Annals of burns and fire disasters最新文献

Burns are among the most severe and painful injuries, affecting individuals of all ages, including children, adults and the elderly. The gold standard for burn wound coverage is autologous split-thickness skin grafts (STSGs) harvested from an uninjured donor site. These grafts can be expanded through meshing to ensure complete wound coverage. This study aims to present data on applying meshed grafts as a surgical treatment for severe burn patients hospitalized in the Intensive Care Unit (ICU) of the Burn Service at the University Hospital Center "Mother Teresa" in Tirana, Albania. Additionally, it describes our surgical methods for treating severe burns and assesses the limits of survival in critically ill patients within our service. Patients who underwent meshed graft surgery accounted for 20% of all surgical interventions performed on individuals with burns, burn sequelae and trauma. Key factors influencing the decision for meshed graft application included age, total body surface area burned (TBSA%), sepsis, and full-thickness burns. Sepsis and full-thickness burns were significant determinants in the surgical approach. Our surgical protocol involved selective procedures, including multiple escharotomies and delayed escharectomy, typically performed between the 2^nd and 3rd week post-injury. Skin grafting, either with full-thickness or meshed partial-thickness grafts, was subsequently applied to achieve complete wound closure. Multiple escharotomies facilitated wound management, while delayed escharectomy proved to be a safe and effective technique. Our findings suggest that survival is possible in patients with burns covering up to 60% TBSA, with 30-40% classified as full-thickness burns.

The study investigates the potential of Karsen leaves (Muntingia calabura L.) extract in spray gel form to aid the healing of second-degree burns. This experimental research assesses the effects of the extract on key inflammatory and proliferative indicators: wound temperature, erythema, skin moisture and wound contraction. Rats with induced burns were treated with varying concentrations (12.5%, 15% and 17.5%) of the extract over 14 days. Results demonstrated that the 15% concentration effectively managed wound base temperature and enhanced wound contraction, while the 17.5% concentration significantly reduced erythema and retained skin moisture in the proliferative phase. These findings suggest that Karsen leaves extract in spray gel form has promising therapeutic benefits for burn wound healing. Further research could enhance formulation efficacy and expand its clinical applications.

We aimed to evaluate the association between chronic malnutrition and nosocomial infections in pediatric patients with burns and controlled sociodemographic and clinical variables. We conducted a retrospective observational cohort study in the Pediatric Burn Care Unit of the National Institute of Child Health in Peru. Patients were selected using stratified probability sampling with an annual proportional allocation. The exposure variable was chronic malnutrition according to the World Health Organization (WHO) definition, and the response variable was nosocomial infection. We used generalized linear Poisson models with robust standard errors. The relative risk (RR) and 95% confidence intervals (95% CI) of the crude model and of models adjusted for statistical criteria (aRR1) and epidemiological criteria (aRR2) were estimated. Of the 170 patients included in the study, 35% had chronic malnutrition, and the cumulative incidence of nosocomial infection was 22.3%. The frequency of nosocomial infections was 40% in the patients with chronic malnutrition and 12.7% in the normonourished patients. The model results were as follows: crude model (RR: 3.14, 95% CI: 1.75-5.61, p<0,001), statistically adjusted model (aRR1: 2.88, 95% CI: 1.63-5.09, p<0.001), and epidemiologically adjusted model (aRR2: 3.19, 95% CI: 1.71-5.93, p<0.001). Chronic malnutrition increases the risk of nosocomial infections in pediatric patients with burns independent of the demographic and clinical variables measured.

The objective of this study is the evaluation of the use of tranexamic acid (TXA) for the reduction of blood loss and the use of blood products. We conducted a prospective, multicenter, interventional, randomized, blinded study in 4 burn intensive care units. Patients over 18 years of age with at least 5% body surface area burns scheduled for surgery were included. The treated group received 1g TXA intravenously, then 1g TXA over 8h. The placebo group received saline. Blood loss was calculated using the Mercuriali formula. 121 patients were enrolled. The groups were similar in terms of sex, age, burn etiology, total burn surface area (TBSA), SAPS II and ASA scores, weight, height and estimated total blood volume. The median TBSA was 15% and the median graft size was 1499 cm². The graft was typically performed 13 days after injury. Median total blood loss was 0.7 mL/cm² of excised and grafted skin [0.5-1.1] in the TXA group compared to 0.7 mL/cm² [0.5-1.2] in the placebo group (p=0.361). The packed red blood cells (pRBC) volume was similar in the 2 groups (0 [0-550] vs 0 [0-569]; p=0.992). There was no difference between the two groups regarding death, myocardial infarction, stroke, venous thrombosis, graft failure, seizure or acute renal failure. TXA does not offer any additional benefits when used alongside topical epinephrine in limited burn graft surgery. Further studies may be of interest in order to determine the threshold beyond which the use of additional TXA would be useful.

