedural sedation and analgesia (PSA) is dramatically increasing. Enzymatic debridement in critical burn patients is a painful treatment that requires an optimal burn pain control protocol as well as a deep sedation for the entire duration of the procedure. Both hypnosis and opioid-analgesia may lead to significant respiratory depression. Fourteen patients undergoing enzymatic debridement under deep sedation have been included in this case study. All patients receiving oxygen through HFNC were evaluated. All patients underwent continuous monitoring of vital parameters, antithrombotic prophylaxis with low molecular weight heparins and fluid therapy calculated using the Parkland formula. Sedation was successful and well tolerated by all patients and physicians were able to carry out the enzymatic debridement procedure safely. No severe desaturation events were observed. Continuous monitoring of vital signs was carried out. Neither bradycardia events nor hypotensive or hypertensive events requiring treatment occurred. Enzymatic debridement procedures did not lead to any serious adverse events. Based on our experience, the administration of O2 by HFNC at an average concentration of 50% was proven safe and efficacious in the management of drug-induced respiratory depression.

The last French department, created in 2011, Mayotte still lacks its integration into official health statistics, making it difficult to adapt care facilities to needs, as well as planning for prevention. We conducted a retrospective epidemiological study including all patients treated in the Mayotte burns unit between February 1^st, 2022 and January 31^st, 2023 (339 patients). We first studied burn patients on the island, i.e. 300 people. The average age is 10.7 years with 75% of patients under 12 years old. The overall incidence rate is 100/100,000 inhabitants, which seems higher than in the other departments, but 16/100,000 among hospitalized patients only, a figure comparable with the metropolitan level. Burns are most often caused by scalding (82.7%), affect a low surface <10% (91%) and are partial thickness (66.7%). Low-income people are over-represented in the burned population, due to very degraded housing conditions. The other group (39 cases) are patients burned in the Comoros and treated in Mayotte after an average delay of 10 days following the incident. The burns are significantly more extensive (TBSA 16.6% vs. 4.6%), deeper (full thickness 66.7 vs. 2.0%) and caused by flames (66.7% vs. 10.7%). They are more often hospitalized (71.8% vs. 16%), for a total of 608 days in the unit compared to 480 days for the other 300 patients. The Mayotte burns unit must therefore take care of both a particularly precarious local population and an external population suffering from especially serious burns.

Electrical burns are an uncommon type of burn that can cause serious disabilities and mortality. This study aims to provide preventive strategies to investigate high-risk areas of electrical damage in Tehran Province. This is a descriptive cross-sectional study performed on patients with electrical burns referred to Shahid Motahari Educational and Medical Center during 2015-2017. Patients' information was collected in a researcher-made information form. In this study, information of 133 patients with electrical injury was recorded. Electrical injuries occurred mainly in the workplace (63.1%). Nearly half of the population were construction workers. The results showed that most of the electrical burn accidents in Tehran province occurred in the surrounding counties of the city of Tehran (64%). According to the results, it is suggested that preventive strategies first be implemented in high-risk areas of the province of Tehran.

Resuscitation of burns remains a fundamental problem in burn care. Traditional endpoints such as mean arterial pressure and urine output guide fluid therapy for optimal resuscitation, but an ideal marker remains controversial. Base deficit and serum lactate are markers of global tissue acidosis and inadequate oxygenation. The aim of this study was to determine whether serum lactate and base deficit together can be used as prognostic markers in acute burns and their association with sepsis and mortality. A prospective observational study with a sample size of 250 was conducted over 18 months, which included patients with 20-60% total body surface area (TBSA) having thermal burns or scald. Resuscitation was done according to hospital protocol and fluid administration was adapted according to clinical parameters. Serum lactate and base deficit values were analysed at the time of admission, then on day one, two, three and finally on day seven after admission. The two parameters were compared among survivors and non survivors. Patients were followed up till discharge, death or 30^th post burn day. Baseline serum lactate levels are high and base deficit levels low in the patients sustaining burns and the levels normalised over seven days with adequate resuscitation in survivors. Persistently high serum lactate and low base deficit are associated with sepsis and increased mortality. This study indicates that serum lactate and base deficit are useful parameters to predict mortality and promising predictive tools for assessing resuscitation and development of sepsis. Using these tools to guide fluid resuscitation may help mortality and improve overall outcomes.

Deep intermediate burns of the hand are a challenge for both the functional and aesthetic result. In this study we compare the efficacy of early selective enzymatic escarolysis followed by the application of stromal vascular fraction (SVF) extracted from autologous adipose tissue on a dermal substitute scaffold (DS) versus reconstruction by partial thickness skin grafts (PTSG). We enrolled all patients admitted to our referral Burn Center from September 2020 to January 2022 with deep intermediate burns of the hands: clinical data were collected, then the first group of 4 patients were treated with PTSG surgical reconstruction, and the second group of 7 patients with DS+SVF. Subsequently, the morpho-functional and aesthetic outcome (with quickDASH and POSAS questionnaires), the healing time and the number of accesses in the operating room were evaluated. A total of 11 patients and 18 hands were treated in the period considered for the study. The mean TBSA was 22.5±15.2% in Group 1, 23.6±13.6% in Group 2; the mean age in Group 1 was 47.3±17.6 yo, in Group 2 51.4±16.3 yo. The mean follow up was 10±2.5 months. At six months qDASH and POSAS in Group 1 were: qDASH 53.4±2.5; OSAS 53.3±5.1; POSAS 51.3±4.3; in Group 2: qDASH 20.8±7.8; OSAS 19.7±8.1; POSAS 17.4±7.8. Group 1 had an average healing time of 75±15 days vs 20.4±9.3 days for Group 2, and 2.5±0.5vs1 accesses in the operating room. SVF combined with hyaluronic acid-based dermal substitute demonstrated a better morpho-functional and aesthetic outcome, and reduced patient healing time and accesses in the operating room compared to surgical partial thickness skin graft reconstruction in the treatment of intermediate-deep burns of the hand.

Topical antibiotic application and occlusive dressings stand as the current standard of care for partial thickness burn (PTB) treatment. Silver sulfadiazine (SSD) is the most widely used topical antimicrobial agent for acute burn management worldwide. Despite its antimicrobial benefits, there is emerging evidence that SSD might delay wound reepithelialization. We hypothesized that when compared with a topical antibiotic ointment, wound reepithelialization with SSD would be delayed. We created 21 partial thickness burns on the backs of 3 anesthetized female domestic pigs (30kg) using an established vertical progression model. The burns were randomly assigned to topical treatment with SSD, triple antibiotic ointment, or petrolatum ointment applied daily for two weeks, followed by twice weekly for another 2 weeks with intermittent dressing changes. The primary outcome was percentage wound reepithelialization at day 21. Our study had 80% power to detect a 25-percentage difference in wound reepithelialization at day 21. All wounds were completely reepithelialized within 28 days of burn creation. At day 21 the mean (SD) percentages for wound reepithelialization were 73.6 (38.2), 93.2 (16.3), and 65.0 (48.9) in wounds treated with SSD, triple antibiotic, and petrolatum respectively, P=0.049. There was no significant difference among treatment groups in scar depth at day 28. Pseudoeschar formation and erythematous hypersensitivity reactions were common findings on gross analysis with SSD and topical antibiotics respectively. We conclude that SSD delayed reepithelialization of partial thickness porcine burns when compared with triple antibiotic ointment. There were no significant differences in scar depth among the groups.

The dressing is an important element in the management of severe burns. The aim of this study was to present the results of the dressing in room air and peanut oil. This was a descriptive retrospective study conducted from January 1, 2014 to December 31, 2020 in the surgery department of the Dédougou regional hospital center. All patients less than or equal to 15 years of age with a severe burn were included. They all benefited from a dressing protocol in ambient air and with arachis hypogaea (peanut) oil. We collected 81 children with an average age of 4.8 years. All the burns were accidental and they were thermal in 77 cases (95%). They occurred during the harmattan period in 43 cases (53%). The average burned body surface was 23.2%. The burns were deep 2nd degree in 48 cases (59.3%). There were 16 infectious complications (19.7%), including 15 cases (18.5%) of suppuration. Death occurred in two cases. The average epidermization time was 26.2 days and the average length of hospital stay was 12.5 days. Sequelae were noted in 16 cases (20.25%) and 15 cases were adults. The results of the application of the dressing protocol in ambient air and with arachis hypogaea (peanut) oil are encouraging. A larger scale study will provide additional evidence on its efficacy and safety.

Hypertrophic burn scars can occur due to imbalances in the healing process and affect quality of life. They can be assessed with the Patient and Observer Scar Assessment Scale (POSAS). This is an assessment instrument with both a patient scale and an observer scale. This study aimed to assess the reliability and validity of the POSAS score to measure the quality of scars in evaluating burns that produce scar tissue. It also aimed to determine similarities in the assessment of scar tissue using the POSAS score according to observers and patients. This cross-sectional study had a sample of 30 patients, including 19 women (63%). Assessments were performed before the initial treatment procedure and 1 and 6 months after. The post-incision scar tissue assessment results using the POSAS instrument were expressed as a score: 5-50 (observer), 6-60 (patient), or 11-110 (both total). The highest degree of burns was superficial-mid-dermal (20 patients; 67%). The POSAS assessment by doctors and patients tended to be the same and decreased at both months 1 and 6 after the treatment procedure. The mean total score was 51.3 ± 12.1 before treatment, 44.2 ± 9.5 at month 1, and 30.3 ± 5.9 at month 6. This study shows that in evaluating burns that produce hypertrophic scars, similarities exist in the POSAS score according to observers and patients. Precautions at the beginning of the observation will affect the POSAS score.

The burn patient is at high hazard for nosocomial infections (NI) as a result of the nature of the burn damage itself, the immune-compromising impacts of burns, prolonged clinic stays, and intensive diagnostic and therapeutic strategies. The aim of this study is to describe the actual epidemiology of burn wound colonization and infection in the Intensive Care Unit (ICU) of the Service of Burns and Plastic Surgery at the University Hospital Center in Tirana, Albania. The study is retrospective clinical and analytical. Microbiology data, total body surface area (TBSA), patient days (LOS) and mortality were collected from a hospital database for all patients admitted to the ICU of the Service of Burns at the UHC in Tirana, Albania in 2020. The burn wound infection prevalence rate was greater than in 2010 (17.2 vs. 12 infections per 100 patients), while the burn wound colonization prevalence rate was reduced by half (20.6 vs. 44 colonized patients for 100 patients). The burn wound infection incidence rate was increased (47 vs. 42.6 infections per 1000 hospitalization days) and also the attack rate was increased (0.7 vs. 0.5 infections for 100 patients in 2010). The main pathogens were gram-positive bacteria (60 strains; 71%), followed by Gram-negative bacteria (22 strains; 26%), and fungi (3 strains; 3%). The predominant five bacteria were Staphylococcus aureus (55.0%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), Staphylococcus coagulase-negative (8%) and Enterococcus faecalis (5%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 55.3% (31/56) of Staphylococcal isolates. Implementation of anti-microbial stewardship programs is necessary to optimize the treatment of sepsis.