Deep burns of the anterior leg often result in exposure of the anterior tibial crest. Several therapeutic strategies are used to cover this loss of substance: corticotomy, artificial dermis, local or free flaps. Each has its limitations. A simple, reliable and reproducible technique would be ideal. We have developed a technique involving translation of the muscles of the anterior compartment of the leg that could meet these expectations. We present a series of 8 of these flaps performed on 6 patients admitted to the CTB of the University Hospital of Bordeaux in order to evaluate their use and feasibility. Anatomical work was first performed to analyze vascularization. The surgical technique consisted of a corticotomy followed by release of the medial insertions against the tibia and the lateral adhesions against the fascia to transfer all the muscles of the anterior compartment to cover the tibia. Complete, immediate and long-lasting coverage was observed on all flaps, with healing achieved in 21 days. No functional changes or discomfort were noticed, and dorsiflexion was preserved. Translation of the anterior compartment of the leg allows coverage of extended tibial exposure to the distal third. This technique seems to be a good alternative to the other common strategies.

Thermal trauma ranks among the top external causes of death and carries substantial socioeconomic impacts across all demographics. A prevalent complication following severe burn injuries is disseminated intravascular coagulation (DIC) syndrome. The onset of coagulopathy in severely burned patients is an early indicator of mortality risk, which persists throughout their clinical recovery. Early identification of DIC is crucial for determining the scope of surgical interventions. Concurrently, DIC presents a potential target for therapeutic intervention. Thus, forecasting the onset of DIC in burn victims, along with the capacity for its timely prevention and necessary treatment adjustments, is a critical objective. Current predictive models are complex and rely on specific markers not universally available in primary care settings for burn victims, nor do they consider the unique pathophysiological characteristics of severe burn injuries. Considering these factors, the purpose of this study is to develop a simple and effective approach to early prediction of DIC syndrome after severe burn injury in order to identify risk groups and initiate preventive measures.

After the civil war, which caused the migration crisis in Syria, several Syrian refugees immigrated to Turkey. Burn trauma is quite common in refugees who migrated after the war. This study aims to examine the epidemiological and clinical characteristics of refugee patients in a burn center located on Turkey's Syrian border (southeastern region). A total of 1200 patients in the present study were admitted between January 2016 and June 2023 in intensive care units and/or service units of the 25 Aralık State Hospital Burn Center. The data of these patients were obtained retrospectively from the database of the 25 Aralık State Hospital. Of the 1,200 patients, 696 were Turkish citizens, and 504 were refugees. The percentage of burns (total body surface area) was observed to be higher for the refugees (p <0.05). In addition, the mortality rates were higher for refugees (p <0.05). The refugee factor should also be considered in preventing burns and in developing policies for it.

This prospective study was performed on 68 adult burn patients with inhalation injury admitted within 24 hours to the National Burn Hospital from November 2021 to November 2023. Patients were divided into groups of non-CO poisoning and CO poisoning (SpCO ≥10%). The results showed that when hospitalized, the rate of CO poisoning was 35.3%. Prehospital respiratory support was recorded in 58.8% of patients and there was no significant difference between the two groups (63.6% vs. 58.8%; p =.28). Admission SpO₂ of all patients was normal (96.9 vs 97.5%; p =.24). Meanwhile, compared to the non-poisoned group, the proportion of severe inhalation injury was significantly higher (29.2% vs. 9.1%; p =.03), likewise concentration of arterial lactate (5.2 ± 2.7 vs. 3.9 ± 1.8 mmol/l; p = .014) and hypocapnia rate (58.3 vs. 27.3%; p =.012), while lower PaCO₂ values (34.4 ± 7.1 vs. 39.9 ± 9.3 mmHg; p <.01) were seen in the CO poisoning group. The duration of mechanical ventilation, length of hospital stay and mortality were not significantly different between the two groups. Further studies are needed to determine the prognostic value of admission SpCO in burn patients with inhalation injury.

Ketamine is used as an anesthetic agent for pediatric burns patients due to its favorable pharmacological properties. However, concerns persist regarding its repeated administration in children due to potential neuropsychic adverse effects with varying reported prevalence in the literature. This study aimed to evaluate the similarity between midazolam and propofol in their ability to mitigate ketamine-associated neuropsychiatric effects. The non-randomized crossover clinical trial involved pediatric burn patients aged 4 months to 17 years who underwent dressing changes under general anesthesia. Each patient received the Midazolam-Ketamine and Propofol-Ketamine protocols, with a 48 to 72-hour interval. The study was carried out in the plastic, reconstructive, aesthetic and burn surgery unit. A total of 92 dressing changes were analyzed in 22 pediatric patients with a median age of 3 years. Of these patients, 45.5% had severe burns. The median doses of midazolam and propofol were 0.04 mg/kg and 1.47 mg/kg, respectively. Ketamine was administered at a median dose of 2.00 mg/kg for both protocols. Neuropsychic manifestations occurred in five cases with the Midazolam-Ketamine protocol, and two in the Propofol-Ketamine protocol without significant difference. Nystagmus was significantly more common in the Propofol-Ketamine protocol, while tachycardia, hypertensive spikes, and desaturation were more frequent in the Midazolam-Ketamine protocol. The Midazolam-Ketamine protocol was associated with a longer recovery time. In conclusion, both protocols could be considered similar in terms of preventing the presumed neuropsychic effects induced by ketamine. In light of this study, the Propofol-Ketamine protocol emerges as the preferred choice in our current practice due to its better hemodynamic and respiratory stability, as well as a faster wake-up time.